Archive for the ‘Third Trimester’ category

Day Three: The Delivery

March 3, 2011

This post is a continuation of my labor, delivery, and postpartum story. When we left off, the first 48 hours of labor had drawn to a close and I was only five centimeters dilated.

See Labor: Day One for a breakdown of the going-ons on the first day and Labor: Day Two for a review of what happened on the second day.  Read on to find out what happened on day three.

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Things happened quickly after my doctor made the decision to do a c-section. I watched everything as if I were floating outside of myself. I was scared and nervous. It just seemed like a dream. The anesthesiologist came back and injected a boatload of some sort of painkiller into my epidural and they rolled me into a sort of staging area outside of the operating room. Here we waited for our turn.

Once inside, I tried to take it all in, but it was just so much. There were like three or four nurses and two doctors standing at the foot of the table. The anesthesiologist stood behind me. Everything was stainless steel. A nurse asked me if I could move my feet. I tried, but could not, but was not convinced that I was numb. They strapped my arms down to the side of the table like you see on TV and they put up that crazy paper shield right in front of my face so that I couldn’t see anything. I was kind of freaking out.  My doctor was standing on my left and an assistant was standing on my right. Just before the surgery, my doctor leaned around the shield and showed me what looked like a pair of pliers. He says, “I just cut you several times with these and you did not feel it.” I think he was trying to put my mind at ease, but his comment only served to freak me out further.

During the actual event, I did not feel anything. Not even the tugging or pulling or pressure you sometimes here about. Before I new it, my doctor was saying, “He looks good.” He held my baby up over the curtain for just a moment, but I couldn’t really see him because the curtan was basically in my face. I was still pretty freaked out and I said nervously, “He’s not crying.”

They took little Lukas over to a bassinet in the corner of the OR where they had oxygen and all kinds of other treatments, but he didn’t really need them. Just like that, he let out a surprised yelp and then started to cry in earnest. Tears of relief pricked at the corners of my eyes.

Meanwhile, the doctors and nurses were working on putting me back together. They discovered that Lukas’ cord was in a full knot, which explained why his heart rate kept dropping. And they found a large fibroid (the reason for our ectopic pregnancy scare at six weeks), which they removed. As soon as they started to close me up, I felt pressure in my shoulders. Sort of under my collar bones. That and nausea. I mentioned this to the anesthesiologist, who assured me that both were normal (the pressure is a result of gas that is trapped in the abdominal cavity during the surgery) and gave me something that eased the gas pain and Phenergan for the nausea.

My husband took pictures of the baby, of my open belly, of the knot in Lukas’ cord, even of the fibroid. Kind of gross, but I was glad he did it, so that I could sort of relive the expereince later after I had calmed down. I was not able to hold Lukas in the operating room because the pain in my shoulders was too great, but my husband was and we have a great picture of him in his white jumpsuit and “shower cap” holding our little bundle.

It wasn’t long, though, before I was able to hold him. Out in the recovery room, the nurse tested my sugar (the only test that I or my husband didn’t do during this entire week-long event) and then they propped me up and let me hold him. I can’t even describe the feeling. It’s like a dream. It doesn’t seem real. After a little bit of bonding and a few visits from family, they took Lukas to the nursery for a quick checkup and took me and my husband to the postpartum unit. They rolled Lukas into the room just behind us, and reported that he was doing splendidly. His BG was near perfect and he showed no signs of distress. And with that our postpartum adventures began.

Check back soon for one more post about our experiences in the postpartum unit.

Labor: Day Two

March 2, 2011

This post is a continuation of my labor, delivery, and postpartum story. When we left off, the first 24 hours of labor had drawn to a close and I was still only one centimeter dilated!!

See Labor: Day One for a breakdown of the going-ons on the first day. Read on to find out what happened on day two.

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So my second evening in the hospital began similarly to the first evening. They nurse turned off the Pitocin and ordered me a tray from the cafeteria. I was allowed to take a shower and eat a little something before the foley ball would be inserted. Before I was able to shower, though, I started to get pretty significant contractions. This was a surprise to all of us because we had stopped the Pitocin. Luckily the hot shower helped to alleviate the pain and the contractions subsided before the foley ball insertion.

