Wednesday, July 22, 2009

The 2009 RTS Endorsements are in!

I use a Medela pump in style. The only thing I have to compare it to is the hospital grade pump they loaned me while E was in the special care nursery so I can't say whether it's better or worse than any other consumer grade pump, but it's served my needs well. I'd buy it again, which is not the case for all of our pre-baby acquisitions. FWIW, having used it and seen the way all of the parts connect, I'd totally feel comfortable using a second-hand pump, if you have access to one, and I'm generally a little neurotic about stuff like that. The only part you'd be reusing is the motor and the bag - anything that comes near you or the milk can be purchased separately at a reasonable cost, so all of that stuff would be brand new to you.

The requests for pump info made me think about what things I really like and what things I could do without. I now present you with MY unsolicited-but-hopefully-not-without-value list of baby must-haves*:

#1, hands down: Aden and Anais swaddling blankets. These are the only blankets we found that were big enough to effectively swaddle our little wriggler. We tried the miracle blanket and it was a total fail. I know they work for a lot of people but Elliot was out of that thing in five minutes or less several nights in a row before we retired it. He couldn't get his arms free but had no difficulty pulling his legs up out of the sack part. The A&A blankets are big enough that we can wrap them all the way around him for a secure hold and they still work on our nearly 15 pound chubster. Bonus is that they are gauzy enough that I don't panic when he pulls them up over his face (as I found him this morning - see Exhibit A below) and they were perfect for draping over his infant seat when he was little and we didn't want people fawning over (read: germifying) him.

The best book we own is Dr. Sears' The Baby Book, or the bible, as it's called in our house. It's got a LOT of information on a LOT of different topics. We have yet to encounter an issue it couldn't help us with - knock on wood! (His vaccine book was super-helpful as well.)

I believe I've mentioned this before on this blog but the itzbeen timer was more valuable during the first few weeks than I can put into words. I don't know how new parents get by without one. If you or your little one ends up needing any medication during those early days, this gadget is all the more essential. Sleep deprivation seriously messes with your sense of time and there were many times where I insisted E "couldn't possibly" be hungry or wet, only to glance at the timer and see I'd completely lost an hour or more.

black and white drawings book (any): We got Look Look by... I can't remember the author (Peter something?) but you can find it on amazon. This was the first inanimate object that would hold Elliot's attention for more than a second or two and it was such a relief to give our silly sounds and faces a hard-earned break!

moby wrap: Lifesaver.

prefolds to use as burp rags: Economical and way more absorbent than any of the other options out there.

sleep gowns: These were really great when he was a newborn and we were doing frequent diaper changes during the night but trying to maintain as much infant sleepiness as possible! We consistently reached for these first right up until he grew out of them all.

vicks rectal thermometer (the little oval-shaped one with the short probe): This is SO easy to use and I was waaay stressed about rectal temping. We do it frequently for peace of mind and I really appreciate having such a user-friendly tool for the job.

10,000 mAh rechargeable D batteries: The swing burns through battery power like nobody's business but the high mAh rating on these makes them last forever. We rotate ours maybe once a month?

Cloth diapers and accessories: We are cloth diaper addicts. I could write a whole post about our loves and hates in that department but I don't want to bog this post down with it. Send me an email at [name of this blog] at gmail if you're interested, or maybe I'll do a separate CD post soon.

A couple of brand showdowns:

Boppy v. My Brest Friend: Boppy, no contest. It's easier to nurse with because you can squish it into different positions and it's also good for propping the baby up in various ways (pre-sitting, tummy time, etc.).

Medela v. Lansinoh lanolin: Medela, again no contest. The Lansinoh brand has a weird, waxy consistency that gets all over everything and doesn't absorb at all.

Things I wish weren't currently taking up space in our house:

- Infant bathtub: We've used it twice. We take him in the regular tub with us.

