Flip your dad the bird if you weigh 5 pounds!!!!

Though a big poop (and we're due) could get her below the line again, she is OFFICIALLY OVER FIVE POUNDS for the first time EVER.  Birth weight was 4# 15.2oz (or .3, depending on your hospital scribe) and, due to our "Fois gras" syringe treatment (though she is NOT being raised for consumption), a sensational set of innate suckling skills, and enviable hutzpa, the girl is packing on the ounces like Kyle Dake taking on the next weight class.

Here's the sweet duo I get to share a bed with.  

On this, her first week birthday, we are celebrating her tininess, reassured by her weight gain that it will be fleeting.  Here are some wonderfully expressive faces and skinny arm movements.  Some of her funniest expressions come during burp sessions.  

She's fun to imitate thought doesn't yet appreciate the interaction.  We do.  

We had our first major outing yesterday!  We walked up to the video store and Walgreen's on 15th (about a mile each way) and felt very adventurous.  Fiona slept the whole way, making little stirrings as we got close to home.  It's a walk she's been on so many times (150?) that I wouldn't be at all surprised if she recognized the feeling of the final staircase descent down Pike to 19th, a block from home.  

We continue to love our generous smattering of visitors.  Duncan, Stephanie, and Desmond came over... maybe it was Wednesday.  This calendar stuff is hard.  

All of a sudden he looks HUGE!

And Megan brought us lunch yesterday and got some good snuggle time in.  

Fiona mostly slept through everything... including 3 hours of obnoxious cable guys testing channels and leaving their cell phones on death metal ringtones.  

OK, a little on the topics of:

-Poop/gas challenges.
Fiona has been rock-solid consistent in her patterns; we wake her every 3 hours to feed during the day and set alarms at night so she doesn't go longer than 4 hours.  As we've documented her gaining weight and felt confident in my milk supply, we allowed that bit of nocturnal leniency for our sanity and it's been working great.  We had our first little hiccup in the routine last night when, at the 9pm feeding she started arching her back away from the breast and crying more than she had before (which has been very little).  She would be consolable when snuggled, knees to chest, against our skin, and calmed when we took her on a walk around the full-moonlit neighborhood.  We figured it was poop/gas-related and we were able to syringe her enough of a feed to get her to bed.  With some magic toots and squirts, she's back to her happy self.

-She will grow up.
I had the revelation that I was of two minds about wanting to fatten her up.  Don't worry; this is not a story of Munchausen's by proxy.  But she's SO DAMNED CUTE in the preemie clothes Katy dropped off yesterday with a bag of frutis and veggies (which made a yummy dinner).  I was feeling the natural fear/reticence of the unknown future that I often feel twinges of before a new school year, a new job, whatever.  Then I thought of how cool all the upcoming stages will be and thought, "we will revel in her 3-month self and her 2-year-old self" and relaxed back into enjoying her current fleeting featherweightitude.

-Being unpregnant rocks.
After 4 installments starting during last Friday's contractions (remember those?!) we finally finished watching Milk last night (So good, and it gives me a throw-back to my med school trip to Lesotho when I first watched it with the public health interns; apparently the same day we "borrowed" a donkey).  And I realized, while reclining on the couch, that my back didn't hurt.  Crazy!  And I can eat a whole sandwich without discomfort.  And I stopped taking my twice daily ranitidine and can STILL drink a cup of coffee and put hot sauce in my tomato soup.  And my deep breaths are SO DEEP.  And, C-section belly feels like nothing compared to the shoe-tying impediment of the last month.  Speaking of which, I feel dandy.  And when else do you get to lose 25 pounds in a week while eating grilled cheese, fig newtons, and strawberry shortcake (thanks, Schlough)?!  I keep taking my tylenol and ibuprofen and we took that walk pretty darn slowly yesterday, but I am so grateful to kind and capable surgeons who brought this little girl out safely a week from tonight.

OK, we're gonna sling up this baby and go get a few sunshine rays before our next feeding.

xo, Liz

Settling into a home routine

Lifetimes have passed since Friday night.  Epochs.  I don't even know where to start.  So I'll start with this glass of cheap red wine at my side: Elliott and Fiona and I went for our first walk since last Thursday.  We did so much walking during the pregnancy.  My body feels pretty darn good after the C-section and, as long as I keep taking my tylenol and ibuprofen every 8 hours or so, daily life poses little challenge as long as someone pulls me out of the couch and I don't forget I had surgery and try to limbo under dangling cherry tree branches (oops!).  

