Thursday, February 20, 2014

Captain's Log: Day 20

It's hard to believe Flynn has been with us for almost 3 weeks already.  Time both flies and creeps at a glacial pace.  Thankfully at this point my head has cleared enough to process how crazy the past few weeks have been.

There are several things I have often heard regarding adjusting to life post delivery.  One is that if you have a c-section make sure you get up and start walking around as soon as possible to help speed up recovery.  Immediately post-op and through the next day I was bed ridden to ride out my 24-hour magnesium treatment then spent a day in ICU but by day 3 I was up and about as much as possible, making sure to slowly stand upright and walk the halls for exercise as often as I could manage.  I don't know if I was just incredibly lucky or if walking really does help that much but I must say I feel like my section recovery was relatively quick and easy.  By the end of the first week I still had some discomfort but was otherwise moving around fairly normally and feeling pretty good.  I consider myself blessed to have had a manageable recovery physically since the emotional recovery rocked my boat hardcore.

I've heard many a mother mention how crazy their hormones were in the weeks immediately following delivery but none of them could adequately paint a picture of the nightmare that was to come.  I call it a nightmare, which might be a bit drastic, but it didn't feel like an overstatement at the time.  Almost immediately I felt plagued with an overwhelming sense of fear, uncertainty, anxiety and dread.  There was a tiny person that was relying on us to fulfill its every need and I felt completely unprepared for the task, no matter how much babysitting experience I'd had in the past.  Clif was beyond amazing with his help and support and had a level of confidence that I craved desperately.  Even though he was keeping it together, and trying to help me do the same, I spent almost every day for a solid 2 weeks internally begging for my mother to come help me get through the hormonal upheaval.  Clif was doing absolutely everything right but sometimes there just isn't a substitute for Mom.  I couldn't explain how I felt other than wrong, desperate to feel normal again.  In addition I had exactly zero appetite and was forcing myself to eat a handful of bites of food for 3 meals a day to try to make sure I was going to be able to provide Flynn with some kind of nutrition from nursing.

In the mornings I woke up feeling ok, prepared to tackle a diaper change and feeding with Flynn.  Then I would watch the clock, calculating when I should wake him up again and how the timing of the next feeding would impact the timing of the rest of the day.  I was constantly counting hours, trying to balance between 2-3 hour nursing sessions but still give him enough time to sleep, especially if it took some time to get him back to sleep after the feeding before.  Getting him back up to birth weight became an obsession when his pediatrician expressed concern that he was nearing the 2-week mark and still had several ounces to gain to get back to birth weight after not gaining anything over the previous 3 days.  Life was all about checking diapers, nursing, pumping, supplementing Flynn with additional formula if he was still hungry and I hadn't pumped enough to cover the extra need and spurts of sleep.  Several days it felt like I'd never do anything else but repeat this schedule again and again, much less ever see the world outside the walls of our house.  I felt trapped, desperate, like a failure and fought waves of panic. 

After the first week some days started to feel a little bit better and I had a mix of hormonal suffocation and moments of feeling sane and competent.  Sometimes I could smile, feel comfortable and at ease with each moment of our day, other times I would burst into hysterical sobs for no reason at all.  Mornings started out with optimism then later in the afternoon the dread crept back up, only to be washed away again during our pre-bedtime nursing.  Now, at almost 3 weeks, after having a handful of successful extended trips away from the house, most days are positive and the hormones seem to have settled out significantly.

All things considered, Clif and I are pretty stinking lucky.  Flynn (knock on wood) so far sleeps really well and we usually have to be the ones to wake him up to eat.  Now that he has gained back and exceeded his birth weight we have changed to letting him wake us up at night instead of setting alarms, but still wake him to try to keep to a schedule during the day.  This makes for still feeling somewhat chained to the house (nursing on the go is challenging due to the need for extra equipment) but we don't feel as much pressure as we did before.  In addition, since Clif works from home and I get 3 months of maternity leave, we have lots of time together to adjust to having little Flynn.  So many parents don't get that kind of time together and I can't express how thankful I am that we do.  Clif changes most of the diapers and I do all the nursing but our greatest achievement has been our nighttime routine where I prep a bottle and pump a supply for the next night while Clif changes, feeds and puts Flynn back to sleep.  This means we are both up together, supporting each other, and we reduce our time up at night by half.  Getting us both back in bed faster helps with getting as much sleep as possible and means less opportunity for resentment if one of us is dragging our tails in the wee hours while the other is blissful in dreamland.  Our mantra has been 'team work makes the dream work' and it is working wonders for us.