A foley ball is a balloon-like device that is inserted into the cervix through a catheter. Once inserted, the doctor fills it with water to expand the cervix. The expansion is relatively painless. But the insertion is less than pleasant. The doctor could not seem to get the damn thing in the right place. And it hurt. Bad.

The second night passed much like the first night. Testing and waiting and trying to nap between interruptions. Now that we were more familiar with our surroundings, we could make out the activities going on in the rooms around us. We could watch the contraction monitors by the bed and match them to the rooms where the deliveries were occurring. All around us, women were screaming, babies were coming, and families were celebrating. And we were still testing and treating and waiting. By morning, we were more than ready to get this show on the road.

When the doctor removed the foley ball, at least we had some good news. I had dilated to 5 centimeters. Yea! So the next step was to break my water. Which caused immediate, painful, full-on contractions. They came fast and furious. So fast that I hardly had time to catch my breath between them. It seemed like an eternity while I waited for the anesthesiologist to show up and administer the epidural.

So the lesson here? Request the epidural before they break your water. And require painkillers before they insert a foley-ball.

Once the epidural was in and I was comfortable, they started to push the Pitocin again. But every time they increased the level of Pitocin, the baby’s heart rate would drop. At one point it dropped so far and for so long that they started to prep me for an emergency c-section. My husband and I were both scared to death, because they don’t even tell you what’s going on until they have you half wheeled into the hallway. All we could hear was a lot of alarm bells ringing and people talking. There was absolute chaos in my room and a great deal of urgency. And then, just as fast it started, it stopped. The baby’s heart rate returned to normal, and the excitement was over. But as a result, I spent the rest of my labor wearing an oxygen mask and being turned from side to side. Which is especially hard to do when you can’t feel your legs.

At the end of day two, we were exhausted and beat down. The on-call doctor checked my progress and I was still at only five centimeters. Certainly not dilated enough to deliver a baby. So my doctor came in and said we’d be doing a c-section. I was so disappointed. So tired. This was exactly what I didn’t want. But there was no other option. I got a little teary, and started to stress out about what was coming. Major surgery. Yikes.

Check back tomorrow for the details of day three.

Labor: Day One (Finally!)

March 1, 2011

Scrolling through the archives of my blog the other day, I realized that I never really told you all about my labor, delivery, or postpartum experiences. I started a collection of posts on these topics some time ago, but never finished them.

It’s just so hard to explain the rush of activities and emotions that occurred over the course of those seven short days. I  kept trying, but was never satisfied with the results. And then my netbook died, taking those draft posts along with it.

So I thought I might try again. And this time I’ll be sure to back up my files.

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You might recall that the day before my induction, we had an amniocentesis which confirmed that BabyNoName was ready to be delivered. The office assistant gave us instructions to arrive at Labor and Delivery the next day at 5pm.

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We arrived at the hospital right on time at 5pm and the nurses were ready for us. I was surprised by the amount of paperwork to be completed and the details to be finalized. But I was comforted by the fact that the nurses seemed confident in their ability to deal with my “special” circumstances and their seeming interest and concern about my baby’s well-being.

It seemed to take forever, but it was probably only a couple of hours before we finally got started with the IV and then the Cervidil. As a reminder, Cervidil is a gel that is applied to the cervix by means of a tampon-like device that is placed in the vagina. It’s supposed to thin the cervix and, in some cases, can even dilate the cervix. As expected. It caused light cramping, but was not difficult to deal with. I was still allowed to get up, walk around, and use the bathroom on my own.

My husband and I fell into a routine of testing and logging my BG every hour. At one point, I was low and the nurse let us treat it with our own stash of supplies, so from there on out, we took care of my BG.

