Tuesday, April 26, 2011

3233 Baby details

Tuesday, April 26, 2011

Definition: Perfluxity - the feeling that you are drowning in a sea of information.

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Daughter had wanted as natural and intervention-free a birth as possible. She had started out planning a home-birth, and had engaged a midwife. She read everything she could. She was certain she could go natural. I supported her in that, because I believed she could. She went beyond me, however, in that she had zero trust in doctors. She was scared near to death that if she went "conventional", she'd end up another of the victims of the scandalous American love affair with C-sections.

She's also a bit of a control freak, especially where her body is concerned.

However, impediments piled up. Her first choice in midwife turned out to be an undependable flake. The next was not much better. The insurance company threw up barriers. And so on. The final blow came when she was diagnosed with gestational diabetes. That plus her age (35 and first pregnancy) made her pregnancy high-risk.
Quick lesson: Gestational diabetes begins at or after the 24th week when the hormones from the placenta interfere with the mother's pancreas' ability to make sufficient insulin. Without sufficient insulin, there's too much sugar in the mother's blood. This excess sugar passes through to the baby. The baby then makes large amounts of insulin and converts the excess sugar to fat. You end up with a very large chubby baby. They tend to be especially large in the upper body, and the size of the baby's head and shoulders can make vaginal delivery difficult if not impossible. In the worse case scenario, the head makes it though, but the shoulders, being softer, cannot and become wedged.

For a short time after birth, the baby still is making excess insulin, but is no longer getting all that sugar, and becomes hypoglycemic. This can cause lower calcium and magnesium levels, "the jitters", jaundice, and breathing difficulties. Most of that resolves itself in a few days with care and feeding. Gestational diabetes does not cause birth defects, since the major organs are well formed before the 24th week. However, the child may have a higher risk of childhood obesity and of developing type 2 diabetes in mid-life. For some reason, breast feeding for six months lessens those risks.
So, with the "high risk" tag, home birth was no longer an option. Daughter shopped hard for an obstetrician who she felt would be willing to allow her in the hospital the kind of birth experience she envisioned.

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The call came at 2:50 am Monday. Daughter's water had broken, although she wasn't yet in what might strictly be called labor. Ordinarily, the doctor would say it's ok to wait a bit before going to the hospital, but her amniotic fluid was heavily stained with meconium (baby's first poopy, normally not passed until late labor, delivery, or after birth). This is not good. It can cause serious problems if aspirated.

I had Fred the van in their driveway by 3:10, and she and Hercules and what looked like enough luggage for an arctic expedition (I'm not kidding!) were ensconced in a nest of blankets, foam, and pillows in Fred's open belly, and we set out at about 3:30 am. (None of us, by the way, had had more than 2.5 hours sleep.)

The fog was thick. So thick that I missed the turns out of our own neighborhood, a route I drive every day! And got lost! Four blocks from the house! None of the usual landmarks were visible. I had the GPS, and Jeeves would say, "Recalculating. Turn right on XYZ street", but I'd miss the turn because I literally couldn't see the intersection, even as I drove past it. It was so bad I could have been driving across someone's lawn and I wouldn't have noticed until I hit their house.

After maybe five minutes of stumbling around, we found the main road, and at least I could see the line down the middle. We arrived at the hospital a little after four, heavy fog all the way. Hercules took Daughter in, and by the time I'd parked Fred and gone upstairs, she was in a gown in a bed and hooked up to belts across her belly.

She wasn't dilated very much - maybe 3 cm. (I didn't write down times and numbers, and over the next 20+ hours things got a little foggy.) There was a monitor at the nurses' station with feeds from all the monitors in all the rooms, and I noticed that on all but one of them, the contraction bumps sloped halfway up the height of the strip. On one of them, the bumps went straight up to the top of the strip, ran flat across the top, and then fell down. That was Daughter's strip, echoing the monitor in her room. I don't know if it was just a difference in the position of the belly straps, or the fact that Daughter has virtually no body fat that made hers look so different, but I know she was having a very hard labor.

Very.

She tried kneeling, crouching, leaning forward against the raised back of the bed, lying on a blanket on the floor. By early afternoon it was obvious she was exhausted. But she was only up to 5 cm, and the baby's heartrate was a bit too high. The doctor was getting concerned because of the meconium. The longer the baby was in there with it, the greater the chance of aspirating it. She had to show steadier progress.

