Premature Birth - long

Let me start by saying this isn't a "normal" MDC birth story...but it is a story I feel needs to be shared...you can try for that homebirth, you can be denied for a heart condition, you can then try for the least medical birth possible...only to find yourself betrayed by your body and delivering a baby nearly two months early (there are other moms on this board who have delivered much earlier than that...this is written for all of us who've been there and wonder where OUR birth stories fit)...

My first pregnancy I was overly stressed, didn't eat well, and ended up delivering at nearly 35 weeks due to pre-eclampsia. My labor was "induced" only in that they had stopped my preterm labor to give them time to plan. After a 13 hour labor, including 20 minutes of pushing total, I delivered a son who was breathing and healthy. He was able to come home with me right away. He spent minimal time away from me while in the hospital. We had trouble with breastfeeding, he had swallowing problems (lung incursions when he swallowed), and he had bowel and kidney issues. He is currently in developmental preschool for developmental issues.

I was SURE I was the fault behind my early delivery, as research since then had led me to a plan and I was SURE I would make it this time. I was healthier and knew more.

I had trouble getting pregnant. After several very early miscarriages due to a lack of progesterone...I finally succeeded with twins. Though the second sack did not look good and was not as developed as the other. I lost the "lesser" baby between 7 and 11 weeks (I suspect around 10 weeks because of heavy bleeding).

All things considered, everything went well with my second pregnancy. I wasn't even showing any signs of pre-eclampsia (I had been following Blue Ribbon the whole time). Then around 24weeks (June 2006) things started to go a little wrong, blood pressure going up, swelling going insane, but only trace proteins in my urine. I checked my diet, and made absolutely certain I was following the diet properly, because obviously I shouldn't have this problem if I was...apparantly, you can do everything right, and STILL get sick)

Nothing seemed to get worse though so the doctor and I weren't too concerned. He put me on a blood pressure medicine and kept monitoring me every other week. At the mid/end of July we started weekly monitoring and NSTs.

On August 7, 2006, two days after my last NST, when I was 33 weeks and 1 day pregnant, I started noticing consistent contractions. I'd had some contractions before, but nothing consistent (even had a few during my NST). I didn't think much of it...until they continued - persistently - even after a nice relaxing bath. I called the doula and my doctor's office to talk to the nurse. The calls began around 1pm and I was asked to call every hour until the office closed. By 5pm the nurse REALLY wanted me at the hospital...

So, I waited until my husband got home at 6 and we headed to the hospital, just to get checked out. They were seeing the contractions on the monitor, but were far more worried about my 180/110 blood pressure. I was trapped there for hours in triage. It was the most uncomfortable bed you can imagine...

The contractions eased on their own, but the blood pressure stayed up, and just got worse through the evening. It was nearly midnight, and my back was starting to bother me. I thought it was that nasty bed they had me trapped on...

The pain in my back changed from slightly sore (I slept wrong) to horrific agony on the right side. Extreme pain. I begged the nurses and through them, my doctor, to let me go home. I thought a good rest in a good bed would take care of things. I figured the awful bed was the cause of my back pain, and didn't even think to mention it to anybody...

The doctor said he would prefer if I stayed, but he would let me make the decision so long as I went in the morning for followup blood tests. Unbeknownst to me, my Uric Acid had come back "funny" on the blood drawn while I was at the hospital, but it hadn't been enough to let the docor know what was wrong.

We were released and arrived home around 2 am Tuesday morning. I ate part of a banana because I was sure I should be hungry since I'd missed dinner (my doula had snuck me a plain bagel, but I ate little because it made my stomach hurt a little) and horrific stomach cramps and agony in my back, the likes of which I cannot adequately describe, decsended. I thought I was going to die...that isn't accurate, I WISHED I would die...I hurt worse than anything else I'd ever experienced.

I went to bed, though I slept very little...I was up going to the bathroom and vomiting all night. The pain did not subside, but got worse. At 5am I knew I had to go back to the hospital, deep inside, I knew something was very wrong. Why it took me until then, I don't know, but right then I KNEW. I let my husband sleep until 630 or so before I couldn't stand to wait anymore...I woke him and begged him to call the doctor. He hadn't slept well that night either. He was exhausted because he'd been up getting me a fresh washcloth to wash my face, emptying the trash can and helping me clean up and get back in bed... He is a wonderful husband, and I'm lucky to have him.

The doctor said to go back to the hospital. I would have done anything to stop the pain at that point. I had a horrid fear of having a section, and, at that moment, if they had told me I needed one to stop the pain, I'd have run to the OR...granted I didn't, but part of me was tempted to!

The doctor had them draw the repeat blood work he wanted. After the blood work came back, I knew things weren't good. I had HELLP Syndome (hemolysis (breakage of red blood cells), elevated liver enzymes, and low platelet count (an essential blood clotting element)). They did a quick ultrasound to check on the baby (heartbeat, size, to get an idea of what they would be facing since they had no choice but to deliver me as HELLP is deadly), started me on an IV with magnesium sulfate (to prevent seizures), padded my bed to prevent me from injuring myself if (the nurses said "when" which scared my husband to no end) I siezed, gave me the betamethazone steroids (to help mature the baby's lungs), and started an induction (at my urging, they suggested a csection).