- Storage bottles for breast milk: The bags are easier to use, easier to freeze (you can lay them flat then stack them), and they hold more milk. I'm not talking about the bottles that come with the pump - those you need. I'm talking about the little "pre-sterilized" vials that are sold in 12 packs and hold less than 3 oz. of milk each. Ours still have the safety seal intact.

- Non-disposable breast pads: I bought a bunch thinking I'd be using them daily but I only leaked for the first couple of weeks and could have gotten by with a single set or one box of disposables.

- 1001 baby blankets: We registered for a couple and received about 25 as gifts. Other than the A&A swaddlers, a handful of flannel receiving blankets, and one special hand-knit treasure, we don't use any of them.

Good luck and happy registering!! :-)

*These are the things that worked for us. They might not work for you because that seems to be how it goes with all baby stuff - one person's godsend lands in another person's garage sale pile. (See blurb above re: widely-celebrated miracle blanket.) That said, I was always on the look out for reviews I trusted when we were working on our registry and shopping plans, so here are my top picks, for whatever they're worth to you!

Monday, July 20, 2009

old horse, new tricks

Perhaps you noticed I haven't commented on your blog in a while. Hopefully you noticed it wasn't just yours I was neglecting. What happened was that I got Google Reader. (Yes, I am aware I'm like the last person in the world to do this. Incidentally, I also signed up for Facebook** a few days ago but I think I was third or fourth to last on that one.)

The other thing that happened was I started catching up on blogs while pumping at work. The double electric pump makes it quite easy for me to read your latest and greatest, but typing something back to you? That's a bit harder.

Anyway, I'm going to work on getting back into commenting in spite of these two routine busters. I have been reading along religiously and sending lots of love, albeit silently.

**Speaking of that, if you know who I am in a non-anonymous-blog kinda way and you're on Facebook, please be my friend. I'm still learning the ropes so I may be boring for a while, but I'll catch on eventually.

Friday, July 17, 2009

with gratitude

Thank you so much for those of you who waded through that novel of a birth story, and for your compassionate comments on our experience. I wish so much I had a different one to share. Finally getting it signed, sealed and posted helped more than I expected it to, as did your affirmations of our strength.

To answer the question about chorio... It occurs when bacteria from the vagina is introduced into the uterus, most commonly through artificial membrane rupture (check), prolonged membrane rupture (check), multiple internal exams (check), and internal monitoring (double check). It's one of the main things they try to prevent with the GBS test, which I passed, by the way. Once it settles in, you start feeling really sick and your uterus becomes tender to the touch from the outside, so you can imagine what it feels like during a contraction. Ultimately, you end up with dramatically increased risk of many of the things we won the lottery on: Need for pitocin (75%), C-se.ction (40%), and pneumonia in the newborn (10%). If it strikes earlier in pregnancy, which it does sometimes despite the absence of all of those labor-specific causes I mentioned, it requires immediate preterm delivery and all of the challenges associated with that.

Of course I ask myself whether I would have gotten it if we'd stayed home longer. I don't know. All I know is that we truly did the best we could at the time. Knowing that gives me a feeling of powerlessness that is hard to make peace with, but I'm working on it.

Tuesday, July 14, 2009

Chapter Five: Here Comes the Sun

ETA: If you are starting here, scroll down. The first four installments of the story are below on this same date. Yup, I'm a dummy and posted them in an entirely unhelpful sequence. Sorry.

With the surgical epidural in place, my pain was finally relieved and my body decided it was time to get some needed rest. As I was being wheeled into the OR, I was focusing on every ceiling tile to try to keep myself from falling asleep. Once on the table and strapped into the restraints (a terrible part of the c-sec.tion I had no advance knowledge of!), I told the anesthesiologist I was working really hard to stay awake and she said, “It’s okay, take a nap. I’m here. I’ll keep an eye on you.” Seriously?! I’d stayed awake until then and I was going to miss the good part? There was no way I’d waited through my whole pregnancy only to miss the famous “It’s a…” announcement, and I needed to hear that baby cry to know everything was okay. I used every trick in the book to keep myself from sleeping. Fortunately, it only took a few minutes for them to get him out.

