Wednesday, October 26, 2011
Thursday, March 25, 2010
My incredible healing repeat cesarean.
CLICK to read the Traumatic Birth Story that led me here
On March 4, 2010 my friends got together and threw a Blessingway for me. It was beautiful. Many of my friends and their children came to support me and lift up their blessings for my impending VBAC. They made a labyrinth for me to walk. It was so special. As I walked the labyrinth, I threw flower petals in my path, marking the blessings I sent out in hopes of a smooth and easy labor and a beautiful healthy baby girl.
At the end of my Blessingway, one of my friends, a chiropractor, taught me some acupressure points to help make the irregular contractions more meaningful and even. After the Blessingway, my contractions became regular and strong. I started having to poop a lot and the next morning I passed a quarter-sized mucous blog that had red streaks in it. I got really excited. I thought, “This is it!”
Not yet…
On March 5th, I had been contracting pretty regularly at about 6 minutes apart but wasn't getting any closer, so I went for a walk... had several small contractions, but had three that made me stop and work hard through them. My son enjoyed riding the neighborhood on his trike and we got lots of stares from neighbors who came to see what all the moaning was about... and one very old Russian immigrant grandmother who lives in our apartment complex, barely speaks English, and who has had a crush on my son since he was born came to give me some grandmotherly advice on laboring.
Got home and went to lie down and rest... fell asleep for about a half hour but got woken by a particularly strong contraction accompanied by a hard kick to my lungs... When I got up, I found that my son had conked out. Shawn carried him into the bedroom now that I wasn't taking up the whole bed... and then he came out to help me through some hard contractions that we finally found were 4 minutes apart... so Shawn called Kristina. She left the birthday party she was at and came to my rescue...
Before she arrived, my mother and sister showed up. And my contractions started spacing out... and getting lighter... Alex woke up when the pizza delivery guy came to deliver the pizza my sister had ordered before she got to my house... Amanda took over helping do counter pressure in Shawn's place because his arms have really weakened... his back is so bad... and my mom just kind of sat on the sidelines telling me how good I was doing...
When Kristina got there, my contractions had spaced out to about 11 minutes. We timed a few... worked through a couple of hard ones but it was clear that my work was done for the night and I was absolutely exhausted. So Kristina told me to get some rest and she went back to her party.
I lay down on the couch, disappointed... and once I stopped working so hard, DH started up the Wii for my mom and sister and they got SUPER loud and generally invaded my house.
I had fun watching them play but to tell the truth, I was awfully disappointed that things pretty much tanked when they got there... but ecstatic that I wasn't in the hospital where they would start hassling me about a repeat cesarean for stalled labor. I finally had enough and went to lie down in my dark, quiet bedroom... they got the hint and left.
I fell asleep and even though I had really super strong contractions all night they were really irregular...
March 6th, Kristina and I were talking about trying to just let things go after I posted on Facebook that I was going to quit for the night the 5th... we both agreed that my body will do what it should in its own time and that trying to rush things is just going to wear me out physically and emotionally. We talked about my need to control things and my excitement over what seemed to be labor and how sometimes our bodies just ease into things. After that I prayed and got out my scriptures... I laid the scriptures spine down on the table and just let them fall open (I do that when I am just reading for inspiration or peace rather than for study) and they fell open to Exodus 31 and the first thing that my eyes fell on was verse 17
It is a sign between me and the children of Israel for ever: for in six days the Lord made heaven and earth, and on the seventh day he rested, and was refreshed.
I thought that was pretty clear! So I posted the reference on Facebook and started resting... my contractions stopped entirely.
Sunday night, March 7th, I started having extremely consistent contractions at 8 minutes apart and lasting around 60 seconds, but not painful... they just felt like pressure, squeezing, and kind of achy like I was about to start my period and it took my breath away and my heart raced. Last Thursday and Friday though the consistent and irregular contractions I felt were really painful... like a charlie horse all over me... they lasted all the next week…
Saturday, March 13th the contractions started coming every 5 minutes and lasting 2 minutes each… I decided to go into the hospital to make sure the baby was tolerating the long contractions… We left to go to Harrison. They stopped us at the door saying that Dr. Lowe (who I later found out was formerly called Dr. Rankin, who delivered Alex) was on duty and was refusing to attend me for a VBAC, and although they can't technically turn me away in labor, unless I signed a cesarean consent form they would not be able to do more than put me in a bed and see if I was in labor. So we left.
We headed to Tacoma General. They put me on the contraction and heart rate monitors, but before we even got there my contractions had slowed... On the monitors though, Lirum was doing fantastic. Variable heart rate, 1 or 2 possible decels that could have been when I moved or something. BUT:
My blood pressure was really high. That concerned me. They did a vaginal exam, that was excruciating... Kristina said she heard me screaming down the hallway! I have had vaginal exams before... cervical checks, pap smears, etc... but I have NEVER experienced that kind of agony before! I was barely dilated a fingertip... so, with my pressures being high and no dilation, we decided to do a Biophysical Profile and monitor my blood pressures for a while and then do another cervical check to see if I was indeed in labor.
Lirum BARELY got an 8/8 on the BPP, she didn’t want to move, but at the last second she arched her back and the tech called it good. The placenta... oh the placenta... 1 1/2 weeks before, my placenta looked spotty, but not really terribly calcified, that day it was completely white... there weren't any dark spots on it at all. That is a REALLY fast degradation! The tech saw it and couldn't help but say "WOW! That placenta is all used up!" I knew as soon as I saw that bright white placenta that I wasn't going to get my VBAC... especially with my blood pressure so high.
We got back to the room, and they came to check my dilation to see if I was progressing at all... but after that first cervical check 2 hours before, I had only had 3 or 4 contractions... and I even walked around the birthing unit trying to get it going before the BPP. So my cervix hadn't budged. At least after I told the doc that her first cervical check was excruciating, she was MUCH gentler. They left after that and I pretty much just told everyone there that I would not be having a VBAC. I knew it... it was only a matter of time before the doc came in after looking at the BPP results and comparing them with my last one... and sure enough... She came in and said that if I were in active labor that night, she wouldn't have a problem with me having a VBAC, but to wait God knows how much longer for me to start active labor on my own, since induction isn't an option, it is just too risky.
I wasn't even upset! I mean, sure, I was disappointed, feeling a loss of something I had worked so hard to achieve... but really, the whole point of working for a VBAC was to give my baby girl the best start in life... now a VBAC isn't the best start I can give her. If I wait for labor to start on its own, it could be weeks, and by that time the placenta could give out entirely... or if I go into labor, she could not tolerate it well... It was just too risky. IT WAS MY CHOICE. That made all the difference.
I think it was absolutely fantastic the way I was treated at Tacoma General... the on call doc, Dr. Miller, was a gem. She was completely unbiased, supportive of my wish to pursue a VBAC and listened to me and made me feel like a real person and not just another patient to be "handled". I think she was impressed with me and my knowledge of my options and research... It was like we were on equal footing! Not once during my entire stay tonight did I ever feel in any way belittled, abused, or hornswaggled. So KUDOS to TG! I think the clincher though was when the doc said "I think you probably could have interpreted your BPP yourself!" After I told her that I had seen the change in the placenta with my own eyes and that I thought it would be best to have a cesarean.
So I asked to be discharged. I wanted to sleep in my own bed and have a good meal and head to Harrison and have a cesarean the next day. We wanted to be closer to home as it would be easier for Shawn to deal with Alex.
March 14th, I called Harrison to schedule my medically necessary repeat cesarean and they said that if I was not in ACTIVE labor, they would transfer me to Seattle because of my seizures... yeah, they did a cesarean for Alex and I had seizures then... I was irate. I called Tacoma General and got to talk to my favorite OB from OBAC. Dr. Erin Wisbey-Martin. She and I discussed my case and she consulted with other docs at the hospital and we decided that my case was not “emergent” meaning my and Lirum’s lives were not in immediate danger. Lirum had been doing well even through the contractions and my placenta was not detached… it was on its last legs, but it hadn’t given out yet. And TG only does “emergent” cesareans on the weekends. So, we scheduled me for Wednesday, March 17th at 2pm with a noon check in time. I chose the date because it was the only one available where Dr. Wisbey-Martin would be able to do the cesarean. I was to be on complete bed rest till then.
Shawn was beside himself with joy... he was still holding out hope that we could do something to get me to go into labor naturally so we could VBAC, and now we had 3 more days to try rather than having to go in that day. We made an appointment to see my friend, the chiropractor to see if she could help.