The idiot who tried to start the induction screwed up because he was in a rush and broke my water instead of just placing the catheter to irrigate (read irritate) the cervix. This is around 5:00pm August 8, 2006 (other than that small bit of banana I threw up, I hadn't eaten since lunch Monday, and had no urge to eat...I felt awful). We met with a NICU person to discuss what to expect when Adara was born. There were the typical concerns with her gestation - breathing, temperature, feeding...and then the other risks because of HELLP and the treatments to keep me from seizing.

I underwent blood draws every three hours or so, and my platlets continued to drop and my liver enzymes continued to rise. The doctor asked me to consider an epidural, because he was worried that I wouldn't be able to make it to delivery. By this point, I had dilated to 5 centimeters. I said NO to the epidural...I wasn't in pain and didn't want one. I'd had enough taken away...my homebirth because of mitral valve prolapse (and when you need antibiotics, you can't deliver at home here), then my "as intervention free as possible" birth...and now they wanted to add an epidural?? To take away what little bit I had left to me?!

For hours and hours the anesthiologists came and begged me to reconsider, because my blood levels were getting worse and worse, and at a certain point (which I was very close to, for some doctors I was already beyond their comfort level) they would no longer be able to do it (because I was losing my ability to clot) and I would have to have a general if I needed a section...

I kept saying no. All night long, and through the next morning. By that point, I had been in labor with good contractions - sufficient strength and length, but could have been a little closer together (though I was in no real pain! My poor doula...I feel bad, she stayed there with me the whole time, and I really didn't NEED help) - with pitocin for longer than my ENTIRE labor with my son and I was STILL only 5 centimeters.

Then Adara's head came down around 11am August 9 and the monitors went crazy...her heart rate was dropping, and not recovering well with contractions. I was put on oxygen. I was changed to different positions (I hadn't been allowed up to even go to the bathroom since the mag sulfate had been started (course even being allowed to sit up enough to use a bedpan instead of being cath-ed had been a real fight (I fought because I figured as much vertical time as possible would be better to help the baby move down), and when I was up my blood pressure was up to 200+/120s). Nothing seemed to make the baby all better, but it helped just enough...

The anesthesiologists were back to beg me again. This time after much arguing and pleading, I conceded to having the epidural placed BUT I would not allow ANY medication. They argued, and finally agreed.

Just before 1pm my doctor was back to talk to me. My platlets and enzymes were reaching a frightening level, I was STILL 5 centimeters (though finally a little stretchy to 6), I was at the limit he would give for pitocin, and I was rapidly approaching the 24 hours with water broken mark...he wanted to do a section now, but gave me the option (he always gave me the facts and let me choose, he knew I would tolerate no less) to wait 2 hours or so and see if I progressed (or delivered)...he had a scheduled surgery at another hospital and would come back to see me afterward if I wanted to wait.

We all (husband, doula, and I) discussed it. I wasn't in agony anymore (I guess that mag sulfate isn't all bad), but with the baby clearly stressed, we chose to go ahead. She was little, any increase in risk for infection was serious for her, and too much stress could make it harder on her when she WAS born. There was a greater risk to me because of my blood levels to do the section (higher chance of bleeding out). We choose to go ahead...because I chose my baby having better odds over my wishes and my odds. I took some time like the doula suggested and I cried my heart out with my husband...we were giving up the last of our hoped for birth plans...and we mourned that loss together. I still mourn what was lost, but not how my baby came to be here.

Adara Evelyn was born at 2:11pm August 9, 2006 by cesarean section. She was 33w3d, 1864 grams (4 pounds 1 ounce), and 17.5 inches long.

She didn't cry right away...my husband and I both held our breaths waiting...hoping...to hear that cry. When she cried after getting some CPAP (continuous positive airway pressure) we both burst into tears with a little relief laughter thrown in...she sounded just like a mewling kitten...like a newborn kitten. She was breathing relativey well after a little bit and was taken off CPAP and I was allowed to see her for a moment before she was whisked upstairs to the NICU. As we had planned, my husband went with the baby, and my doula came in to sit with me during the stitching up. Only one person at a time was allowed in the OR with me, but the doctors agreed to a trade off so that I wouldn't be alone.

I asked for a pump and started pumping by that evening, every three hours through the night. I'd been told I should pump for 20 minutes...I thought that meant each side. It was a long night. I spent the next 26 hours in a bed in the high risk maternity ward with mag sulfate still pumping into me one floor below my baby...I saw only pictures of her and heard what other people had to say. My son was brought to the hospital, he'd been prepared to witness Adara's birth and prepared for a normal baby...he was confused, but clearly loved his baby sister. He desperately wanted to hold her, but could only lightly touch her.