I got my precious announcement and heard him cry, which made me start crying, of course. He didn’t sound good. His little cries were short and staccato, like he wasn’t able to catch his breath. They had a team from the NICU on hand and they started working on him right away. It seemed like it took forever for them to stabilize him. He was having a lot of difficulty breathing. It was probably only fifteen minutes or so but it felt like an eternity. I kept starting to doze off then clawing my way back to consciousness. Once they were ready to take him to the special care nursery, they brought him over and let M hold him for a minute. I was scared to touch him because I was shaking so badly, and I was still fighting sleep like crazy, but at least I got to lay eyes on him. He was all wrapped in white and he was so tiny and perfect. The whole thing felt completely surreal.

They took me back to the L&D room to sleep for a couple of hours before transporting me to a regular room. The pediatrician came in at some point and gave us a rundown on how he was doing. He let us know that we couldn’t see him then because it was shift change time, but M could go down in a half hour or so. She waited with me until I was moved then set out on her first of two attempts to find Elliot, but we only knew where the regular nursery was and she couldn’t find him. I know it sounds completely crazy that we were in the same hospital as him and couldn’t get to him, but that’s actually a perfect example of how exhausted and disempowered we were at that point. From my perspective at least, it just seemed like par for the course and demanding that someone take her to him simply never occurred to me.

In the early afternoon, they let me get into a wheelchair and a nurse took us down to the Special Care nursery. It turned out Elliot had ingested and inhaled amniotic fluid containing both infection and meconium so he was on a CPAP machine to give him oxygen and help him breathe and he had a tube down his throat that was extracting the gunk from his poor little tummy. He was also on two IV antibiotics: One for the chorio infection and another to try to prevent pneumonia. His breathing was really labored and it was tough to see him struggling and covered with tubes. He turned out to be a good little fighter and within the first couple of days, he pulled out his own tummy tube (!) and was weaned to room air. Unfortunately, he also developed pneumonia during that time and earned himself an extended hospital stay for more antibiotics and observation. As hard as it was being separated from him in the hospital, it nearly killed me to go home without him. Leaving went against all of my maternal instincts and I cried with every step on the way out, then had terrible nightmares the whole first night home. I have so much empathy for women who have to leave their babies for even longer stays. A few days into the pneumonia treatment, all of his tiny veins were blown so they gave up on IV access and turned to IM injections, which he tolerated pretty well. Not so well tolerated was the test they did to follow up on the kidney issues they found on his ultrasounds. It was terribly invasive and he and I both cried through the whole thing, but the results were good – for a change!

Speaking of good, there were other glimmers of light here and there: First and most obviously, we ended up with a healthy baby boy. There were three people – M, our doula, and my mom – who were in the room from start to finish with only minimal breaks here and there. I stuck it out because I didn’t have a choice. I can only attribute their dedication to a deep and unwavering love for me and our son. Our doula, a very close friend who was 16 weeks pregnant herself at the time, was awake and on her feet with me for 24+ hours and she didn’t charge us a penny. My mom literally wore through the fabric in the heels of her socks from spending so much time standing by my bedside. Once I’d agreed to the c-sec.tion and began grieving the change of plans, she told me I was the strongest woman she’d ever known and that she’d never seen anyone work so hard for something. And M… where to start? M was basically awake and on her feet for 50-something hours with me. I’m not even sure she ate after we got to the hospital. She shouldered the burden of being the thinking half of our birth team in the midst of more pressure and chaos than either of us have ever experienced. She had to watch me in pain for hours on end. She honored my request to have my mom present and tolerated her vigilance so that I could have my desired birth environment. Then, she held my hand and offered reassurance as everything we wanted slipped away from us a piece at a time. She bravely attended to our son (the first baby she ever held!) in the operating room when he was sick and intimidating and I was too out of it to know what was happening. And during the days that followed, she wheeled me down to the Special Care Nursery every two hours around the clock and offered moral support while I fought to breastfeed, and pieced me back together when I cried over the sheer magnitude of it all. I don’t mean to be cheesy, but how do you find words to thank someone for something like that, or to explain how much more you love them when it is behind you?