I posted our plans online, as there were several people following my progress on different sites. They all knew how important it was to me to try for a VBAC. After Alex’s birth, I swore I would VBAC… and I worked hard over the next 3 years to educate myself about birth and my own health. I learned more about VBAC and repeat cesarean than most doctors! And when some of my friends heard that I had consented to a repeat cesarean, the proverbial crap hit the fan. I got bombarded by people telling me that I was giving up… that the docs had pulled the wool over my eyes… that Lirum was fine and why was I not still working for it… etc… It really hurt. I made the decision based on all the available evidence. I was comfortable with my choice. I knew it was right. These people, knowing only bits and parts of the whole story, passed judgment on me. I started to question my choice. Was I really making the right choice, or was I just scared? I talked to Kristina… she has been my rock through this whole thing… she helped me to understand that most of the people I had bashing my choice now were people who were not invested in me as a whole… just in seeing me have a vaginal birth. These people were on crusades to have VBAC’s or were so invested in seeing me have the one they couldn’t have that nothing else mattered to them. Putting that all into perspective reassured me that I was doing the right thing.
Monday, the 15th we headed to the chiropractor’s. She was amazing! We worked for over 2 hours using homeopathics, acupressure, and adjustments… but because of where my placenta was located, turning the baby from where she was lying on my right side to my left side to help her press on the cervix was unlikely. The contractions got stronger though and we thought if we just went home and rested, we would go into active labor… Before our work, my blood pressure was 170/92… afterward, it was 116/68. Joella invited us to come back and do more work Tuesday if we wanted to, but I decided that would be unnecessary… because Tuesday the contractions slowed back to the crampy charlie horse contractions… I knew my body wasn’t going to do this… I just wasn’t ready. I was only 39 weeks and 3 days along, and I knew that it was going to take longer for me since I had never had a vaginal birth and last time it took over three days just to get to 4cm. and I was in active labor!
I called the doc Tuesday, the 16th as she requested, to go over what the cesarean entails... I hadn't ever had what I would call an "elective cesarean". With Alex I was in labor for days before they tried to break my water and decided to do a cesarean... so I wanted to go over how exactly it would work and she said it would be better to go over it the day before so that I could sit on it overnight and be ready with any questions for her when she saw me for the surgery.
Here was the plan:
When I arrived at noon they planned to strap on the monitors and get a good reading on the baby and my contractions... then do a cervical check to see if I had dilated, if I did, then this would allow me time to make any progress before determining if they would cancel the cesarean and allow me to labor. They planned to put in the IV and do all the pre-op prep except for the spinal, which would be done 1/2 hour before the surgery. The Obstetric unit's operating room table has a weight limit of 200lbs.... so they had to do my cesarean on the main surgical floor where they have a "bariatric surgical table". There was a question as to whether Shawn would be allowed… They expected the surgery to take a minimum of 1 hour... possibly longer depending on the extent of the existing scarring... They planned to use something called a "wound vac" which I hadn't ever heard of... to ensure that I didn't get an infection. They planned to follow my existing scar on the skin and fixing the wound so that hopefully I won’t get the keloid part at the top. She said that because I am a "high risk cesarean" the surgical staff would include THREE ob's, one of them a perinatologist; nursing staff for the operation; nursing staff from the NICU; a pediatrician; and the anesthesiologist. So that's a full house!
Here is reality:
Grandma, Shawn, Alex, and I got to the hospital at noon. They put me in a triage room and told me to change into the hospital gown. They checked my vitals… my blood pressure was still down! They put me on the monitor and did a cervical check… I wasn’t dilated at all… still. Deep down I knew that would happen, but I wasn’t prepared for how that would make me feel. This was the point of no return in my mind. For some reason, even though I had decided to have a cesarean, I guess I had still held a shred of hope that maybe the work we did at Joella’s had made me have a little progress… that maybe the VBAC wasn’t gone. Shawn was as disappointed as I was.
My sister showed up and took over watching Alex. Kristina came and I felt better… I still had that little bit of concern that my Doula wouldn’t show, just like last time. Not that I didn’t trust Kristina, but because I was so hurt last time. The little triage room was full. It was nice, I felt supported and loved.
The nurse came to put the IV in and draw some blood for a CBC and blood type, just in case I needed blood infusions. Then the doctors came in to see me, Dr. Abbi, Dr. Flaim, and Dr. Wisbey-Martin. They poked my belly this way and that, and determined that because of the amount of weight I gained since my last cesarean, following the existing surgical scar would be unrealistic. They decided to do a “bikini cut” cesarean. They also told me that they would have to use staples instead of sutures as I had requested because the incision would be under a skin fold. A little bit after that, someone came in and shaved my belly and the tip of my pubic hair to allow for the surgery.
About 20 minutes later, a L&D nurse named Sharon came to take me to the O.R., I was surprised to see that they asked me if I would rather WALK than be wheeled up on a bed or wheelchair! That was the first moment that I realized that this experience truly would be more dignified…
I researched and studied and absorbed every little factoid I could over the last three years… I had good and bad experiences through my whole pregnancy and had written a birth plan to cover this situation, just in case. Then I found out that cesarean was the best way and I lost my chance to VBAC. I had just been turned away by the hospital I thought would be best for me. Then I had landed squarely in the hands of the hospital I decided I would not want to go to because I believed that they were only in it to protect themselves rather than to provide me and my daughter the best birth possible for us.… and it was my last option, there was nowhere else to go… and here they were giving me hope that this would be more than my last birth ever dreamed of being.
I walked to the O.R., leaving my husband on the elevator because they still weren’t sure if the anesthetist would allow him into the main O.R. I walked onto the floor and was met by surprised stares from people who hadn’t seen a patient walk onto the floor in a long time. Apparently the only cesareans that are done on that floor are extreme emergencies… I walked into the room and was met by a bustle of people cheerily talking and listening to upbeat music. I was sat on the table and strapped back to the baby monitor, but Sharon couldn’t get a proper reading with me sitting up so she gave up. I mentioned to the room in general that I was allergic to Latex and someone turned and said, “Well, shit, we need to get a different kit in here.” Sharon went to find a latex free urine catheter. Someone came over and asked if I liked the music. I suddenly remembered that I had put in my cesarean plan that I wanted to be asked this question… It completely slipped my mind. They said they had Pandora.com up on the computer and asked me who my favorite artist was. I told them I really liked Norah Jones and they went and typed her name in. Immediately I heard more soothing music, I almost cried… they were seriously honoring my birth plan!
Soon the anesthetist came in, a cheerful man named Tompkins, someone said “Hi, doc!” and I felt eased that this was a nice guy in a good mood. I asked him then if my husband could come in during the cesarean. He looked at me like I was crazy and said, “Well of course!” Suddenly Sharon stepped into motion; she got on the phone and called up to the waiting room to see if they could get my husband up there fast. Someone had already taken him to get scrubbed though, so she couldn’t find him and didn’t know that someone had already taken him, so she called L&D and asked someone there to find him. Then she called his cell phone. She found him quickly and he was there in just a few minutes. He was dressed in a white paper jumpsuit, but she laughed and pulled out a package with some dark blue thick paper scrubs that looked much more comfortable. He left with her to get changed. During all this hustle the anesthetist had started trying to get me started on the spinal.
After trying for nearly half an hour and failing each time he stuck me, and putting me in a lot of pain from each jab… he FINALLY gave up. It took him two tries to get the epidural in instead. But, as Sharon explained to my husband who was holding my hand through most of it, an epidural takes longer to take effect for a surgery than a spinal because a spinal is like dumping pain meds down a drain… an epidural is like putting a sponge in the sink and pouring the pain meds into the sponge and waiting for it to drain down the sink. So they laid me down on the operating table and went back to work hooking me up to all the various machines: an EKG, BP monitor, Infant HR monitor, pulse ox, oxygen nasal canula, etc… Shawn commented on the music and I told him about how they let me choose the station. Then they decided I was numb enough to insert the catheter… but I wasn’t. It was horrible!