As soon as my blood pressure, liver enzymes, and platelets started to return to normal, I was allowed off the IV and moved upstairs to post partum. I think it was harder to be there...hearing all the babies with their moms...

I immediately went down the hall to see my baby in the NICU. She was laying in an incubator, fed only by IV (TPN - Total parenteral nutrition - and Lipids), but they were just starting a "test feed" of formula (I hadn't managed more than a few precious drops of colostrum - which they gave her by syringe) when I arrived to see how she would do. I sat in that chair next to her incubator and cried. I pleaded with her to forgive me...that she didn't deserve to suffer. The two other moms nearby looked at me and offered what looks of comfort they could. I could feel their support.

The nurse came over and gave me some tissues and she asked me if I would like to hold her. For the first time, I held my baby. I was the first to really hold her other than the moment my husband got to show her to me before she was whisked upstairs. She was attached to heart monitors, pulse/ox monitor, temperature monitor, and an IV with three lines going into it that was almost larger than her hand. I was blessed that my baby was breathing on her own and I got to see her beautiful face.

When she was 2 days old, I was able to try to breastfeed her once per day. She took to it like a champ!! Contrary to what the neonatalogists thought, she was my very own barracuda baby! My sister visited me that day and made me an offer. She would take my son home with her 2 hours away and watch him so I could spend time with Adara. We accepted. My husband had gone back to work, and Ryan couldn't visit the NICU (well he could but he had issues being there)...so once I went home I wouldn't have been able to visit Adara much. It worked well for us, and my sister learned how to put all of her fancy, foster parent lessoning to work on real situations (gentle discipline being unheard of in our family before me, and required by fostering, she had to learn how to apply it).

Adara's IV locked up (common problem, the IVs must be checked every hour because of this, it's just one more alarm among the many) the next night and they moved it to her other hand. She wasn't on "full feeds" (the amount of formula or breastmilk necessary for her to grow and thrive), so she was still getting the TPN (a clear yellow liquid) and lipids (white, sort of looks like whole milk, but thicker) through her IV. I was allowed to try to feed her 3 times a day because she had done so well with one time (no bradys or apnea, not overly tired). I got to bathe her that night, it wasn't her first bath, but I got to bathe her.

I left the hospital the next day (4 days after the birth)...nothing broke my heart more than walking out of that hospital without my baby.

Two days later (the night between the 5th and 6th day in the NICU) Adara's IV locked up again (IV lines have to be frequently moved in preemies especially with the thick lipid solution) and they doubled her feeds to get her to full feeds. If she was able to take full feeds then they wouldn't have to find another place to put the IV back in. She had some trouble with that increase and balked at finshing her feeds. They told me that afternoon that they might have to put an NG tube in to maintain full feeds. I went back early the next day to spend the whole day with her, in the hopes that I could convince her to eat well or at least be with her if they had to put the tube in. When I walked in that morning, the neonatalogist stopped me and my heart sank. I was terrified. That may seem silly, unless you've been in the NICU, but for those who've been there when the doctors stop you to talk BEFORE you've seen your baby, you usually have reason to worry!

He saw my face and quickly told me that everything was fine, and that Adara had done so well overnight that they were going to send her home the next day, provided she had no As & Bs (Apnea or bradychardia episodes), continued eating, did well at being transferred to an open crib, kept her temp up, etc. All those typical contingencies to release. I spent the day bouncing between absolute joy and fear that SOMETHING would happen.

Well, nothing happened. She passed her car seat test (some preemies can't sit in a car seat with desatting), kept eating, her temps stayed up, we took our obligatory child CPR "class" (can't release a NICU baby without parents having CPR training), etc. and we went home the next morning.

Adara outdid everyone's impressions and all the standards...she was ready to go home very quickly given her gestation (shortest stay is usually two weeks, most kids stay between 4 weeks and their due date).

Thursday, August 17, 2006, I was able to take my baby home. She was 8 days old and weighed 4 pounds 6 ounces.

She is still breastfeeding like a champ. She is just shy of 7 months old and weighs a whopping 15 pounds already.

For your viewing pleasure, pictures of:
Adara at birth http://www.geocities.com/ketryn/Adara8-9-061453.jpg
http://www.geocities.com/ketryn/Adara8-9-061532.jpg
the first time I held her http://www.geocities.com/ketryn/DSCF0010.JPG
her release date http://www.geocities.com/ketryn/Adara17.jpg
her first outing http://www.geocities.com/ketryn/0819061129.jpg
held by her big brother http://www.geocities.com/ketryn/RyanAdara3.jpg
today http://www.geocities.com/ketryn/0108071704.JPG

She loves being wrapped and slung, and I need to expand my collection or at least materials

You may not agree with the choices I made for her birth (what choices were left), but I'm content with the choices I was able to make. It's not an MDC birth story, it's not a birth story most people WANT to hear...but it is my daughter's birth story...and no matter how I may mourn the way I lost my dreams, I don't mourn her birth. She is here and healthy, and I'm here and healthy, and there is no better story than that.