Before I have too many thoughts about recent events, here are some photos.

Goodbye snuggles with Uncle Jorge:

and Uncle Tuggy

Using Grammy-knit, arm-dwarfing socks to keep her from scratching her face during feeding.

Because she was born under 2,500 grams (this has started seeming strangely normal to me now) she underwent a "carseat test".  This entailed going on a practice make-believe car trip for 90 minutes in a carseat in the nursery while wearing an oxygen probe on her toe.  Carseats are rated for 5 pounds and up and we needed to make sure she didn't flop forward and close off her airway.  She has to sit on a towel, use two head inserts (pictured), and be flanked by rolled up blankets, but dog-gonnit, she kept her oxygen up.  Here she is ready to take a REAL car trip for 0.7 miles from the First Hill Family Medicine Clinic parking lot home to Union St.  Super cute.  

The syringing continues at home!  My milk came in Monday (day 3) like Ithaca Falls after a spring storm and we have more milk than we know what to do with --glad we got that mini milk fridge for her room-- so we're now breast feeding with a nipple shield (soft plastic sombrero that sits over my nipple, pokes her palate when she latches, and helps trigger her suck reflex and hone her aim; we'll wean this off as she gets stronger and more coordinated) for 15 minutes a side and then syringing 20cc of pumped milk.  She's eating like a champ and making her way back to her birth weight.  One sweet part of this routine is that Elliott and my mom can help feed her.  I need to pump every time for my own comfort so we have plenty of milk for Elliott to feed her in the middle of the night while I pump instead of waiting for me to produce the milk for THAT feeding.  This means shorter feeding routines during the night and smoother transitions back to sleep for all three of us.  

She's the one-eyed Fiona.  

We have a GoPro mount above the changing table for some daily snippet collection.  

These little terry cloth diapers fit her better than all the other cloth diapers we stock-piled in anticipation of her arrival.  

Just chillin' with Pop in the rocking chair.  They're an amazing pair.  I love this man so much.  As you might imagine, he's incredibly patient, naturally gifted at soaking up and fully engaging in the present, and infinitely understanding of what either of us might be feeling (ranging from superhuman elation to desperate fatigue to the intense need to eat NOW - as well as what Fiona is feeling :)).

Look at those eyes.  Jeez.  

It's so special that Fiona can snuggle with Grammy every day and hear her voice singing to her.

Here's a little video (not from the fancy camera; we still haven't managed to go through all our video from the hospital but I will!  'cause it'll be awesome.) of early baby life.  

The smallest gDiaper we have.  I had to walk away when Elliott put this on her because laughing hurt too much.  

Love to you all.  Thanks for your support, love, and for just keeping in touch.  We soak it up!

But for now there's a little girl rooting on a blanket on my lap so I gotsta go feed her. 

xoxo, liz, elliott, and fiona

Welcome, Fiona!

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

Early visitors (one baby weighs 5 times the other baby)

Skin-to-skin with Pop

 Nose suckling

Swaddle master

 Posing

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

Next Adventure: This is a big one!

 Now HOW did we get here?

There was that awesome Huron City wedding just last August...

a honeymoon backpacking trip to Goat Rocks 10 days later,

with some stunning views and scrumptious meals.

And then there was that camp-site in Jordan Basin...

and two weeks and a LOT of urination later the thrilling morning revelation:

Nancy and Matt's beautiful wedding on Bainbridge where we spilled the beans to friends (after being caught drinking lemonade at the rehearsal dinner!),

a chromosomal screening scare, a tearfully relieving ultrasound and amniocentesis to tell us she's a she, has the standard collection of DNA, and a beautiful nasal bridge and long-bones,

some underwater music time,

Countless daily challenges and thrills (puking, crying, midnight snacking, napping, goofing off), flurries of nesting and voila: it's May and almost baby time!

Only time and our sleep "patterns" will tell how much we'll keep this blog up.  But we are so amazingly grateful to feel supported by our huge network of loving friends and family and want to keep everyone in our daily lives by whatever means we can.  So we'll do our darnedest!  

This little girl is due two weeks from today (May 19th) and, until then (or maybe a little later) we'll be digging into remaining work time, frolicking in the ridiculous Seattle sunshine, helping her lay down more fat via caring maternal consumption of avocado, Tillamook cheddar, and frozen yogurt, and getting in as many date nights as possible.  

Love you guys lots!

xo, Liz and Elliott

Joanne! :

Here's Elliott's old Eeyore swaddled in your beautiful blanket sitting in Eva's old seat.
Thank you, friends!