We are prepared to meet whatever turn our birthing takes.
We are prepared to meet whatever turn our birthing takes.
I'm glad we practiced our hypno-birthing mantras (thanks, Kerry!) because they've come in handy these last couple days. We were settling into the new routine of WAITING and coming up with nesty tasks to do. My mom flew in Tuesday morning and had helped us plant a container vegetable garden and we'd gone out to eat and walk and see friends. Kerry, my wonderful old Ithaca friend and pregnancy buddy this year had given birth to a thriving little girl on May 3rd and I was totally jealous and ready ANY TIME to start labor.
Welcome, Emma Elizabeth Mizrahi, pictured here with Kerry and Big Sister, Saia.
We have celebrated the growth of the belly.
Cukes, tomatoes, peppers, chard, carrots, basil, and melons are germinating.
Oh, and the sage is replanted.
So, let's labor already! Knowing most first pregnancies go days or a week past their due date and that ours was still 2 days away, we were trying to prepare to stay pregnant for another 10 days or so. But then we went in Friday morning for a scheduled AFI and NST, tests for amniotic fluid and evaluation of the fetal heart rate done after babies hit their due date and designed to make sure the placenta (a uniquely temporary organ) is still doing it's job. Feeling pretty jovial, I plopped down for the ultrasound table and... didn't see any fluid. Baby Agnes, however, was squirming and practicing her breathing, and generally looking like her awesome ultrasound self. Our wonderful friend, Sonal (reference previous posts about our Ethiopia trip), who works in our doctor's practice, came in to tell us that our AFI was officially "1" and that we should go pack our bags and meet our doctor at the hospital for admission and labor induction for oligohydramnios (too little fluid).
Jeepers, what a plan change! I felt a mix of relief that pregnancy was over and alarm that we happened upon this potentially worrisome state of uterine affairs. We dropped Mommy at her apartment, drove home, hugged roommates and KP, who had stopped by by chance to say "hi" since work had brought her to a nearby cinema that morning, threw some extra undies in our pre-packed hospital bag knowing this stay could be a few days long, and ran an errand.
When we got to OB triage at Swedish we met Mommy (who had just the day before taken a grandparent class and gotten a Swedish birthing tour -- how convenient!) in the waiting room talking with our doctor, Ellen Lackermann, who had been briefed by Sonal. From triage we repeated the ultrasound and confirmed the fluid was super low (AFI of zero by this new account) and discussed the plan.
Agnes' heart rate was doing just fine (for those of you who like the lingo: 130s, moderate variability, good accels, no decels) and we decided to try to induce with a Cook catheter which puts mechanical pressure on the cervix and can start labor along without the only-very-slowly-reversible prostaglandin effect of topical misoprostol. Since my cervix was hiding too far back to feel, I lay flat on my back to allow a speculum exam for Dr. Lackermann to see the cervix and assess whether we could insert the catheter. UnFORTunately, just the act of getting on my back caused her heart rate to drop to 80 (way too low...) for 4 minutes. Our nurse immediately pushed her "Oh $h!t" button on the wall, bringing in three nurses and a doctor with IV fluids, oxygen mask, and talk on an emergent C-section". During that time I flipped back and forth to both sides, contemplated a crash section, and tried to channel my inner state of preparation for whatever turn my birthing was currently taking. Her heart rate bumped right back up and showed good signs of oxygenation but Elliott and I were both brimming with tears when the emergency party filed out.
I'll fast-forward: Because her heart rate looked so good after that hiccup, we decided, in conversation with our doctor and the consulting obstetrician, Dr. Eggers, that we could still proceed with the Cook catheter attempt and try to get me into labor. We wanted a fair shake at a vaginal delivery and this still seemed like a safe option for Agnes. He got the catheter placed (inserting a balloon with 55cc of saline JUST within the uterus and taping the catheter to my leg so that it pulled down and encouraged my cervix to stretch open and thin). With a hand massage from Elliott and a visualized Huron City sunrise that process went just fine. By the time we moved from triage to a labor room, I had started having contractions every 3-7 minutes that became increasingly distractingly painful, Agnes' heart rate seemed to totally tolerate the little contractions, and we all felt encouraged.
I got 3 liters of (hypotonic) IV fluid and chugged a solid gallon of water in an attempt to get some fluid into my poor little uterus. Needless to say I had to pee every 20 minutes. One of these times I came back to bed and her heart rate dropped to 80 again necessitating some time on my hands and knees, some more oxygen, and a "that's your second strike" conversation with the obstetrician. That happened again when I hadn't even changed position from lying on my left side and we started to think more seriously about how unlikely it was that she would tolerate real labor.