Hercules and I had a conference in the hall. We both knew Daughter was adamant about avoiding an epidural, and especially about avoiding pitocin (oxytocin). But she was obviously already exhausted. She wasn't dilating as fast as she needed to if she was to avoid a C-section. She needed a break. We convinced her to give it a try, if only so she could rest a little, and being a drip, they could taper it off when she was ready to push. She was concerned that it would slow or lessen contractions - and - this part made no sense to me - the nurse said that's an old wive's tale, it doesn't affect contractions, but with the epidural they'd have to give her pitocin to make sure. (Um, isn't that an implied contradiction?) Anyway, she agreed to the epidural and pitocin on the condition that she was in charge of the dosage level. She didn't want to feel nothing.

Now, anyone who knows me knows how strongly I feel about unnecessary intervention in the birth process. Daughter is even stronger. But as I explained to her then, unnecessary intervention, intervention only for convenience, is absolutely a bad thing. But necessary intervention can be a wonderful thing. It can help you to do what is needed. Even a Cesarean (she tensed at the very word) can be a good thing, when the only alternative is worse.

So she got the epidural, and continued with the lowest possible dose (or so they told us). At any rate, she could feel the contractions enough to make her pant.

Time passed.

She developed a fever. It rose quickly. They didn't know why, but attributed it to an infection due to the meconium (which I thought was virtually sterile, containing nothing that she didn't already have inside her). They were worried that if she had an infection, so did the baby.

Eventually she had tubes all over her. The IV sprouted multiple branches - saline, antibiotic, pitocin. There was the epidural. The Foley. They put a tube into the uterus to flush it with saline to wash out the meconium. (There was a lot of it.) There was an internal monitor - not the one screwed into the baby's head - this one just ran past the baby to measure (I gather) pressure on the baby. Because her water had broken so early, this was also a concern. There were two belts around her belly - one for contractions and one for baby's heart rate.

She finally made it to 9 cm dilated, and stopped.

She remained at 9 cm for the next seven hours.

She cried. She felt that she had somehow failed. She had the epidural reduced to next to nothing, but she still didn't dilate any more. We explained over and over that she was wonderful, she did everything right, that whatever was going on was nothing she could control, It just was.

Stasis. She still had the fever.

She agreed to the Cesarean.

That was about midnight.

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Now, it wasn't exactly a red emergency, but I've seen this happen before in non-emergency situations and it always amazes me. Within seconds of her saying yes, a SWAT team of nurses poured through the door to unplug everything she was attached to, and she was being wheeled down the hall before we even realized it. Another smaller team rushed in and pushed a papery set of scrubs on Hercules, shoved him into the bathroom to change, and rushed him down the hall, and in seconds I was standing alone in the empty room, with scraps of paper swirling down to the floor, like a scene in a movie shot in an abandoned city.

I suspect they do that so you don't have a chance to change your mind.

Then a nurse stuck her head in the door and told me to gather up their personal belongings, and take them out of the room. "To where? Where will they be going next?" "Don't know. Take it all to the waiting room."

The arctic expedition, remember?

It took me three heavily loaded trips. By the third trip, the room had been cleaned and there was a new bed all made up in there. I felt like we'd been ignominiously kicked out.

I found Hercules' mother in the waiting room. She had driven 12 hours up from the Carolinas.

Hercules showed up in his scrubs sometime a little before 1 am, with photos.

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The baby (she still has no name) is now in the NICU. She has ALL the usual gestational diabetes symptoms. Daughter breastfed almost immediately after delivery, and goes to the NICU very few hours. She has a lot of milk, had no problems with "letting down", and Baby latched on tight right off the bat and drains Daughter thoroughly. I hear she's loud - when she's not eating or sleeping, she's screaming. That's a GD thing, too. The jittery thing. I hope that clears up soon.

It's actually very lucky that Daughter got stuck at 9 cm. It may have saved some lives, or at least bodies.

If she had made it all the way to 10 and the pushing stage, she would have done her utmost to push that baby out. The head would have made it out, because it's smoother and harder, but the shoulders would have gotten stuck. Baby's got shoulders like a football player, a common GD problem. (See the photo below. Hercules' new nickname for her is "Mack Truck".) The shoulders, being softer, don't make it through, an obstetrician's nightmare because in that condition, a Cesarean is difficult, and vaginal delivery often results in shoulder damage - broken bones or nerve damage.

Maybe two minutes old:

Now THAT'S a fat baby. Cheeks, lips, thighs, even the feet. Catch the Mommy-killer shoulders:

I'm left with some questions. Howcome ultrasound can detect a penis, but not a linebacker's shoulders? Shouldn't they know about this before labor even starts?
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2 comments:

the queen said...

Amazing!

Becs said...

A natural candidate for the swim team!