I’m still struggling to overcome the loss of the birth we wanted. We worked so hard to prepare ourselves for the hard work of a natural labor and delivery. We lined up every support and resource we thought we’d need and then some. In the end, I ended up using one thing out of our fully-stocked hospital bag (a headband to hold my hair back while I pushed) and everything else (including our birth plan, literally and figuratively) stayed where it was. The birthing tub we reserved and paid for never even made it out of the closet. I feel like the experience as we’d planned it slipped away so discreetly, I didn’t even realize it was happening until it was over. I don’t know what I’d do differently next time – I’m not sure anything could have been done differently. I guess I’d have tried to stay at home longer, although even as I type that I’m don’t think I could have talked myself into it at the time without the hindsight I have now.

I have more processing to do on this, but I’m afraid if I don’t post what I have, it’ll be another four months until I ever commit anything to record. So, this is where I will leave the story, for now. Perhaps an epilogue will follow before too long.

Chapter Four: A Hard Day's Night

Shortly after midnight on the 14th (around 48 hours into active labor, 24 hours after hospital admission, and 13 hours post membrane rupture), I was declared “close enough” to 10 to start pushing. The nurses went over all of the instructions with me – where to push, when to breathe, etc. – and told me my doctor had asked to be called when I was “pushing well.” I pushed through a couple of contractions but became frustrated because I felt like I didn’t have enough sensation to know how/where to push. I asked to have the epidural turned off so I could use a squat bar. I tried squatting as the epidural was wearing off but it just wasn’t working. I tried sitting up on the edge of the bed but Elliot’s position made this impossible – his legs were up into my rib cage and I couldn’t contract my abdomen forward at all, even just to sit up versus lying flat. I should note that not once did that boy stop kicking, even during the time I was pushing. My mom could feel him pounding away below my rib cage even I was trying to push him out during a contraction.

Once the epidural was finally down all the way, I learned (in the form of blinding, searing pain that I am at a loss for words to fully describe) that I’d injured my left hip somehow during labor to that point. I don’t know if it was from laying too long on my right side or what, but the pain in my hip was at least as bad as the worst contraction I’d experienced so far and it was constant. I kept trying to push through it with M and our doula supporting my legs and a nurse doing the towel-tug-of-war thing with me, but each time, I dissolved into sobs before the end of the 10 count. I was also having painful contractions at this point (made worse by the infection, I now know) but it was really just the hip pain that I couldn’t handle. I couldn’t find a way to stop it from hurting and I couldn’t push against it. Near the end of this phase of things, I’d been pushing about three hours and I was falling asleep between contractions and waking up to push/cry. It was pretty awful. At some point, someone had thought we were close enough to a vaginal birth that they’d warmed up the table for him and laid out all of the supplies for his arrival, but I didn’t realize this at the time. I felt like I wasn’t making any progress and started telling M I wasn’t sure I could do this. A nurse overheard and asked me if I was asking for a c-se.ction. That is one thing I remember perfectly because – amazingly – it hadn’t even crossed my mind up to that point that we might be getting into that territory. I was completely shocked to hear her mention it as even the most remote possibility. I said that I wasn’t asking for that but I knew I was in too much pain and I didn’t know what to do. They decided to call my doctor at this point. They also turned my epidural back up to try to relieve some of the hip pain but it was too late. The pain from my hip and the infection had become so severe that even the epidural wasn’t able to get up over it. I felt completely delirious at this point and I was literally taking myself into another mental space to get through each contraction.