Elliott and I had nice, calm conversations with Drs. Eggers and Lackermann about our apparently increasingly slim chances of getting Agnes through labor and vaginal delivery without constant worry of dropping her heart rate. A dropping heart rate means temporarily poor oxygenation. Prolonged poor oxygenation means increasingly acidic blood which, depending on its duration and frequency, starts correlating with risk of cerebral palsy. These little dips with good recovery were not, on their own, worrisome but I started picturing the 7-minute deceleration and the ensuing emergency Cesarian that was feeling like our likely future if contractions picked up. When Dr. Eggers left me and Elliott to talk alone, we were agreeing that the only reason to continue laboring would be to satisfy our own (natural and even noble) desire for a hard-earned and beautiful vaginal delivery. There seemed no likely benefit and quite a bit of likely risk to Agnes from that pursuit. As a family doctor with a mostly midwife's heart I wanted to be absolutely sure we weren't jumping prematurely to a medical intervention but felt very clear that her safety trumped my ego in this case. We cried a bit at the incredible imminence of our daughter's arrival, the intense gravity of this child-centric decision, and the loss of our hoped-for labor then, with light hearts, called our families and told our team we were ready for surgery.
The C-section was actually kind of awesome. Elliott got to wear a Tyvek (TM) suit, we loved the 3 doctors who scrubbed in (Lackermann, Eggers, and Amy Drumm, one of our family med OB fellows who primaried the surgery), and everything went great. I got a spinal block (weird, warm sensation from the ribs down that left me feeling just the tugging pressures of strong hands) and house-wrapped Elliott stood at my head, held my hand, and kept me posted on the goings-on behind the curtain. He said reassuring things like, "There's a bunch of blood and some yellow squiggly stuff; I guess that's fat" and, "There's a large garden tool in you now" and, quite soon after, "There's her head!". I felt some strong tugging at my belly and then heard a cry that sent us into sobs of love and relief, and then saw a tiny pink/purple body with skinny, perfectly wriggling limbs carried to the warming table within my view, finally. Elliott went over to be with her and take some video (stay tuned for upload!) and I just lay there crying with happiness and listening to her beautiful pipes.
After she got a little goup suctioned from her airway they weighed her in at 4 pounds, 15.3 ounces (what?!), swaddled her up, and gave her to Elliott to bring to me to kiss and stare at. I puked a couple times as they sewed me up but pretty quickly we were wheeling me back to the delivery room to dote and nurse.
Photo bonanza interlude:
Nurse Agnes and Agnes-cum-Fiona
Skin-to-skin with Pop
Nose suckling
Swaddle master
Posing
Much more later! We're going home in the next couple hours.
Love to all!
xoxo, Liz, Elliott, and Fiona
Jeepers, what a plan change! I felt a mix of relief that pregnancy was over and alarm that we happened upon this potentially worrisome state of uterine affairs. We dropped Mommy at her apartment, drove home, hugged roommates and KP, who had stopped by by chance to say "hi" since work had brought her to a nearby cinema that morning, threw some extra undies in our pre-packed hospital bag knowing this stay could be a few days long, and ran an errand.
When we got to OB triage at Swedish we met Mommy (who had just the day before taken a grandparent class and gotten a Swedish birthing tour -- how convenient!) in the waiting room talking with our doctor, Ellen Lackermann, who had been briefed by Sonal. From triage we repeated the ultrasound and confirmed the fluid was super low (AFI of zero by this new account) and discussed the plan.
Agnes' heart rate was doing just fine (for those of you who like the lingo: 130s, moderate variability, good accels, no decels) and we decided to try to induce with a Cook catheter which puts mechanical pressure on the cervix and can start labor along without the only-very-slowly-reversible prostaglandin effect of topical misoprostol. Since my cervix was hiding too far back to feel, I lay flat on my back to allow a speculum exam for Dr. Lackermann to see the cervix and assess whether we could insert the catheter. UnFORTunately, just the act of getting on my back caused her heart rate to drop to 80 (way too low...) for 4 minutes. Our nurse immediately pushed her "Oh $h!t" button on the wall, bringing in three nurses and a doctor with IV fluids, oxygen mask, and talk on an emergent C-section". During that time I flipped back and forth to both sides, contemplated a crash section, and tried to channel my inner state of preparation for whatever turn my birthing was currently taking. Her heart rate bumped right back up and showed good signs of oxygenation but Elliott and I were both brimming with tears when the emergency party filed out.