We made small talk for a bit and then suddenly, my blood pressure plummeted, I got nauseas and sweaty and the anesthesiologist was right there… putting something into my IV… and asking me questions… I don’t recall the questions he asked, but he seemed concerned and Shawn kept asking why my pressure was low, at one point he said it was 79/46. The room kind of faded for a second, but then all of a sudden my heart was racing and the anesthesiologist said, “There we go!” And the whole room breathed a sigh of relief and went back to business, and I went back to talking to my husband. The anesthetist put some anti-nausea meds in and I was just fine…
The OBs came in then, and the curtain went up and they started taping my belly up so that they could get at the right spot to do the surgery. I could still feel everything, and it was very interesting… cold prep solution and the tape and then they just waited… every few minutes they would draw something across my belly and ask if I could feel that. Eventually I couldn’t and they went to work. During the next 25 minutes, I talked with Shawn and asked questions of the anesthetist and OBs, Sharon came over frequently to check on me… it was nice. Nothing was ever talked about except that it directly affected me and my baby. Every 10 minutes or so, when I would start to feel my legs, the anesthetist put more medication in the epidural. Then it felt like they practically STOOD on my stomach and I felt pulling and I couldn’t breathe… I remembered that this was the way I felt just before my son was born… I got excited… apparently too excited; Shawn started telling me to calm down because I started shaking in anticipation. Seconds later I felt a release and completely lost the ability to take a breath in. The anesthetist leaned toward me and told me to breathe…
And then I heard my baby girl. The room went dead silent. I gasped and actually started to hyperventilate a little, and then the tears came, and I started talking to her… telling her I was there and that I would hold her in a minute… They took her to the NICU table and checked her briefly and then they wheeled the NICU bed over to where I could see her. Sharon told them that I wanted to keep the placenta and that I didn’t want Lirum wiped off before I could touch her. Everyone who mentioned the baby called her by her name instead of calling her “baby” or “chunker” like the last cesarean team did to my son. They had asked during the prep what her name was and everyone in the room knew it and actually remembered. I felt full of joy and peace. I touched my baby and kissed her head before she was cleaned off. I watched as they shortened the cord stump and did all their other checks and wiped her off. They said her Apgar scores were 8 and 9. Then they wrapped her up and handed her to Shawn and he came over and held her by me and I reached over and touched her and stroked her cheek and listened as Shawn talked soothing words to her… she was beautiful. She had a head full of dark hair the color of Shawn’s, chubby cheeks that just made me want to kiss her and never stop and olive complexion just like Shawn’s… She is going to be the most beautiful woman to walk the earth…
Shawn took Lirum to the NICU for observation after I had time with her. It only took another 20 minutes to close me up and install the wound vac, during which time Sharon held my hand continuously, telling me what to expect in the days ahead and how beautiful Lirum was. And the doctor softly said to me, “Jennifer, you did everything right. You worked so hard, and you have a beautiful little girl! I am so sorry you didn’t get your VBAC.” I cried. That little act of mercy will stay with me forever.
Then they dropped the curtain and waited till I could feel my legs. Then they brought in a monstrosity of a bed that was to be my home for the next 3 days, and aired up the mattress that was already underneath me and moved me over to the bed. I was wheeled to the Post-op Recovery Area where I was watched for the next hour and a half by a nurse who literally never left my bedside. She checked my uterus every 15 minutes, gave me ice chips when I asked for them, and monitored my blood pressure, temp, and how far up the anesthesia was still effective. I felt cared for. I felt like I wasn’t forgotten. Someone was there, talking to me every minute, I wasn’t just shoved aside. The recovery nurse talked to me about the birth and how I felt and the baby and everything! I told her about how we had come to this point and all the support that I had. Things couldn't have been better... well unless I had a VBAC... but for a cesarean it was ideal. Besides my little blood pressure crisis, the whole thing was textbook.
Eventually, I was determined to be well enough to go to my room on the Mother Baby Unit where I could see my family and be with my daughter. It was fun getting there. The bed was electric, it only moves if it is turned on and someone had forgotten to plug it in when I got to the recovery unit… so it was dead. They managed to get three nurses to push the darn thing… and got it to my room. No one knew how to maneuver it though and so it was absolutely hilarious, like the dang three stooges… it was comical… By the time we got to my room we were all laughing.
I was able to immediately nurse my baby girl, who didn’t want to open her mouth and had a tied frenulum, but she quickly fixed that on her own, and I got her to open her mouth wide by the second day. She was a champion nurser. She weighed in at birth at 9lbs 5.5oz., by the time we left the hospital on March 20th, she was 8lbs. 8oz., and three days later at her one week checkup, she was 9lbs 8oz.!
Because of my seizures, my husband and I agreed that it would be best if I were not alone with our newborn daughter during my recovery in the hospital… We couldn’t expect a nurse to sit with me round the clock, and my son would not be allowed to stay at the hospital overnight – nor would it be fair to him to have to… and we didn’t want to use the nursery! So, my grandma and husband struck a deal: she would stay with me overnight and he and my son would come up and sit with me during the day while grandma went home to rest. It worked great, and I didn’t even have any seizures…
I was able to get the catheter out 12 hours after the surgery and the IV out at 18 hours. After getting the catheter out they gave me six hours to pee on my own… it took me 5 ½ hours! I would sit on the toilet, my bladder feeling like it would burst from the fullness, and not be able to pee! It was horrible… I nearly gave up and asked for a catheter just to relieve the pressure… but finally we had success, and I was told that as a prize, I could shower! YEAH! It felt so good. I was amazed at how much better I was moving around after this surgery as compared to my son’s cesarean… I was taking care of all my own needs, and the pain was pretty minimal. I used Tylenol and Ibuprofen to deal with the pain, asking for the prescribed Percocet only 2 or 3 times when I just couldn’t deal with the back pain and headaches from the epidural wearing off. I was on normal food immediately, instead of being titrated up to normal food like I was with my son’s surgery. It was great! The best part was that every person who came to my room didn’t just coo over the baby and treat me like a sideliner; I was treated with the respect that a new mother deserves! I was talked to about my baby instead of ignored… I was asked how I was doing instead of having someone just assume and act accordingly. People didn’t just come in and start doing things to my baby, they consulted with me first! It was an amazing experience. One of the things that made my last cesarean so bad was that I felt ignored, like I had served my purpose and was now irrelevant. I never felt that this time. Every Nurse, CNA, and Doctor was amazing.
I wasn't ever offered any formula! THAT IS AMAZING! With Alex they were shoving it down our throats, literally... we were even told that we would be arrested for child abuse and neglect if we didn't supplement him and that Alex couldn't be released from the hospital unless we agreed to supplement! We left the hospital with Alex and literally CASES of pre-mixed liquid soy formula bottles (just throw on a nipple!) and powdered formula for when that ran out, an SNS system to use, coupons, pacifiers, bottles, and other formula feeding paraphanelia... With Lirum it was totally different. Lirum hasn't ever had any formula in her life. The only issue I had was that they kept coming in and asking when I nursed her and for how long each session and which breast I used... I nursed Alex for 2 1/2 years and I haven't EVER watched the clock! Being asked to was very weird... I nurse on demand and I don't give a thought to which breast or how long at each breast... lol... eventually they gave up when they would ask and I would say, "Hmmmm I really don't know!" They started asking me how many wet or poopy diapers she had instead... that I could tell them!
They preformed a few tests on Lirum, of course. She passed the hearing test with flying colors. They did a new pulse ox test on her to check her heart… that made the echocardiogram that they had ordered during the pregnancy unnecessary. They did the PKU. And finally, they checked her bilirubin… At 52 hours old the light test showed that her bilirubin was 13.7 so they did a blood test. We were concerned because she was yellowed and had been sleeping a lot. The blood test came back that she had a level of 11.2… so there was no concern. She was still yellow, but she had what is called “physiologic jaundice”, which is common in breastfed babies and is totally harmless. It goes away just as soon as the mother’s milk comes in and baby gets more than just colostrum.
They didn’t even bat an eye when we told them we didn’t want her bathed at the hospital, we would not be vaccinating, and that we only wanted half the vitamin k shot… but apparently a NICU nurse threw a fit when my husband declined the eye drops. She told him that she would have to report us to CPS because the eye drops were mandated by law and there was no waiver. My husband stood his ground though and no eye drops were administered. The pediatrician came to my room the next day and I asked him about it. He looked shocked that my husband had been treated that way and explained to me that it was policy that if parents refuse the eye drops when the mother has a STD, they call CPS because the parents would be putting a child at risk. But, he noted, I don’t have any STDs, “And besides, wasn’t she born by cesarean?” I told him she was and he just laughed. He did have a talk with the NICU team and the nurse in question came and apologized for her confusion.
