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Preemie 101

With Olivia’s early arrival, we were welcomed into a brand new exclusive club: the world of preemies.  We didn’t ask for this entrance pass and I wouldn’t wish our experience on my worst enemy.  There were endless hours of waiting, grieving, worrying, and coordinating arrangements.

As a mama-to-be, I had heard countless stories of women going past their due date and trying anything to get their labors started.  I had NO CLUE how common the other extreme was!  The March of Dimes currently states that 1 in 9 women will deliver prematurely… I nearly fell out of my chair when I heard this number!  Our own qualitative research immediately validated this high prevalence.  It seemed everyone we talked to about our experience either knew someone that had delivered early or was themselves a preemie!  In my humble opinion, it seems like a knowledge gap exists in providing critical information to women on this reality.  There has to be a way to communicate this statistic so women can prepare their minds and create realistic expectations… all without creating needless worry or planting a seed of doubt into their minds that they can carry the baby to term.

Caring for a Preemie

I’ll never forget what the attending neonatalogist told us after Olivia’s delivery.  After explaining a procedure and seeing the worried looks on our faces, he stated: “Olivia will be the person she is meant to be.  She is just going to have a longer story.”  That little nugget of reassurance was such a comfort.

It quickly became clear that the medical goals for our 33 Week-er included:

Breathing easily and safely.

  • Olivia’s breathing began to deteriorate after she was born to the point she was on 70% oxygen.  The doctors immediately suggested treating her lungs with a round of surfactant, which would help keep her the tiny alveoli in her lungs from sticking together and allow her lungs to inflate more easily.
  • For the first couple of days, Olivia was hooked up to a C-PAP machine (continuous positive airway pressure).  This device delivered oxygen along with gentle pressure to keep her airways open.
  • Olivia graduated to a nasal cannula emitting high humidity before she was taken off all oxygen.
  • One of the nurses called Olivia her little hummingbird as our girl would have periods where her breathing became very rapid.  Other times, she experienced periods of apnea.  To counteract this problem, the doctors started her on a brief regimen of caffeine.  This drug had to be gradually stepped down and out of her system for at least 1 week before they considered letting her go home.

Regulating her temperature.

  • Olivia’s journey started in an open air bed with a warmer directly overhead to maintain her temperature.  When her condition stabilized, she was moved to an isolette.  This little incubator, even though it looked more intimidating, was actually a step in the right direction!  After Olivia was able to regulate her temperature, she was moved to an open air crib with frequent temperature checks.

Coordinating her suck/breathe/swallow reflex.

  • Progress in this department was SLOW.  The nursing team placed a g-tube down Olivia’s nose into her tummy relatively early so they could “gavage” her feedings or directly provide breastmilk/formula to her stomach.
  • During some of Olivia’s first attempts at bottle feeding, she only took in about 5-15 mL of fluids.  She progressively worked her way up to taking 60 mL during most feedings throughout the day.  If Olivia was awake, the nurses would allow us to attempt bottle feeding.  Any amount that she did not finish in 30 minutes was then given through the g-tube.  If Olivia didn’t finish within this critical window, the nurses explained that she would be expending too many precious calories compared to the amount she was taking from the bottle.  After Olivia’s breathing improved and she was capable of regulating her temperature, we were in a holding pattern waiting for this particular reflex to properly mature.  Some days, she took her bottle feedings like a champ.  Other days, Olivia was more interested in sleeping so many of her meals were “gavaged.”  The nurses reassured us that one day, everything would just click.  Imagine our surprise when we arrived at the hospital one day to find Olivia had pulled out her g-tube by herself!  Our spirited sweetheart was ready!
  • Thoughts in general:  I have an incredible amount of respect for this reflex.  Olivia choked two times during her feedings while I was home alone after we brought her home from the hospital.  My heart nearly jumped out of its chest from sheer panic.  Her system was still sorting out glitches in the required sequence of movements.

We are eternally grateful that Olivia’s prognosis was always positive during her time in the Special Care Unit.  We never questioned whether or not she would make it.  All in all, our experience was a CAKE WALK compared to the complications awaiting parents of other premature babies, especially micro-preemies (infants born before 26 weeks gestation or weighing less than 800 grams).  I can’t even imagine, even though I’ve had a first hand glimpse into the preemie world, the roller coaster of emotions that these parents face on a daily basis and the compounding effects of stress.

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Olivia’s Birth Story: Part 2

This post is a follow-up to Olivia’s Birth Story: Part 1.