When my doctor arrived, she took one look at me and the fetal monitor strip and said it was time for a c-sec.tion. I was crushed to hear this, but I knew I didn’t have any stamina left for anything else. They called the anesthesiologist to administer the higher level epidural. While we were waiting, Elliot’s heartbeat was lost again. I knew from past experience that in a few seconds, the room would flood with light and people and I’d be manually flipped from side to side. My hip and uterine pain was so severe at this point, I had the thought that I had to make myself completely limp or I’d die (literally, I thought I would die), and so I did. My doula told me later she thought I lost consciousness at this point, but I remember it all. They came in and did the flip-check-flip-check routine. My doctor reattached the fetal monitor – 168bpm. And then someone said, “that’s Mom”. My heart rate was at 168. My whole family was in the room at this point – my mom had been there the whole time and my dad had just come in to wish me luck before the surgery, and this completely freaked everyone out. When they finally got Elliot back on the monitor, there was no more messing around. We were headed for surgery within minutes.

Chapter Three: Lucy in the Sky with Diamonds

This is where things start to get very fuzzy on me. I believe that the following things happened. I do not believe they were necessarily in this order:
  • Around noon, we agreed to let them break my water. They did this and declared it to be clear and of the appropriate volume.
  • The contraction monitor kept slipping off and they eventually talked us into an internal one so that they could more accurately dose the pitocin and try to get things moving a little faster.
  • A few hours into the epidural or the pitocin (I can’t remember which), a nurse checked me and said she was pretty sure I was “there” and about ready to push. That was the most excited I ever was during the whole labor. Unfortunately, the other nurse (or a doctor?) she brought in to confirm this found that I was barely dilated any further than I had been at the last check hours earlier - maybe around a 4 at this point? The first nurse was embarrassed and explained her mistake away by saying she meant I was fully effaced (which I was) rather than dilated. Um, that’s definitely not the way she made it sound. Talk about a mind f-ck.
  • They lost Elliot’s heartbeat too many times and finally insisted on an internal monitor for him too. We were too tired to argue and, more to the point, too tired of having the entire L&D unit rush into the room in full panic mode every time the monitor lost his little signal. Even with this, they still lost his heartbeat whenever I turned on my left side so my movement was even more restricted.
  • I started running a fever. M and our doula took shifts putting towels soaked in ice water (literally, whatever container they were using to hold the water was half-full of ice chips) on my head and I was still hot. They cranked the AC up until everyone else in the room was shivering and I still couldn’t cool off. (Sign #1 of The Bigger Problem)
  • The anesthesiologist came in to check my epidural and asked if I was using the pump much. I said no, only once or twice an hour. She was appalled and said I shouldn’t be feeling that much pain. I explained that I’d asked to keep the level low but she remained alarmed. (Sign #2 of The Bigger Problem)
  • During one check in the early evening (?), a physician or nurse said “smells like chorio” and they started antibiotics for an infection. (Allow me to introduce: The Bigger Problem)

Chorio is an infection of the amniotic membrane affecting 1-2% of pregnant women. In addition to making the infected woman feel generally terrible, it causes high fever, uterine tenderness, fetal tachycardia and increased maternal heart rate. It’s really bad news.

Chapter Two: With a Little Help from My Friends

Once admitted, we declined the epidural and pitocin but agreed to try some stadol. I thought that if I could just relax a bit, that might be enough to move me off the plateau I was stuck on. The stadol was awful. I’m not a fan of that floaty, out-of-body feeling and I was so freaked out by it, I wasn’t able to let myself relax very much. When the Stadol wore off, my contractions were much stronger but I had dilated less than another cm. At that point, I hadn't slept in over 24 hours so I agreed to a low-level epidural in hopes I could get some rest. M and I went into our plan for natural childbirth knowing we really wanted it and were committed, but also that if I was so wiped out by the time I needed to push and I ended up with a c-section, it would all be in vain. I was disappointed to have reached the point where we felt it was needed, but it so clearly seemed like the only option. The epidural didn’t hurt at all and within a half hour or so, I was feeling a lot more comfortable. I asked them to keep the level low, and an hour or so in, I asked them to turn it down more. I didn’t want to be too numb to push when the time came. At this level, it made the pain tolerable but not enough that I could sleep through a contraction. I mostly just listened to music and did breathing exercises as the hours crawled by.