Lirum did end up needing supplementation during her NICU stay while I was in post-op… but we had brought expressed breastmilk that a friend had given us for just this occasion. Shawn tried to convince them to let him cup feed Lirum the breastmilk, but they said that studies had shown that it was an aspiration risk and they wouldn’t allow it. His options were to bottle feed or use an NG tube. He chose the tube to avoid using a bottle and possibly causing nipple confusion… this also prevented her from being OVERFED, which is a common happening with bottle feeding. They pumped out the contents of her stomach and then measured that amount out of the breastmilk we brought and filled her stomach back to that level.
Shawn felt awkward in the NICU, the only parent there who was able to hold his obviously healthy daughter… surrounded by babies and parents in crisis, but it was required to go to the NICU instead of the nursery after a cesarean on the main O.R. floor… Altogether, Lirum did great. There was never a single concern that lasted more than a few minutes that she wasn’t absolutely healthy.
My wonderful Doula, not only showed up, but she was present… she helped my husband to navigate the immediate after birth and really was there for him… which was the best gift she could have given me. My husband STILL says thank you to her every time she is even mentioned! I can’t stress how important she was to our experience, even though I had a cesarean.
The last thing to go for me was the wound vac on the day I went home. That was truly horrible. I had told them that I was allergic to latex and adhesives, so they purposely got a latex free hypoallergenic tape to secure the wound vac to my stomach… but apparently it had a latex derivative in it… when they removed the tape and wound vac, they found that I had developed giant blisters everywhere the tape had touched. That was what had been itching since I had regained feeling in my belly! The wound care specialist had assured me that itching was a sign that the wound was healing… oops! They decided not to dress the blisters there, so they could air out… but they gave me a roll of paper tape, since I knew I never had a reaction to that, and a few dressings to use at home. I took my last shower and was discharged.
Here I am, a week later and I had my staples removed yesterday and Lirum and I are doing great! I ended up having a secondary reaction to the paper tape, that caused more blisters… but keeping it clean and slathering on Neosporin seems to have taken the bite out of it and it is well on the way to healing. I am taking my placenta pills, courtesy of a friend who encapsulated it for me. But the greatest thing I can say is this:
For a cesarean, it couldn’t have been better. I can't believe the difference education and preparation made in our experience, but you can prepare and educate all you want and if your chosen place of birth is not cooperative, you will still have a bad experience. Thank you a thousand times to Tacoma General for blessing me with a healing experience.
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UPDATE
May 3, 2010
I discovered today that Lirum's life could have been in serious danger. Had my 6 week post partum checkup today, which went really great. Lirum showed off and caught everyone's attention. She nursed and then decided to stretch for 20 minutes, then roll over and push herself up on her hands.
I was surprised by the operative report. The last ultrasound the Friday before she was born, showed a completely calcified placenta, the op report from her Wednesday cesarean (I was 39 weeks and 6 days) said Lirum's placenta was partially detached and came off the rest of the way with "minimal uterine massage". They had to SCRAPE Alex's placenta off! And only 5 days later! I am so glad she was born when she was, any later and it could have been disasterous! Not to be melodramatic, but for Heaven's sake... I have heard so many stories of stillborn babies from detached placentas.
But now I am having all kinds of strange feelings... I worked hard to even be given the chance to VBAC, then I decided to have the cesarean after seeing the ultrasound... which obviously was the right decision... but I had doubts that it really was an emergency since they were ok with postponing it for 5 days, had that twinge of guilt that I was giving up, and comments from certain people in my online community didn't help that... But I was glad to have had those 5 days to try to go into labor naturally... and when it didn't I was almost relieved because I questioned whether I was really strong enough, which is silly. And then the cesarean was so wonderful and healing of all the hurt I had left over from Alex's birth. But still, could I have VBAC'd? Was the placenta really THAT bad? How long could I have pushed it? I could have avoided another scar and all those damned blisters from the adhesive reaction! Then to hear this today makes me want to vomit. I had no idea that she was really that close to having a completely detached placenta... OBVIOUSLY she's fine... I mean she is just beautiful and bright and strong... I just love her so much, and to think that I could have killed her by selfishly pursuing a VBAC after seeing the placenta so bad off... I could have chosen to ignore that and say that I was already so close to 40 weeks why not just induce with pitocin, my GOD that could have killed her right there, the doc offered that option on Friday... and for a split second I nearly almost thought about saying yes and then I thought of all the reports that said pitocin was so horrible for VBACs... I could have gone home and just waited for labor to go on it's own... how long would I have waited? I didn't FEEL the placenta coming off the wall, how would I have known? What if I had gone and had natural labor start at 41 or 42 weeks and had Lirum stillborn? Knowing that she's just fine doesn't help these feelings pass... it just doesn't and I just can't breathe...
On March 4, 2010 my friends got together and threw a Blessingway for me. It was beautiful. Many of my friends and their children came to support me and lift up their blessings for my impending VBAC. They made a labyrinth for me to walk. It was so special. As I walked the labyrinth, I threw flower petals in my path, marking the blessings I sent out in hopes of a smooth and easy labor and a beautiful healthy baby girl.
At the end of my Blessingway, one of my friends, a chiropractor, taught me some acupressure points to help make the irregular contractions more meaningful and even. After the Blessingway, my contractions became regular and strong. I started having to poop a lot and the next morning I passed a quarter-sized mucous blog that had red streaks in it. I got really excited. I thought, “This is it!”
Not yet…
On March 5th, I had been contracting pretty regularly at about 6 minutes apart but wasn't getting any closer, so I went for a walk... had several small contractions, but had three that made me stop and work hard through them. My son enjoyed riding the neighborhood on his trike and we got lots of stares from neighbors who came to see what all the moaning was about... and one very old Russian immigrant grandmother who lives in our apartment complex, barely speaks English, and who has had a crush on my son since he was born came to give me some grandmotherly advice on laboring.
Got home and went to lie down and rest... fell asleep for about a half hour but got woken by a particularly strong contraction accompanied by a hard kick to my lungs... When I got up, I found that my son had conked out. Shawn carried him into the bedroom now that I wasn't taking up the whole bed... and then he came out to help me through some hard contractions that we finally found were 4 minutes apart... so Shawn called Kristina. She left the birthday party she was at and came to my rescue...
Before she arrived, my mother and sister showed up. And my contractions started spacing out... and getting lighter... Alex woke up when the pizza delivery guy came to deliver the pizza my sister had ordered before she got to my house... Amanda took over helping do counter pressure in Shawn's place because his arms have really weakened... his back is so bad... and my mom just kind of sat on the sidelines telling me how good I was doing...
When Kristina got there, my contractions had spaced out to about 11 minutes. We timed a few... worked through a couple of hard ones but it was clear that my work was done for the night and I was absolutely exhausted. So Kristina told me to get some rest and she went back to her party.
I lay down on the couch, disappointed... and once I stopped working so hard, DH started up the Wii for my mom and sister and they got SUPER loud and generally invaded my house.
I had fun watching them play but to tell the truth, I was awfully disappointed that things pretty much tanked when they got there... but ecstatic that I wasn't in the hospital where they would start hassling me about a repeat cesarean for stalled labor. I finally had enough and went to lie down in my dark, quiet bedroom... they got the hint and left.
I fell asleep and even though I had really super strong contractions all night they were really irregular...
March 6th, Kristina and I were talking about trying to just let things go after I posted on Facebook that I was going to quit for the night the 5th... we both agreed that my body will do what it should in its own time and that trying to rush things is just going to wear me out physically and emotionally. We talked about my need to control things and my excitement over what seemed to be labor and how sometimes our bodies just ease into things. After that I prayed and got out my scriptures... I laid the scriptures spine down on the table and just let them fall open (I do that when I am just reading for inspiration or peace rather than for study) and they fell open to Exodus 31 and the first thing that my eyes fell on was verse 17
It is a sign between me and the children of Israel for ever: for in six days the Lord made heaven and earth, and on the seventh day he rested, and was refreshed.
I thought that was pretty clear! So I posted the reference on Facebook and started resting... my contractions stopped entirely.
Sunday night, March 7th, I started having extremely consistent contractions at 8 minutes apart and lasting around 60 seconds, but not painful... they just felt like pressure, squeezing, and kind of achy like I was about to start my period and it took my breath away and my heart raced. Last Thursday and Friday though the consistent and irregular contractions I felt were really painful... like a charlie horse all over me... they lasted all the next week…
Saturday, March 13th the contractions started coming every 5 minutes and lasting 2 minutes each… I decided to go into the hospital to make sure the baby was tolerating the long contractions… We left to go to Harrison. They stopped us at the door saying that Dr. Lowe (who I later found out was formerly called Dr. Rankin, who delivered Alex) was on duty and was refusing to attend me for a VBAC, and although they can't technically turn me away in labor, unless I signed a cesarean consent form they would not be able to do more than put me in a bed and see if I was in labor. So we left.