We've come a long way already but know that every day will be a chance for something new and exciting, an opportunity for us to grow and will have the possibility for everything we've established so far to change.  Together we can adjust, adapt and make every new situation work, that is the fact that I will hold on to to help combat my worries and doubts.

Sunday, February 9, 2014

Delivery Day: The Rest of the Story

Mom spent the first night with me to let Clif go home to take care of the pets and get one more night of good sleep.  To help get my blood pressure back under control they put me on a magnesium drip which meant I was restricted to the bed until they discontinued the drip.  I don't have enough words for how thankful I was to have mom's support that first night.

The next morning we finished magnesium early and I was transferred from the labor and delivery wing to my room in postpartum.  The room looked the same but the feel of the wing was just different.  I can't put my finger on it, exactly, but I didn't feel as comfortable there.  I'm sure a lot of it had to do with the fact that I suddenly had a tiny new human to take care of in there with me and while there would be nurses on hand if I needed, nothing could replace having mom or Clif in there with me.

My nurse came in around midnight to take Flynn away for his car seat challenge since he was so small and I tried to settle in for some uninterrupted sleep.  Earlier in the evening I'd noticed that my lip had swollen which has become a fairly standard allergic reaction for me and is mostly just a mild inconvenience.  Not long after I'd laid down to get some sleep I started to notice a second of my strange swelling responses seemed to be kicking in.  My uvula feels swollen and, while luckily doesn't compromise my airway, the potential is there.  In the meantime it makes me gag when I try to talk and makes swallowing anything a great challenge.  As I noticed increasing difficulty in managing the swelling in my throat I noticed my hands starting to swell, particularly in the areas where I'd been all but manhandling myself in various efforts to encourage Flynn to nurse.  The lip I could have dealt with but now I was trying to deal with all three of my strange swelling reactions, two of which were developing into the worst case I'd yet experienced of each.

I broke down and called my nurse who was just on her way back with Flynn from his challenge.  When she got to my room I tried to explain what was going on as best as I could and told her that while I usually can handle the situation, I was starting to have some trouble.  She called the OB on duty to check in on me, unfortunately all he could suggest was a dose of Lasix to draw off water and Benadryl for the allergy.  I knew neither of those solutions would work but I was too tired and feeling too poorly to say so.  The Benadryl hit and I fell deeply asleep sitting up in bed with my hands cradled in my lap.

The next morning my throat was only marginally better but my hands had tripled in size, swelling in all of my fingers, through the palm of my hand and part way up my wrist.  This, as can be imagined, was very concerning to my nurses.  They started to try calling Clif to have him come in as soon as he could while working on transferring me back to the labor and delivery wing.  I was still sufficiently groggy from the Benadryl and made scant little unnecessary movement while I was shifted to a new bed and re-fitted with a catheter while concerned nurses buzzed around trying to figure out what to do with me.  By now the next OB was on the clock and she came to inform me she had made the decision to send me to ICU where they were equipped to handle me if something got worse and my airway closed.  I tried to assure her that, while ultimately I would do what she wanted, my throat was starting to feel better and just needed more time.  She was adamant and I couldn't blame her for being concerned.

I was wheeled in my bed upstairs to ICU and transferred into my personal bay to be hooked up to leads, BP cuff, IV of more magnesium and finger monitor.  A few doctors and nurses came through to get my story and try to determine what was going on with me.  Zyrtec, Pepcid and a steroid were ordered to try to get my swelling under control, otherwise I was left to sleep off the remainder of my Benadryl hangover.  There was a lot of sleeping.  Later in the evening they finally brought a breast pump to me with instructions to pump and dump as they weren't sure if the medications I was on would be harmful to Flynn or not.  My hands, however, were still so swollen I couldn't manage by myself and had to rely on my nurses to pump for me.  The good news was by that point my Give-A-Darn meter was truly broken and I couldn't care less about feeling slightly akin to a dairy cow.