After I’d been on the epidural for a couple of hours, they checked me again and found I still wasn’t progressing much. We finally consented to pitocin on the condition they would start it on the lowest dose and turn it off if it ever seemed that my body was kicking into gear.

Chapter One: I Want to Hold Your Hand

First, a disclaimer: You may want to skip this if you are pregnant and nearing delivery yourself. It's definitely NOT the kind of story I would have enjoyed reading while pregnant. I wish I had an inspirational tale to share. I suppose this is a good read if you’re preparing yourself for the possibility of a detour because we all emerged intact on the other side, but it’s not an experience I would wish upon anyone. Anyone who reads this blog knows Elliot’s birth was nothing like what we hoped for. Other than the final result being a baby, we had to abandon every single preference from our birth plan.

Labor came on gradually with intermittent contractions over several days and we were both feeling ready for the natural birth we'd planned. There were a few nights in a row where I would have a few hours of decent contractions in the early morning (i.e. 2-7am) but they would go away during the daytime. I was 2 cms dilated at my 40 week appointment on Wednesday - my due date. That evening, we went to a restaurant and I noticed my contractions getting noticeably stronger, but still not regular. At home that night, I busied myself with final preparations until around 1am when I tried to go to sleep, figuring I had a big day ahead of me. Unfortunately, I woke with each contraction. By 4am, they were strong enough that I needed help getting through them so I woke M up. At that point, I had about 3-4 hours of very strong, regular contractions that were 10 minutes apart and I thought things were moving forward, but they spaced out again after that.

The contractions continued in an irregular pattern all day Thursday, still strong enough that I needed support to get through most of them. I walked and bounced on the ball most of the day but nothing brought them into a consistent rhythm. In the afternoon, I started trying acupressure points – still not much change. I tried to eat but the contractions were strong enough to make me queasy so I didn’t get much in. By the evening, I was getting tired and frustrated that I wasn’t seeing more signs of progress. M was exhausted too so we decided she would sleep until midnight (and I would try) and we’d go into the hospital at that point, either to get checked right away or to wait awhile but take advantage of their 24-hour well-lit and climate-controlled environment for some hardcore walking, depending on how we were feeling.

I couldn’t sleep at all and I woke M up around 12:30am. The contractions were still irregular but very strong and I was working hard to get through each one. I found I could tolerate them by standing and swaying with M, but that was the only position that offered any relief. We decided I needed a touchstone. I felt like as long as I knew I was making some kind of progress, I’d be able to keep doing what we were doing. If I wasn’t progressing at all, I wanted to talk to my doctor about options for pain relief because I was wearing out and didn’t feel like I’d have enough strength for delivery if it was still several days away. I knew there would be no more sleep between then and the baby without something to cut the pain. We initially thought we might return home if it was determined that I was progressing, but I had the most excruciating contraction in the car and I realized at that point we were at the hospital for the duration because there was no way I was going to restrict my movement like that again! I really wasn’t worried about this because I was positive I’d be dilated a few more centimeters when they checked me. That was not to be. In the labor and delivery assessment unit, they checked me and found that I was still 2 cms but possibly more effaced and the baby was still high. I was crushed.

We hung out there while they contacted my doctor. I was still hopping out of bed for each contraction because standing was the only thing that made them tolerable. The other OB in my practice was on-call so that was who they reached and she recommended an epidural and pitocin. We weren’t down with her suggestion, but agreed to be admitted because it was clear that whatever we were doing on our own wasn’t working and I was wearing thin.

And away we go!

In honor of Elliot's four month birthday, it's birth story time. I'm sure you thought (hoped? ha ha!) this day would never come, but it has. I'm going to break it into installments because it's ridiculously long, so please bear with the many posts to follow...

Wednesday, July 1, 2009

2000 words on good fortune

I took this on July 1, 2008.

I took this on July 1, 2009:

July 1st is my lucky day, apparently.