The Cervidil stayed in all night, and in the morning, the doctor on call checked my progress. Boy was I disappointed to hear that we’d only progressed to one centimeter. One! So next we started with Pitocin through the IV. The Pitocin increased the discomfort of the cramps, but they were still not debilitating. They gave me morphine every four hours or so to keep me comfortable. We also used the exercise ball to sort of massage away the pain and to try to take advantage of gravity.

The nurses really went out of their way to keep me as comfortable as possible, and they were very hands off with the whole BG control thing. They wrote down everything I did, from BG tests to basal adjustments, to low treatments, but really stayed at arm’s length. One nurse told me that as long as I was able to keep everything under good control, they would let my husband and I handle it. But if things got out of control, they would step in. And they kept their word. I was impressed.

So after a whole day of labor with low levels of Pitocin, another on-call doctor checked my progress. Still one centimeter. No, I’m not joking. Oh, how I wish I was! At this point I had been in “labor” for about 24 hours. My doctor stopped in and advised me that they would next try a “foley ball”. I’d never heard of this procedure before. Fair warning: if anybody ever suggests it, consider running in the opposite direction.

Stay tuned for “Labor: Day Two”

The Amniocentesis

July 2, 2010

We arrived early for the 9AM appointment. Sitting in the waiting room, I was excited and nervous, giddy even. My stomach was tying itself in knots. Our car was loaded up with our hospital bags and the car seat just in case.

Earlier in the week, when I explained the plan to colleagues and friends, they were alarmed. “You’re having an amnio? Isn’t that risky?”

I repeatedly explained what the doctor told me. Yes, an amniocentesis carries a small risk of miscarriage. That’s why they use them sparingly in the first trimester to detect genetic and chromosomal disorders. But at 37 weeks, technically full term, “miscarriage” is really nothing more than an early delivery, so the risk of fetal death is just about nill. Even if I were to go into labor and deliver the baby as a result of the amnio, the chances that he would not survive were next to nothing.

In the exam room, the ultrasound technician lubed up my belly and started running the wand over it. We looked at Baby NoName’s limbs and kidneys. She measured his leg bone, his belly, his head. She estimated his weight at six pounds, four ounces, right where he should be for 37 weeks. She looked for big “pockets” of amniotic fluid and estimated the amount of fluid surrounding the baby. She tried in vain to get us a picture of his face, but he had “dropped” so far into my pelvis, that she could not get his whole face, just a profile. “Oh well, we’ll see his face in person soon enough,” I said with an anxious laugh.

The doctor came in and asked if we had questions. Not really. The procedure is pretty straight-forward. They use a needle to extract amniotic fluid from the uterus so that they can determine whether or not the baby’s lungs are fully developed. I asked how long it would be until we had the results. “We’ll call you with the results by 4PM tonight. But I can usually tell just by looking at the fluid. It should be cloudy.” He warned me that the needle is really long. They’re kind of one-size-fits-all, so they need to be pretty long to accommodate moms with a bigger layer of fat. I looked away because I didn’t want to see the needle. I don’t have a problem sticking myself with a needle, but I’m not so comfortable when someone else is wielding the syringe.

He turned out the lights so that he could focus on the image on the ultrasound screen. He joked, “I have to turn out the lights so that I can see better.” I focused on the screen, too. That long needle was kind of freaking me out.

He inserted the needle and I prepared for the sting. But it didn’t hurt at all. Actually, the insertion felt a lot like an insulin shot. After that, I could feel the needle in my belly, but there was no pain. It just felt kind of weird. The whole thing was over in just a couple of minutes. The nurse turned on the lights. “Looks good and cloudy,” he said.

Next he did an internal exam to check my cervix. I was not dilated at all. So assuming that the test results confirmed his “cloudy” diagnosis, Cervidil would be our next step.

In the meantime, we headed over to the fetal evaluation department at the hospital for an hour-long non-stress test. They wanted to monitor the baby and my uterus for normal activity, heart rate, and contractions just to make sure that the procedure did not cause me to go into labor. Baby NoName performed his characteristic turns, kicks, and flips, and, an hour later, the nurse declared the test a success. We were free to go.