We headed to Tacoma General. They put me on the contraction and heart rate monitors, but before we even got there my contractions had slowed... On the monitors though, Lirum was doing fantastic. Variable heart rate, 1 or 2 possible decels that could have been when I moved or something. BUT:
My blood pressure was really high. That concerned me. They did a vaginal exam, that was excruciating... Kristina said she heard me screaming down the hallway! I have had vaginal exams before... cervical checks, pap smears, etc... but I have NEVER experienced that kind of agony before! I was barely dilated a fingertip... so, with my pressures being high and no dilation, we decided to do a Biophysical Profile and monitor my blood pressures for a while and then do another cervical check to see if I was indeed in labor.
Lirum BARELY got an 8/8 on the BPP, she didn’t want to move, but at the last second she arched her back and the tech called it good. The placenta... oh the placenta... 1 1/2 weeks before, my placenta looked spotty, but not really terribly calcified, that day it was completely white... there weren't any dark spots on it at all. That is a REALLY fast degradation! The tech saw it and couldn't help but say "WOW! That placenta is all used up!" I knew as soon as I saw that bright white placenta that I wasn't going to get my VBAC... especially with my blood pressure so high.
We got back to the room, and they came to check my dilation to see if I was progressing at all... but after that first cervical check 2 hours before, I had only had 3 or 4 contractions... and I even walked around the birthing unit trying to get it going before the BPP. So my cervix hadn't budged. At least after I told the doc that her first cervical check was excruciating, she was MUCH gentler. They left after that and I pretty much just told everyone there that I would not be having a VBAC. I knew it... it was only a matter of time before the doc came in after looking at the BPP results and comparing them with my last one... and sure enough... She came in and said that if I were in active labor that night, she wouldn't have a problem with me having a VBAC, but to wait God knows how much longer for me to start active labor on my own, since induction isn't an option, it is just too risky.
I wasn't even upset! I mean, sure, I was disappointed, feeling a loss of something I had worked so hard to achieve... but really, the whole point of working for a VBAC was to give my baby girl the best start in life... now a VBAC isn't the best start I can give her. If I wait for labor to start on its own, it could be weeks, and by that time the placenta could give out entirely... or if I go into labor, she could not tolerate it well... It was just too risky. IT WAS MY CHOICE. That made all the difference.
I think it was absolutely fantastic the way I was treated at Tacoma General... the on call doc, Dr. Miller, was a gem. She was completely unbiased, supportive of my wish to pursue a VBAC and listened to me and made me feel like a real person and not just another patient to be "handled". I think she was impressed with me and my knowledge of my options and research... It was like we were on equal footing! Not once during my entire stay tonight did I ever feel in any way belittled, abused, or hornswaggled. So KUDOS to TG! I think the clincher though was when the doc said "I think you probably could have interpreted your BPP yourself!" After I told her that I had seen the change in the placenta with my own eyes and that I thought it would be best to have a cesarean.
So I asked to be discharged. I wanted to sleep in my own bed and have a good meal and head to Harrison and have a cesarean the next day. We wanted to be closer to home as it would be easier for Shawn to deal with Alex.
March 14th, I called Harrison to schedule my medically necessary repeat cesarean and they said that if I was not in ACTIVE labor, they would transfer me to Seattle because of my seizures... yeah, they did a cesarean for Alex and I had seizures then... I was irate. I called Tacoma General and got to talk to my favorite OB from OBAC. Dr. Erin Wisbey-Martin. She and I discussed my case and she consulted with other docs at the hospital and we decided that my case was not “emergent” meaning my and Lirum’s lives were not in immediate danger. Lirum had been doing well even through the contractions and my placenta was not detached… it was on its last legs, but it hadn’t given out yet. And TG only does “emergent” cesareans on the weekends. So, we scheduled me for Wednesday, March 17th at 2pm with a noon check in time. I chose the date because it was the only one available where Dr. Wisbey-Martin would be able to do the cesarean. I was to be on complete bed rest till then.
Shawn was beside himself with joy... he was still holding out hope that we could do something to get me to go into labor naturally so we could VBAC, and now we had 3 more days to try rather than having to go in that day. We made an appointment to see my friend, the chiropractor to see if she could help.
I posted our plans online, as there were several people following my progress on different sites. They all knew how important it was to me to try for a VBAC. After Alex’s birth, I swore I would VBAC… and I worked hard over the next 3 years to educate myself about birth and my own health. I learned more about VBAC and repeat cesarean than most doctors! And when some of my friends heard that I had consented to a repeat cesarean, the proverbial crap hit the fan. I got bombarded by people telling me that I was giving up… that the docs had pulled the wool over my eyes… that Lirum was fine and why was I not still working for it… etc… It really hurt. I made the decision based on all the available evidence. I was comfortable with my choice. I knew it was right. These people, knowing only bits and parts of the whole story, passed judgment on me. I started to question my choice. Was I really making the right choice, or was I just scared? I talked to Kristina… she has been my rock through this whole thing… she helped me to understand that most of the people I had bashing my choice now were people who were not invested in me as a whole… just in seeing me have a vaginal birth. These people were on crusades to have VBAC’s or were so invested in seeing me have the one they couldn’t have that nothing else mattered to them. Putting that all into perspective reassured me that I was doing the right thing.
Monday, the 15th we headed to the chiropractor’s. She was amazing! We worked for over 2 hours using homeopathics, acupressure, and adjustments… but because of where my placenta was located, turning the baby from where she was lying on my right side to my left side to help her press on the cervix was unlikely. The contractions got stronger though and we thought if we just went home and rested, we would go into active labor… Before our work, my blood pressure was 170/92… afterward, it was 116/68. Joella invited us to come back and do more work Tuesday if we wanted to, but I decided that would be unnecessary… because Tuesday the contractions slowed back to the crampy charlie horse contractions… I knew my body wasn’t going to do this… I just wasn’t ready. I was only 39 weeks and 3 days along, and I knew that it was going to take longer for me since I had never had a vaginal birth and last time it took over three days just to get to 4cm. and I was in active labor!
I called the doc Tuesday, the 16th as she requested, to go over what the cesarean entails... I hadn't ever had what I would call an "elective cesarean". With Alex I was in labor for days before they tried to break my water and decided to do a cesarean... so I wanted to go over how exactly it would work and she said it would be better to go over it the day before so that I could sit on it overnight and be ready with any questions for her when she saw me for the surgery.
Here was the plan:
When I arrived at noon they planned to strap on the monitors and get a good reading on the baby and my contractions... then do a cervical check to see if I had dilated, if I did, then this would allow me time to make any progress before determining if they would cancel the cesarean and allow me to labor. They planned to put in the IV and do all the pre-op prep except for the spinal, which would be done 1/2 hour before the surgery. The Obstetric unit's operating room table has a weight limit of 200lbs.... so they had to do my cesarean on the main surgical floor where they have a "bariatric surgical table". There was a question as to whether Shawn would be allowed… They expected the surgery to take a minimum of 1 hour... possibly longer depending on the extent of the existing scarring... They planned to use something called a "wound vac" which I hadn't ever heard of... to ensure that I didn't get an infection. They planned to follow my existing scar on the skin and fixing the wound so that hopefully I won’t get the keloid part at the top. She said that because I am a "high risk cesarean" the surgical staff would include THREE ob's, one of them a perinatologist; nursing staff for the operation; nursing staff from the NICU; a pediatrician; and the anesthesiologist. So that's a full house!
Here is reality:
Grandma, Shawn, Alex, and I got to the hospital at noon. They put me in a triage room and told me to change into the hospital gown. They checked my vitals… my blood pressure was still down! They put me on the monitor and did a cervical check… I wasn’t dilated at all… still. Deep down I knew that would happen, but I wasn’t prepared for how that would make me feel. This was the point of no return in my mind. For some reason, even though I had decided to have a cesarean, I guess I had still held a shred of hope that maybe the work we did at Joella’s had made me have a little progress… that maybe the VBAC wasn’t gone. Shawn was as disappointed as I was.