I spent a full day and night in ICU before my swelling reduced enough to be transferred back to postpartum.  We had been due to be discharged that day (Tuesday) but were thinking they'd want to keep us one more day due to the unexpected set back.  On towards late afternoon/early evening I was feeling fairly well except for a growing anxiety about spending another night alone in the hospital.  Clif and I started pushing to be discharged.  Luckily Dr. Kula determined that while she was still concerned about my blood pressure, she knew me well enough to know I'd do much better if I wasn't in a stressful situation and agreed to discharge us if I continued to monitor my pressure at home.  By dinner time we were on our way home at last, an event full of mixed emotion for me, predominantly thankful to be on our way back to some semblance of normality.  Well, as normal as life with a new baby could be.

Saturday, February 8, 2014

Delivery Day

Friday evening, January 31st Clif and I were joined by our dear friend, Shiva at Sweet Water restaurant for what we half-jokingly referred to as our Last Meal.  I had crab cakes, fries, roasted brussels sprouts and mixed greens salad with goat cheese.  Afterwards Clif drove me to the Birthing Inn check in for the night.  After two failed attempts on each wrist an IV line was placed below my left elbow in preparation for the next day and Cervidil was given to prepare my body for induction in the morning.  I opted for some Ambien to try to help me sleep, given I had pressure leg cuffs, a contraction and baby monitor strapped to my stomach, an IV line in one arm and blood pressure cuff on the other to try to deal with.  I managed to get some sleep, unfortunately the discomfort of all of the necessary accessories overrode the medication.  In addition trips to the bathroom while trying not to disturb the Cervidil were rather complicated and uncomfortable.

Clif had spent the night at home and came back early in the morning to bring me something for breakfast before they started Pitocin and I would need to switch to a clear liquid diet.  My sister, Laura, and sister-in-law, Judi, arrived soon after and we began the Pitocin drip around 9:00 am.  We did pretty well at first, I even managed to find a comfortable position sitting on a birthing ball, resting over the side of the bed.  The biggest problem we had was it became almost impossible to keep a good monitor trace on Flynn in that position.  We tried to walk a fine line between finding a productive, comfortable position for me and not losing track of how Flynn was doing which meant a lot of holding his monitor and constantly shifting it to try to get his readings.

The Pitocin dose was increased every half hour to try to get labor established.  Contractions were coming so close together they were pretty much on top of each other and there didn't seem to be very much relief in the pain.  By 1:00 pm I was back in bed and only 3 cm dilated.  I was already feeling like I wouldn't be able to get through the entire labor without an epidural or wanting to give up.  Laura, Judi and Clif kept coaching and comforting me, telling me I was doing great and that I could do it.  I thought if I could just manage one contraction at a time, one minute at a time, I would get as far as I could.  I was reluctant to get an epidural because I was afraid of stopping the little bit of progress I'd already made.  I settled into a zone where I stayed as still as I could on my left side, eyes closed, breathing slow and deep, chanting to myself that I could make it through each wave of pain.  At one point my coaches wondered if I'd fallen asleep but I was too far gone to respond.

Meanwhile we had my blood pressure to contend with.  It was already high going into the induction but trying to manage the pain made it worse.  I was given increasing doses of blood pressure medication through my IV to try to maintain some control over it but it seemed to be a losing battle.  Soon Dr. Kula and our nurses started discussing an epidural in earnest to try to help me continue labor and avoid a c-section if my blood pressure got out of control.  I was on the fence, still not ready to give in, hoping to make it at least to 5 cm before agreeing to one.

Around 3:00 pm I was 4 cm dilated, feeling really unsure of my ability to make it to the end and ready for any relief from the constant pain.  My coaches had done an amazing job encouraging me and getting me this far but I could appreciate the concern of the medical staff.  Since I really wanted to avoid the c-section I decided to give in to the epidural.  As soon as I opened my mouth to tell my nurse I was ready, however, my water spontaneously broke.  Later Laura and Judi would say they wished they'd had a camera to catch the expression on my face.  I was a bit out of it but I could tell my eyes widened to the size of dinner plates.  Instead of asking for the epidural I announced I thought my water broke.  I got help to get up one more time to go to the bathroom while everyone else shifted gears with the new development.

If I thought I'd been in pain before I was about to get a rude wake up call.  Sensations intensified drastically and from the bathroom I yelled through the door that I was ready for the epidural as soon as humanly possible.  It was gut wrenching to hear that they needed to check my platelet count before they could place it, to me it sounded like it would be an eternity before I could get some relief.  I all but threw my arm in the nurse's face in desperation.  Laura and Judi tried to talk me through the contractions as best as they could while Clif helped facilitate getting ready for the epidural, but everything was a blur.