The next four or five hours were the hardest part. Waiting for that phone call was excruciating. Right on cue, though, at 4PM, the office manager called from the OB’s office. The results were in and Baby NoName was ready. “Come to Labor and Delivery tomorrow at 5PM. Eat before you come. In fact, eat something good, because they won’t let you eat once you’re admitted,” she advised.

Wow. This is it.

One final update before the big day

June 4, 2010

We’re down to just a weekend before the big amnio. If all goes as planned, this might be my last post for a little while. I’ll do my best to at least post a couple of pictures once Baby NoName finally makes his big debut, though.

In the meantime, here is an update on my and baby’s health over the course of the last couple of weeks.

As has been the case throughout this pregnancy, Baby NoName and I are healthy. Neither of us has an diabetic complications to speak of, although I continue to struggle with “real people” pregnancy symptoms like swelling, heartburn, and round ligament pain. These have mostly improved now that I am on my “staycation” and resting more.

For the last three weeks, though, I have really struggled with my BGs. I’ve averaged about 100 throughout the entire pregnancy until these last couple of weeks. Now my average is up to 120. I’m seeing an alarming number of post-prandial readings in the 170-180 range and an occasional number in the 200s. Of course, I do my best to bring these numbers right back down, but they are alarming after all of the great numbers I saw up until this point. I have no idea how much of an effect this new development will have on baby’s BG when he is born, but you can be sure I am worrying about it. Hopefully all of the good numbers I’ve managed to accumulate throughout the pregnancy will offset some of these higher ones.

It seems that my basal and bolus rates are increasing every two to three days. And the needs are not consistent. One day this week, I used a 140% temp basal all day, and the next day, my numbers dropped back down into the normal range.

My average daily insulin intake is up to 82 units, up from 35 units pre-pregnancy and up from 75 units a couple of weeks ago.

I’ve gained about 17 pounds over the course of this whole journey. Given that I came into this at a less than ideal weight, I was hoping to keep my weight gain to about 20 pounds or so, so I am pretty happy with this number. Still, I am not exactly thrilled with my new, flabby and water-logged figure. I do my best to avoid seeing my rear end. It has widened considerably. And my arms and legs look increasingly like stuffed sausages. Yikes.

Psychologically, I am a bit of a mixed bag. I am so excited to finally meet this little guy. But I am scared and nervous, too. Can I actually do this? Childbirth? Breastfeeding? Childcare? What if it turns out that I am not “mom material?” I’m sure we’ll figure it all out as we go along, but that doesn’t mean that these thoughts don’t keep running through my head.

Spending the last couple of days at home has not helped. When I was always running to work and appointments, I didn’t really have time to think about what was coming up next. But now that I’ve had a chance to relax and regroup, it’s given me time to think about these types of things.

Tip of the week: Avoid the TLC channel and the shows Baby Story and Bringing Home Baby during the last couple of weeks of your pregnancy. I’ve seen all sorts of births on TV this week: c-sections, at-home births, natural births, medicated births. In one episode, the mom was in so much distress that the doctor asked the camera crew to turn off the cameras so that they could deliver the baby. My mind made up all kinds of scenarios for what happened while the cameras were off.

My life is about to change in ways I can’t even begin to imagine. And this is something that I’ve always dreamed about. The journey has been long and stressful but oh so worth it. But I realize now more than ever that this journey is not even close to over. In fact, you might say that it’s just beginning.

Maternity Leave: The Ins and Outs

June 2, 2010

So I am officially on maternity leave now. Technically, it is a sort of pre-maternity-leave vacation. You see, my company requires that I use any remaining vacation during the first days of my actual FMLA/short term disability leave. That is, all types of leave, including vacation and sick time run concurrently, or at the same time. So you can’t use your vacation and then use your FMLA and then use your short term disability. The clock starts ticking on all of them on the day you begin your leave. In my case, this is the day the baby is born.

The really crappy part about this is that my HR department did no clarify this requirement with me until I was already in my third trimester. Too late to travel to an exotic location for a “baby moon.”