My sister showed up and took over watching Alex. Kristina came and I felt better… I still had that little bit of concern that my Doula wouldn’t show, just like last time. Not that I didn’t trust Kristina, but because I was so hurt last time. The little triage room was full. It was nice, I felt supported and loved.
The nurse came to put the IV in and draw some blood for a CBC and blood type, just in case I needed blood infusions. Then the doctors came in to see me, Dr. Abbi, Dr. Flaim, and Dr. Wisbey-Martin. They poked my belly this way and that, and determined that because of the amount of weight I gained since my last cesarean, following the existing surgical scar would be unrealistic. They decided to do a “bikini cut” cesarean. They also told me that they would have to use staples instead of sutures as I had requested because the incision would be under a skin fold. A little bit after that, someone came in and shaved my belly and the tip of my pubic hair to allow for the surgery.
About 20 minutes later, a L&D nurse named Sharon came to take me to the O.R., I was surprised to see that they asked me if I would rather WALK than be wheeled up on a bed or wheelchair! That was the first moment that I realized that this experience truly would be more dignified…
I researched and studied and absorbed every little factoid I could over the last three years… I had good and bad experiences through my whole pregnancy and had written a birth plan to cover this situation, just in case. Then I found out that cesarean was the best way and I lost my chance to VBAC. I had just been turned away by the hospital I thought would be best for me. Then I had landed squarely in the hands of the hospital I decided I would not want to go to because I believed that they were only in it to protect themselves rather than to provide me and my daughter the best birth possible for us.… and it was my last option, there was nowhere else to go… and here they were giving me hope that this would be more than my last birth ever dreamed of being.
I walked to the O.R., leaving my husband on the elevator because they still weren’t sure if the anesthetist would allow him into the main O.R. I walked onto the floor and was met by surprised stares from people who hadn’t seen a patient walk onto the floor in a long time. Apparently the only cesareans that are done on that floor are extreme emergencies… I walked into the room and was met by a bustle of people cheerily talking and listening to upbeat music. I was sat on the table and strapped back to the baby monitor, but Sharon couldn’t get a proper reading with me sitting up so she gave up. I mentioned to the room in general that I was allergic to Latex and someone turned and said, “Well, shit, we need to get a different kit in here.” Sharon went to find a latex free urine catheter. Someone came over and asked if I liked the music. I suddenly remembered that I had put in my cesarean plan that I wanted to be asked this question… It completely slipped my mind. They said they had Pandora.com up on the computer and asked me who my favorite artist was. I told them I really liked Norah Jones and they went and typed her name in. Immediately I heard more soothing music, I almost cried… they were seriously honoring my birth plan!
Soon the anesthetist came in, a cheerful man named Tompkins, someone said “Hi, doc!” and I felt eased that this was a nice guy in a good mood. I asked him then if my husband could come in during the cesarean. He looked at me like I was crazy and said, “Well of course!” Suddenly Sharon stepped into motion; she got on the phone and called up to the waiting room to see if they could get my husband up there fast. Someone had already taken him to get scrubbed though, so she couldn’t find him and didn’t know that someone had already taken him, so she called L&D and asked someone there to find him. Then she called his cell phone. She found him quickly and he was there in just a few minutes. He was dressed in a white paper jumpsuit, but she laughed and pulled out a package with some dark blue thick paper scrubs that looked much more comfortable. He left with her to get changed. During all this hustle the anesthetist had started trying to get me started on the spinal.
After trying for nearly half an hour and failing each time he stuck me, and putting me in a lot of pain from each jab… he FINALLY gave up. It took him two tries to get the epidural in instead. But, as Sharon explained to my husband who was holding my hand through most of it, an epidural takes longer to take effect for a surgery than a spinal because a spinal is like dumping pain meds down a drain… an epidural is like putting a sponge in the sink and pouring the pain meds into the sponge and waiting for it to drain down the sink. So they laid me down on the operating table and went back to work hooking me up to all the various machines: an EKG, BP monitor, Infant HR monitor, pulse ox, oxygen nasal canula, etc… Shawn commented on the music and I told him about how they let me choose the station. Then they decided I was numb enough to insert the catheter… but I wasn’t. It was horrible!
We made small talk for a bit and then suddenly, my blood pressure plummeted, I got nauseas and sweaty and the anesthesiologist was right there… putting something into my IV… and asking me questions… I don’t recall the questions he asked, but he seemed concerned and Shawn kept asking why my pressure was low, at one point he said it was 79/46. The room kind of faded for a second, but then all of a sudden my heart was racing and the anesthesiologist said, “There we go!” And the whole room breathed a sigh of relief and went back to business, and I went back to talking to my husband. The anesthetist put some anti-nausea meds in and I was just fine…
The OBs came in then, and the curtain went up and they started taping my belly up so that they could get at the right spot to do the surgery. I could still feel everything, and it was very interesting… cold prep solution and the tape and then they just waited… every few minutes they would draw something across my belly and ask if I could feel that. Eventually I couldn’t and they went to work. During the next 25 minutes, I talked with Shawn and asked questions of the anesthetist and OBs, Sharon came over frequently to check on me… it was nice. Nothing was ever talked about except that it directly affected me and my baby. Every 10 minutes or so, when I would start to feel my legs, the anesthetist put more medication in the epidural. Then it felt like they practically STOOD on my stomach and I felt pulling and I couldn’t breathe… I remembered that this was the way I felt just before my son was born… I got excited… apparently too excited; Shawn started telling me to calm down because I started shaking in anticipation. Seconds later I felt a release and completely lost the ability to take a breath in. The anesthetist leaned toward me and told me to breathe…
And then I heard my baby girl. The room went dead silent. I gasped and actually started to hyperventilate a little, and then the tears came, and I started talking to her… telling her I was there and that I would hold her in a minute… They took her to the NICU table and checked her briefly and then they wheeled the NICU bed over to where I could see her. Sharon told them that I wanted to keep the placenta and that I didn’t want Lirum wiped off before I could touch her. Everyone who mentioned the baby called her by her name instead of calling her “baby” or “chunker” like the last cesarean team did to my son. They had asked during the prep what her name was and everyone in the room knew it and actually remembered. I felt full of joy and peace. I touched my baby and kissed her head before she was cleaned off. I watched as they shortened the cord stump and did all their other checks and wiped her off. They said her Apgar scores were 8 and 9. Then they wrapped her up and handed her to Shawn and he came over and held her by me and I reached over and touched her and stroked her cheek and listened as Shawn talked soothing words to her… she was beautiful. She had a head full of dark hair the color of Shawn’s, chubby cheeks that just made me want to kiss her and never stop and olive complexion just like Shawn’s… She is going to be the most beautiful woman to walk the earth…
Shawn took Lirum to the NICU for observation after I had time with her. It only took another 20 minutes to close me up and install the wound vac, during which time Sharon held my hand continuously, telling me what to expect in the days ahead and how beautiful Lirum was. And the doctor softly said to me, “Jennifer, you did everything right. You worked so hard, and you have a beautiful little girl! I am so sorry you didn’t get your VBAC.” I cried. That little act of mercy will stay with me forever.
Then they dropped the curtain and waited till I could feel my legs. Then they brought in a monstrosity of a bed that was to be my home for the next 3 days, and aired up the mattress that was already underneath me and moved me over to the bed. I was wheeled to the Post-op Recovery Area where I was watched for the next hour and a half by a nurse who literally never left my bedside. She checked my uterus every 15 minutes, gave me ice chips when I asked for them, and monitored my blood pressure, temp, and how far up the anesthesia was still effective. I felt cared for. I felt like I wasn’t forgotten. Someone was there, talking to me every minute, I wasn’t just shoved aside. The recovery nurse talked to me about the birth and how I felt and the baby and everything! I told her about how we had come to this point and all the support that I had. Things couldn't have been better... well unless I had a VBAC... but for a cesarean it was ideal. Besides my little blood pressure crisis, the whole thing was textbook.
Eventually, I was determined to be well enough to go to my room on the Mother Baby Unit where I could see my family and be with my daughter. It was fun getting there. The bed was electric, it only moves if it is turned on and someone had forgotten to plug it in when I got to the recovery unit… so it was dead. They managed to get three nurses to push the darn thing… and got it to my room. No one knew how to maneuver it though and so it was absolutely hilarious, like the dang three stooges… it was comical… By the time we got to my room we were all laughing.