I hadn't even noticed when Dr. Kula came in the room but she wanted to check our progress, I was relieved to hear we were at 7 cm dilated.  By the time the platelet count came back and the anesthetist was ready to go I could barely get around the end of the bed to the other side between peaks of contractions.  Judi and Laura had to leave the room leaving Clif to sit in front of me while the epidural was placed.  The anesthetist asked if I had any questions, my only one was how long it would take to kick in.  By this time my composure was next to non-existent and I made little effort to try to hide or control my discomfort.  I flipped between high pitched keening and low, gutteral groaning, punctuated by a string of "ow, ow, ow"s while trying to sit perfectly still, waiting desperately for relief.   It felt like an eternity but I started to relax in a matter of moments.  Clif and my nurse had to help me lie back in bed and each moment I relaxed even more.  The more I relaxed the less I cared about what she wanted to do to make sure Flynn was doing alright.  We were still having a hard time getting a good read on Flynn's heart rate so Dr. Kula wanted to use an internal monitor that was more accurate to see how he was doing.  I could tell fairly quickly that something wasn't quite right with what I heard, my worry confirmed a second later when Dr. Kula told me Flynn's heart rate had dropped to 60 bpm and that he needed to be delivered immediately via c-section.  I managed a nod and an "ok", his well-being was by far the most important thing.

In a matter of seconds my room was full of medical staff and before I knew it I was being rolled in bed out of the room, Clif left behind in the chaotic aftermath.  As we were wheeling into the surgical suite I still hadn't quite processed what was going on.  It wasn't until I was on the surgical table, watching how quickly everyone worked to get me ready for section through the reflection of the surgical lights that it dawned on me that this was a legitimate emergency situation.  They barely had time to swab my stomach before Dr. Kula was cutting and working handily to get Flynn out.  I didn't feel any pain but the yanking and tugging was intense.  Before I could blink the tugging stopped and Flynn was whisked to a table at the side of the room.  I turned to look but couldn't see past the doctor and two nurses standing over him, blocking my view.  I couldn't hear anything and remember thinking that something felt really wrong, feeling especially worried when one of the nurses looked up across the table at the nurse across from her with what I perceived to be a concerned expression.  I paid no attention to the people working to close me up, which was easy since everyone seemed so quiet.  I only cared about watching that table, tears streaming down my face, wondering why someone couldn't tell me what was going on.  I kept up a desperate mantra of, "Dear Lord, please let him be alright".

Finally I heard a tiny sound, then a slightly larger one then a few cries that sounded like they had actual substance behind them.  One of the nurses working on Flynn looked over at me, flashed a quick thumbs up and I think I took my first breath in several minutes.  Nothing else going on in that room mattered after seeing that sign of reassurance that he was going to be ok.  A nurse eventually brought him over to me, wrapped tightly in a blanket, and let me hold him with one arm against me chest for a minute so I could see him.  I held him as long as I could at that angle before I had to give him back, worried my arm was going to fatigue.  I had to wait several more minutes on the operating table for an x-ray technician to arrive to check me.  We'd rushed into surgery so fast there hadn't been a chance to count the surgical pack before beginning so the x-rays were to make sure nothing was left behind inside.  Eventually I was wheeled out of the suite to join Clif in his surgical attire who had been bonding with Flynn and we had our first moments together as a family.

I later learned:
-When I was taken out of the delivery room for section Clif was left behind in the room, alone, not knowing exactly what was going on.  An off duty nurse who recognized him happened past and asked if he was ok, which he wasn't.  She helped get an update on my situation and him get into the surgical suite to see me.
-When Flynn was delivered his Apgar score was 2 at one minute: he had color and a heart beat.  They had to give almost 2 minutes of rescue breathing initially and at minute 5 his score was up to 8.
-When Dr. Kula checked me the last time as she was checking on Flynn I had dilated to 8-9 cm and we were almost ready to push.
-The thought is that Flynn's heart rate dropped so low because he may have grabbed a hold of his cord.

Flynn was delivered at 5:19 pm on Saturday, February 1st, 2014, weighing 5.13 lbs at delivery and measuring 19 inches long.