I'll fast-forward: Because her heart rate looked so good after that hiccup, we decided, in conversation with our doctor and the consulting obstetrician, Dr. Eggers, that we could still proceed with the Cook catheter attempt and try to get me into labor. We wanted a fair shake at a vaginal delivery and this still seemed like a safe option for Agnes. He got the catheter placed (inserting a balloon with 55cc of saline JUST within the uterus and taping the catheter to my leg so that it pulled down and encouraged my cervix to stretch open and thin). With a hand massage from Elliott and a visualized Huron City sunrise that process went just fine. By the time we moved from triage to a labor room, I had started having contractions every 3-7 minutes that became increasingly distractingly painful, Agnes' heart rate seemed to totally tolerate the little contractions, and we all felt encouraged.
I got 3 liters of (hypotonic) IV fluid and chugged a solid gallon of water in an attempt to get some fluid into my poor little uterus. Needless to say I had to pee every 20 minutes. One of these times I came back to bed and her heart rate dropped to 80 again necessitating some time on my hands and knees, some more oxygen, and a "that's your second strike" conversation with the obstetrician. That happened again when I hadn't even changed position from lying on my left side and we started to think more seriously about how unlikely it was that she would tolerate real labor.
Elliott and I had nice, calm conversations with Drs. Eggers and Lackermann about our apparently increasingly slim chances of getting Agnes through labor and vaginal delivery without constant worry of dropping her heart rate. A dropping heart rate means temporarily poor oxygenation. Prolonged poor oxygenation means increasingly acidic blood which, depending on its duration and frequency, starts correlating with risk of cerebral palsy. These little dips with good recovery were not, on their own, worrisome but I started picturing the 7-minute deceleration and the ensuing emergency Cesarian that was feeling like our likely future if contractions picked up. When Dr. Eggers left me and Elliott to talk alone, we were agreeing that the only reason to continue laboring would be to satisfy our own (natural and even noble) desire for a hard-earned and beautiful vaginal delivery. There seemed no likely benefit and quite a bit of likely risk to Agnes from that pursuit. As a family doctor with a mostly midwife's heart I wanted to be absolutely sure we weren't jumping prematurely to a medical intervention but felt very clear that her safety trumped my ego in this case. We cried a bit at the incredible imminence of our daughter's arrival, the intense gravity of this child-centric decision, and the loss of our hoped-for labor then, with light hearts, called our families and told our team we were ready for surgery.
The C-section was actually kind of awesome. Elliott got to wear a Tyvek (TM) suit, we loved the 3 doctors who scrubbed in (Lackermann, Eggers, and Amy Drumm, one of our family med OB fellows who primaried the surgery), and everything went great. I got a spinal block (weird, warm sensation from the ribs down that left me feeling just the tugging pressures of strong hands) and house-wrapped Elliott stood at my head, held my hand, and kept me posted on the goings-on behind the curtain. He said reassuring things like, "There's a bunch of blood and some yellow squiggly stuff; I guess that's fat" and, "There's a large garden tool in you now" and, quite soon after, "There's her head!". I felt some strong tugging at my belly and then heard a cry that sent us into sobs of love and relief, and then saw a tiny pink/purple body with skinny, perfectly wriggling limbs carried to the warming table within my view, finally. Elliott went over to be with her and take some video (stay tuned for upload!) and I just lay there crying with happiness and listening to her beautiful pipes.
After she got a little goup suctioned from her airway they weighed her in at 4 pounds, 15.3 ounces (what?!), swaddled her up, and gave her to Elliott to bring to me to kiss and stare at. I puked a couple times as they sewed me up but pretty quickly we were wheeling me back to the delivery room to dote and nurse.
Photo bonanza interlude:
Nurse Agnes and Agnes-cum-Fiona
Early visitors (one baby weighs 5 times the other baby)
Skin-to-skin with Pop
Swaddle master
Since she's tiny, we're pumping colostrum after each feed and giving it to her through a tiny syringe.
Yum!
Much more later! We're going home in the next couple hours.
Love to all!
xoxo, Liz, Elliott, and Fiona
2 comments:
That is my niece! What a story, Liz. I am so happy for all of you. That it went well, that you were able to calmly think about it all in the midst of everything, and that Fiona is HERE! I SO wish I could run out and hold her for a while, but I will make do for now with photos and videos, and concentrate whenever I have a minute on sending love to all three of you.
Sitting here holding my baby, reading about you holding YOUR baby, and totally crying.
Must stop crying before we head to Dr. Loehr for the two week checkup.
I LOVE YOU!!!!!!
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