I was able to immediately nurse my baby girl, who didn’t want to open her mouth and had a tied frenulum, but she quickly fixed that on her own, and I got her to open her mouth wide by the second day. She was a champion nurser. She weighed in at birth at 9lbs 5.5oz., by the time we left the hospital on March 20th, she was 8lbs. 8oz., and three days later at her one week checkup, she was 9lbs 8oz.!
Because of my seizures, my husband and I agreed that it would be best if I were not alone with our newborn daughter during my recovery in the hospital… We couldn’t expect a nurse to sit with me round the clock, and my son would not be allowed to stay at the hospital overnight – nor would it be fair to him to have to… and we didn’t want to use the nursery! So, my grandma and husband struck a deal: she would stay with me overnight and he and my son would come up and sit with me during the day while grandma went home to rest. It worked great, and I didn’t even have any seizures…
I was able to get the catheter out 12 hours after the surgery and the IV out at 18 hours. After getting the catheter out they gave me six hours to pee on my own… it took me 5 ½ hours! I would sit on the toilet, my bladder feeling like it would burst from the fullness, and not be able to pee! It was horrible… I nearly gave up and asked for a catheter just to relieve the pressure… but finally we had success, and I was told that as a prize, I could shower! YEAH! It felt so good. I was amazed at how much better I was moving around after this surgery as compared to my son’s cesarean… I was taking care of all my own needs, and the pain was pretty minimal. I used Tylenol and Ibuprofen to deal with the pain, asking for the prescribed Percocet only 2 or 3 times when I just couldn’t deal with the back pain and headaches from the epidural wearing off. I was on normal food immediately, instead of being titrated up to normal food like I was with my son’s surgery. It was great! The best part was that every person who came to my room didn’t just coo over the baby and treat me like a sideliner; I was treated with the respect that a new mother deserves! I was talked to about my baby instead of ignored… I was asked how I was doing instead of having someone just assume and act accordingly. People didn’t just come in and start doing things to my baby, they consulted with me first! It was an amazing experience. One of the things that made my last cesarean so bad was that I felt ignored, like I had served my purpose and was now irrelevant. I never felt that this time. Every Nurse, CNA, and Doctor was amazing.
I wasn't ever offered any formula! THAT IS AMAZING! With Alex they were shoving it down our throats, literally... we were even told that we would be arrested for child abuse and neglect if we didn't supplement him and that Alex couldn't be released from the hospital unless we agreed to supplement! We left the hospital with Alex and literally CASES of pre-mixed liquid soy formula bottles (just throw on a nipple!) and powdered formula for when that ran out, an SNS system to use, coupons, pacifiers, bottles, and other formula feeding paraphanelia... With Lirum it was totally different. Lirum hasn't ever had any formula in her life. The only issue I had was that they kept coming in and asking when I nursed her and for how long each session and which breast I used... I nursed Alex for 2 1/2 years and I haven't EVER watched the clock! Being asked to was very weird... I nurse on demand and I don't give a thought to which breast or how long at each breast... lol... eventually they gave up when they would ask and I would say, "Hmmmm I really don't know!" They started asking me how many wet or poopy diapers she had instead... that I could tell them!
They preformed a few tests on Lirum, of course. She passed the hearing test with flying colors. They did a new pulse ox test on her to check her heart… that made the echocardiogram that they had ordered during the pregnancy unnecessary. They did the PKU. And finally, they checked her bilirubin… At 52 hours old the light test showed that her bilirubin was 13.7 so they did a blood test. We were concerned because she was yellowed and had been sleeping a lot. The blood test came back that she had a level of 11.2… so there was no concern. She was still yellow, but she had what is called “physiologic jaundice”, which is common in breastfed babies and is totally harmless. It goes away just as soon as the mother’s milk comes in and baby gets more than just colostrum.
They didn’t even bat an eye when we told them we didn’t want her bathed at the hospital, we would not be vaccinating, and that we only wanted half the vitamin k shot… but apparently a NICU nurse threw a fit when my husband declined the eye drops. She told him that she would have to report us to CPS because the eye drops were mandated by law and there was no waiver. My husband stood his ground though and no eye drops were administered. The pediatrician came to my room the next day and I asked him about it. He looked shocked that my husband had been treated that way and explained to me that it was policy that if parents refuse the eye drops when the mother has a STD, they call CPS because the parents would be putting a child at risk. But, he noted, I don’t have any STDs, “And besides, wasn’t she born by cesarean?” I told him she was and he just laughed. He did have a talk with the NICU team and the nurse in question came and apologized for her confusion.
Lirum did end up needing supplementation during her NICU stay while I was in post-op… but we had brought expressed breastmilk that a friend had given us for just this occasion. Shawn tried to convince them to let him cup feed Lirum the breastmilk, but they said that studies had shown that it was an aspiration risk and they wouldn’t allow it. His options were to bottle feed or use an NG tube. He chose the tube to avoid using a bottle and possibly causing nipple confusion… this also prevented her from being OVERFED, which is a common happening with bottle feeding. They pumped out the contents of her stomach and then measured that amount out of the breastmilk we brought and filled her stomach back to that level.
Shawn felt awkward in the NICU, the only parent there who was able to hold his obviously healthy daughter… surrounded by babies and parents in crisis, but it was required to go to the NICU instead of the nursery after a cesarean on the main O.R. floor… Altogether, Lirum did great. There was never a single concern that lasted more than a few minutes that she wasn’t absolutely healthy.
My wonderful Doula, not only showed up, but she was present… she helped my husband to navigate the immediate after birth and really was there for him… which was the best gift she could have given me. My husband STILL says thank you to her every time she is even mentioned! I can’t stress how important she was to our experience, even though I had a cesarean.
The last thing to go for me was the wound vac on the day I went home. That was truly horrible. I had told them that I was allergic to latex and adhesives, so they purposely got a latex free hypoallergenic tape to secure the wound vac to my stomach… but apparently it had a latex derivative in it… when they removed the tape and wound vac, they found that I had developed giant blisters everywhere the tape had touched. That was what had been itching since I had regained feeling in my belly! The wound care specialist had assured me that itching was a sign that the wound was healing… oops! They decided not to dress the blisters there, so they could air out… but they gave me a roll of paper tape, since I knew I never had a reaction to that, and a few dressings to use at home. I took my last shower and was discharged.
Here I am, a week later and I had my staples removed yesterday and Lirum and I are doing great! I ended up having a secondary reaction to the paper tape, that caused more blisters… but keeping it clean and slathering on Neosporin seems to have taken the bite out of it and it is well on the way to healing. I am taking my placenta pills, courtesy of a friend who encapsulated it for me. But the greatest thing I can say is this:
For a cesarean, it couldn’t have been better. I can't believe the difference education and preparation made in our experience, but you can prepare and educate all you want and if your chosen place of birth is not cooperative, you will still have a bad experience. Thank you a thousand times to Tacoma General for blessing me with a healing experience.
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UPDATE
May 3, 2010
I discovered today that Lirum's life could have been in serious danger. Had my 6 week post partum checkup today, which went really great. Lirum showed off and caught everyone's attention. She nursed and then decided to stretch for 20 minutes, then roll over and push herself up on her hands.
I was surprised by the operative report. The last ultrasound the Friday before she was born, showed a completely calcified placenta, the op report from her Wednesday cesarean (I was 39 weeks and 6 days) said Lirum's placenta was partially detached and came off the rest of the way with "minimal uterine massage". They had to SCRAPE Alex's placenta off! And only 5 days later! I am so glad she was born when she was, any later and it could have been disasterous! Not to be melodramatic, but for Heaven's sake... I have heard so many stories of stillborn babies from detached placentas.
But now I am having all kinds of strange feelings... I worked hard to even be given the chance to VBAC, then I decided to have the cesarean after seeing the ultrasound... which obviously was the right decision... but I had doubts that it really was an emergency since they were ok with postponing it for 5 days, had that twinge of guilt that I was giving up, and comments from certain people in my online community didn't help that... But I was glad to have had those 5 days to try to go into labor naturally... and when it didn't I was almost relieved because I questioned whether I was really strong enough, which is silly. And then the cesarean was so wonderful and healing of all the hurt I had left over from Alex's birth. But still, could I have VBAC'd? Was the placenta really THAT bad? How long could I have pushed it? I could have avoided another scar and all those damned blisters from the adhesive reaction! Then to hear this today makes me want to vomit. I had no idea that she was really that close to having a completely detached placenta... OBVIOUSLY she's fine... I mean she is just beautiful and bright and strong... I just love her so much, and to think that I could have killed her by selfishly pursuing a VBAC after seeing the placenta so bad off... I could have chosen to ignore that and say that I was already so close to 40 weeks why not just induce with pitocin, my GOD that could have killed her right there, the doc offered that option on Friday... and for a split second I nearly almost thought about saying yes and then I thought of all the reports that said pitocin was so horrible for VBACs... I could have gone home and just waited for labor to go on it's own... how long would I have waited? I didn't FEEL the placenta coming off the wall, how would I have known? What if I had gone and had natural labor start at 41 or 42 weeks and had Lirum stillborn? Knowing that she's just fine doesn't help these feelings pass... it just doesn't and I just can't breathe...