So I am on a “staycation” now. At home. With swollen ankles, sore hips, and heartburn. I’m trying to put the time to good use, though. I am preparing the house for our little one’s arrival. It is slow going, though, because I am tired, swollen, and sore. I spend more time on the couch resting my fat ankles than I do actually preparing. Today our new mattress is being delivered, so I am here to manage that, and then it is off to Target for some last minute baby items. I’m also on the lookout for a seamstress who can sew up the cushion covers for my deal-of-the century, hand-me-down rocker/glider.

You might remember that my struggle with my company over maternity leave was a bit emotional for me. I work for a small company where only one other co-worker has ever been pregnant. So the company has no written policy on maternity leave, and it seems that the policy changes pretty regularly to suit the whims of a few select people in charge. I was really hoping to avoid that kind of battle. I just didn’t need it on top of all of the appointments and tests and emotional ups and downs I was already facing.

In the end, though, probably because I am so darn stubborn, I was able to negotiate what I consider to be a reasonable amount of time, but it is not without risk. And, of course, none of the time is paid except for the 6-8 weeks of short term disability which are paid at 60% of my normal wage.

This is what I was able to cobble together:

  • 4 days of personal leave and 4 vacation days before my leave actually starts. I structured the leave so that the first day of my actual leave will fall roughly on the day the baby is delivered.
  • 6 weeks of short term disability starting on the day the baby is born. I am using 5 days of vacation to cover the elimination period. If I have a c-section, I will get 8 weeks of short term disability leave. The amount of time you get under short term disability is based on the amount of time your doctor says you are unable to work. Typically, your doctor will allow 6 weeks for a vaginal delivery or eight weeks for a c-section. Your leave might be extended if you have complications. If your doctor requires you to be off of work longer than your short term disability coverage lasts, you might then get long term disability. Not all companies offer short term disability leave and the benefits under it differ depending on your plan. Some states require that the company provide a certain amount of short term disability leave, but mine does not. Another important note about short term disability: Many plans have an “elimination period” in which you do not receive benefits. In my case, this is the first week. You can use vacation time to cover this financial shortfall. This is what I decided to do, but only because my company did not give me enough notice to use that vacation for a proper “baby moon.” I would have preferred to have the extra time off and sacrificed the pay during the elimination period.
  • 12 weeks of FMLA (Family Medical Leave Act.) This also starts on the day the baby is born. So basically, I’m losing the first six weeks of FMLA leave because they run concurrently with the short term disability leave and the five days of vacation. Also, you can typically use FMLA time intermittently, as opposed to using it all in one block. Unfortunately, there is a clause in the law that allows companies to force you to take all of your FMLA time in one block if you are taking it for the birth or adoption of a child. A total crock, right?
  • A leave of absence totaling four weeks. This leave is not required by law; it is an extra leave benefit at my company that is approved on a case-by-case basis. Thankfully, this leave does not run concurrently with my other leaves, so it extends my total maternity leave time to four months. Unfortunately, since I will no longer be protected by FMLA, the company is not required by law to hold my job for me during this leave.
  • When I return to work, I will return part time. One surprising perk at my company is that if you maintain 25 hours per week, you can keep your insurance benefits. So I will return to work three days a week starting in October. I will continue on this part-time schedule until the end of the year. I’m losing some vacation and my bonus is going to be pro-rated as a result of the drop in my hours.
  • At the first of the year, I will return to my normal full-time schedule. However, the company is completely within their right to deny me full-time status if they do not have enough work to warrant my return.
  • One other benefit I managed to squeeze into the plan was for my company to cover my tuition for my final MS class which just started last week. This is huge for me, because that class costs over $2,000. The way I understand it, the company does not have to cover the class by law; the only benefit that FMLA requires them to offer me while on leave is health insurance. I argued that, because of the repayment clause in out tuition reimbursement policy, if I decided not to return after my leave, they would get their money back. If I do return after my leave, as is my intention, then they get the same benefit they would have gotten if I was not on leave (a more educated employee.) I think that argument helped.