Friday, March 19, 2010
Saturday, March 13, 2010
Update
NO VBAC.
We left to go to Harrison. They stopped us at the door saying that Dr. Lowe was on duty and was refusing to attend me for a VBAC, and although they can't technically turn me away in labor, unless I signed a cesarean consent form they would not be able to do more than put me in a bed and see if I was in labor. So we left.
We headed to TG. They put me on the contraction and heart rate monitors, but before we even got there my contractions had slowed... before we left the house they were 4-5 minutes apart and lasting at least 2 minutes each... that is why we left... I didn't want to take the chance that Lirum wasn't handling the really long contractions. On the monitors though, Lirum was doing fantastic. Variable heart rate, 1 or 2 possible decels that could have been when I moved or something. BUT:
My blood pressure was really high. That concerned me. They did a vaginal exam, that was excruciating... Kristina said she heard me screaming down the hallway! I have had vaginal exams before... cervical checks, pap smears, etc... but I have NEVER experienced that kind of agony before! I was barely dilated a fingertip... so, with my pressures being high and no dilation, we decided to do a BPP and monitor my blood pressures for a while and then do another cervical check to see if I was indeed in labor.
Lirum BARELY got an 8/8 on the BPP, she wasn't wanting to move, but at the last second she arched her back and the tech called it good. The placenta... oh the placenta... 1 1/2 weeks ago my placenta looked spotty, but not really terribly calcified, today it was completely white... there weren't any dark spots on it at all. That is a REALLY fast degrade! The tech saw it and couldn't help but say "WOW! That placenta is all used up!" I knew as soon as I saw that bright white placenta that I wasn't going to get my VBAC... especially with my blood pressure so high.
We got back to the room, and they came to check my dilation to see if I was progressing at all... but after that first cervical check 2 hours before, I had only had 3 or 4 contractions... and I even walked around the birthing unit trying to get it going before the BPP. So my cervix hadn't budged. At least after I told the doc that her first cervical check was excruciating, she was MUCH more gentle. They left after that and I pretty much just told everyone there that I would not be having a VBAC. I knew it... it was only a matter of time before the doc came in after looking at the BPP results and comparing them with my last one... and sure enough... She came in and said that if I were in active labor tonight, she wouldn't have a problem with me having a VBAC, but to wait God knows how much longer for me to start active labor on my own, since induction isn't an option, it is just too risky.
I wasn't even upset! I mean, sure, I was disappointed, feeling a loss of something I had worked so hard to achieve... but really, the whole point of working for a VBAC was to give my baby girl the best start in life... now a VBAC isn't the best start I can give her. If I wait for labor to start on its own, it could be weeks, and by that time the placenta could give out entirely... or if I go into labor, she could not tolerate it well... It is just too risky.
So I asked to be discharged. I will sleep in my own bed and have a good meal and head back to TG on Wednesday for a cesarean.
One last thing... I think it was absolutely fantastic the way I was treated at Tacoma General... the on call doc, Dr. Miller, was a gem. She was completely unbiased, supportive of my wish to pursue a VBAC and listened to me and made me feel like a real person and not just another patient to be "handled". I think she was impressed with me and my knowledge of my options and research... It was like we were on equal footing! Not once during my entire stay tonight did I ever feel in any way belittled, abused, or hornswaggled. So KUDOS to TG! I think the clincher though was when the doc said "I think you probably could have interpreted your BPP yourself!" After I told her that I had seen the change in the placenta with my own eyes and that I thought it would be best to have a cesarean.
IT WAS MY CHOICE. That made all the difference.
We left to go to Harrison. They stopped us at the door saying that Dr. Lowe was on duty and was refusing to attend me for a VBAC, and although they can't technically turn me away in labor, unless I signed a cesarean consent form they would not be able to do more than put me in a bed and see if I was in labor. So we left.
We headed to TG. They put me on the contraction and heart rate monitors, but before we even got there my contractions had slowed... before we left the house they were 4-5 minutes apart and lasting at least 2 minutes each... that is why we left... I didn't want to take the chance that Lirum wasn't handling the really long contractions. On the monitors though, Lirum was doing fantastic. Variable heart rate, 1 or 2 possible decels that could have been when I moved or something. BUT:
My blood pressure was really high. That concerned me. They did a vaginal exam, that was excruciating... Kristina said she heard me screaming down the hallway! I have had vaginal exams before... cervical checks, pap smears, etc... but I have NEVER experienced that kind of agony before! I was barely dilated a fingertip... so, with my pressures being high and no dilation, we decided to do a BPP and monitor my blood pressures for a while and then do another cervical check to see if I was indeed in labor.
Lirum BARELY got an 8/8 on the BPP, she wasn't wanting to move, but at the last second she arched her back and the tech called it good. The placenta... oh the placenta... 1 1/2 weeks ago my placenta looked spotty, but not really terribly calcified, today it was completely white... there weren't any dark spots on it at all. That is a REALLY fast degrade! The tech saw it and couldn't help but say "WOW! That placenta is all used up!" I knew as soon as I saw that bright white placenta that I wasn't going to get my VBAC... especially with my blood pressure so high.
We got back to the room, and they came to check my dilation to see if I was progressing at all... but after that first cervical check 2 hours before, I had only had 3 or 4 contractions... and I even walked around the birthing unit trying to get it going before the BPP. So my cervix hadn't budged. At least after I told the doc that her first cervical check was excruciating, she was MUCH more gentle. They left after that and I pretty much just told everyone there that I would not be having a VBAC. I knew it... it was only a matter of time before the doc came in after looking at the BPP results and comparing them with my last one... and sure enough... She came in and said that if I were in active labor tonight, she wouldn't have a problem with me having a VBAC, but to wait God knows how much longer for me to start active labor on my own, since induction isn't an option, it is just too risky.
I wasn't even upset! I mean, sure, I was disappointed, feeling a loss of something I had worked so hard to achieve... but really, the whole point of working for a VBAC was to give my baby girl the best start in life... now a VBAC isn't the best start I can give her. If I wait for labor to start on its own, it could be weeks, and by that time the placenta could give out entirely... or if I go into labor, she could not tolerate it well... It is just too risky.
So I asked to be discharged. I will sleep in my own bed and have a good meal and head back to TG on Wednesday for a cesarean.
One last thing... I think it was absolutely fantastic the way I was treated at Tacoma General... the on call doc, Dr. Miller, was a gem. She was completely unbiased, supportive of my wish to pursue a VBAC and listened to me and made me feel like a real person and not just another patient to be "handled". I think she was impressed with me and my knowledge of my options and research... It was like we were on equal footing! Not once during my entire stay tonight did I ever feel in any way belittled, abused, or hornswaggled. So KUDOS to TG! I think the clincher though was when the doc said "I think you probably could have interpreted your BPP yourself!" After I told her that I had seen the change in the placenta with my own eyes and that I thought it would be best to have a cesarean.
IT WAS MY CHOICE. That made all the difference.
Wednesday, March 10, 2010
musings...
When I was pregnant with Alex, at 38 weeks and 4 days I felt the first contractions... they were very similar to what I feel now. And, being stupid and not having anyone to talk to about it, I assumed I was ready to have a baby and enjoyed myself thoroughly... The next day we called the doc who told us to go to L&D to see if we were in labor... and the rest is history.
http://choicespirit.blogsp
Today I am 38 weeks and 5 days along... I have been feeling those same contractions this time and I know that they are preparing me for labor and to bring my baby into this world. My body is doing what it was designed to do! It makes me feel good to know that even though my actions and choices last time led to a cesarean, my body isn't broken. I have spent the last 3 years soaking up everything I could learn about pregnancy, VBAC, and repeat cesarean. I have been surrounded by supportive and loving people who want to see me succeed. I have found an amazing Doula who is more than I deserve... she is also my friend, which means so much more. And the most important thing is that I have faith in my body.
I can do this! I can VBAC!
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