Anyway, that is the low-down on how my maternity leave panned out. I learned a lot more than I ever wanted to know about the laws surrounding maternity leave, disability, and discrimination during this process. I hope I never need to know these things again, but it is good information to have in my back pocket should the need arise.

Finally, an Update

June 1, 2010

First, let me thank the couple of readers I have who have hung on with me through my most recent hiatus. Things are getting kind of crazy in my little world now and blogging has definitely taken a back seat. Without further adieu, here is an update on what’s going on and how things are going.

I am officially 36 weeks pregnant today. Baby NoName is still passing his non stress tests with flying colors. I was scheduled for one yesterday, Memorial Day, and the Fetal Eval Department was closed, so I had to go to Labor and Delivery for the appointment. It was kind of nice to get a sort of dry run for finding L&D and where to park again. The maternity ward was pretty quiet. I’m hoping for the same environment on the big day.

Luckily, when we arrived at the reception desk, I recognized the L&D nurse from the Fetal Eval Department. She fills in there from time to time. Along with Baby NoName’s regular kicks and heart beats, she also recorded two contractions. She says this is normal at 36 weeks. They are just “practice” contractions. They were so weak that I didn’t even realize that they were contractions. They felt kind of like Baby NoName was stretching inside my uterus and just pushing his little walls to their limits. If I have more than six in an hour, I should call my high risk OB.

We officially have a plan for the birth now. Seeing as both baby and I are healthy, we have planned a tentative induction for 37 weeks. That’s next week! I think that if I had resisted and tried to wait this out until closer to 40 weeks, my doctor would have agreed, but the truth is I am tired and grumpy. The testing and prodding and doctor appointments are really starting to get to me. I’m not sure how much longer I can take this routine. Couple that with an increased risk of fetal death in the last month for type 1 diabetic moms, and I am more than ready to get this show on the road.

So the plan is that we have an amniocentesis scheduled for next Monday. The amnio is used to check the maturity of Baby NoName’s lungs. Apparently, the only real risk with an amnio is contractions. When you get an elective amnio in the earlier stages of pregnancy this is more of a risk because it can lead to miscarriage, but at this late stage, the risk is much less because the baby is much more likely to survive if you go into early labor. Basically, contractions at this stage are OK because we are more or less ready to deliver the baby anyway.

If the amnio shows healthy, fully-mature lungs, then we are ready for the induction. If my cervix is not yet dilated, I will be admitted to Labor and Delivery the same evening for Cervidil. This is a prostaglandin gel that they apply to the cervix to soften and thin it. Then they will start the Pitocin through an IV in the morning. Pitocin is an artificial version of oxytocin, the hormone that my body would make naturally during labor to cause contractions.

If I am already starting to dilate on my own, then we will just wait until the next morning, skip the Cervidil, and start with the Pitocin.

I am a little freaked out about the whole induction process. I’m reading that Cervidil can cause painful but non-progressive contractions. And Pitocin can cause contractions to be more painful, but ultimately not work well enough to progress the labor. I have heard horror stories of inductions that last three agonizing and exhausting days and then result in c-sections anyway. It seems that sometimes induction works and sometimes it doesn’t. I expressed my concerns to my doctor who told me that these scenarios are all possible, but that there is no way to know if induction will work until we try it.

He is strongly in favor of induction over a straight c-section given that Baby NoName and I don’t have any of the standard diabetic complications. It is hard for me to believe, but my eyes, my kidneys, my blood pressure, baby’s heart, baby’s weight, and baby’s spine are all perfect. I guess all of those late-night BG checks and the never-ending appointments are finally paying off.

So I made a deal with him. We will try induction for one day (24 hours if we have to use the Cervidil the night before.) If I am not progressing and am not at least semi-comfortable, we will move forward with the c-section rather than waiting another day or two as is his standard procedure.

In the end, I think it just comes down to me freaking out about the whole labor and delivery thing. No matter what route he takes to get out here, it is not going to be a walk in the park,. So ultimately, it doesn’t really matter which avenue he chooses as long as he is healthy.