After arriving at the hospital and facing the reality that we were going to meet our baby almost 7 weeks early, here is how our story unfolded:

The doctor checked me at 1:30am and reported that I was already at 3cm, -2 station, and 70% effaced.  At this point, they also gave me the first of 2 steroid shots designed to speed up the baby’s lung development.  Throughout the night, I continued to have gushes of amniotic fluid.  It was such a weird feeling to have these uncontrollable leaks.  I was grateful to have giant disposable pads underneath me that could be changed out quickly.

Jen, our back-up doula, arrived at 3:30am.  When she entered the room, I was resting on the side of the hospital bed while James sat against my back.  The slight bit of counter pressure was lovely as my contractions intensified.  I wasn’t sure what to expect- another stranger was entering the scene.  A scene that was supposed to be an intensely private affair where I was surrounded by familiar and loving faces.  Another stranger was going to see literally all of me.  If I thought about anything for too long, I started to feel out of control.  Any fears that I might have had quickly dissolved.  Jen became an invaluable member of our team.  She jumped right in but didn’t try to take over.  We really appreciated her warm personality and all of her helpful suggestions.

Fairly early on, this thought train started to dominate my mind:  She is coming.  The baby is coming.  We have no idea what shape she will be in.  I’ve failed her.  The only thing I can do for her is have an unmedicated birth.  If I don’t take any drugs, they won’t be passed to her.  Maybe that will help her initial rough start.  Natural childbirth is the only thing I can give at this point.

At about 3:40am, Jen suggested that I eat a little something.  I had my first Popsicle and we discussed my current nurse.  Everybody in the room was looking forward to the upcoming shift change at 7am.  This nurse was nice but very “by the book.”  She wanted me laboring in the hospital bed and was hesitant to let me move around since my monitors might need readjusting.  Any food or water was kept to a bare minimum.

At some point, we asked if the hospital had a birthing ball I could use.  They found one fairly quickly; however, it was made for a giant!  My tip toes barely touched the bottom of the floor!  By 3:50am, Jen recorded that I was sitting on the ball by the edge of the bed with my Hypnobabies soundtrack playing in the background.  She would later tell me that I was quiet and focused.  By 4:05am, she noted that my waves were becoming more intense.

Birth Story1

At 4:15 am, I used the bathroom and had the beginnings of “bloody show.”  I actually remember being disappointed that there wasn’t more- I was hoping that things would start progressing even faster.  I was ready to get things moving!

James and I slow danced to ease the discomfort of the pressure waves.  I also ate a Luna bar from my mom’s secret stash.  My Mom returned to the hospital with a few items from home that I might need, including an assortment of energy and breakfast bars.  I don’t know how I would have made it through the next couple of hours without this food contraband!  We all laughed as I quickly scarfed down these energy bars- all eyes were on the door to make sure a nurse didn’t catch me eating!

James was able to doze from 5-8 am.  During this time, I listened to Jen’s music.  I absolutely needed something in the background to focus on.  After a few rounds of classical music, it was back to listening to the Hypnobabies scripts.  Both my mom and Jen tried to provide counter pressure on my back to relieve some pain as I sat on the birthing ball.  I definitely preferred a firm touch with no rubbing motion.  Jen encouraged me to keep from scrunching up my shoulders and creating tension in my body by placing her hands firmly on my shoulders and repeating the release cue (a Hypnobabies technique to relax quickly and fully).

7am: Ate another Popsicle and was introduced to our new nurse, Emily.  Emily was such a gift- she basically left us alone the entire time but was on call if we needed anything.  She didn’t get bent out of shape if the monitor lost its signal as I was changing positions.  She let Jen readjust my belts.

7- 7:40am- I preferred to stand at this point.  I quickly ate another contraband item: a breakfast blueberry bar.

James woke up shortly after.  I was so happy that he was able to rest but really glad that he was back in this with me.  We stood and slow danced through the waves.  It seemed like the contractions came closer together when I was standing.  Sitting on the birthing ball was a welcome break.  By 9:30, I was becoming nauseous and having a harder time relaxing during waves.

10:10am- My waves started to linger as I rested on the birthing ball.

10:45am- Internal exam revealed I am 7-8 cm, 100% effaced and a +1 station.  I was thrilled to have made this much progress and hoped that it would all be over soon.  In my mind, I thought our baby would be here by early afternoon.  One of my big fears of having a hospital birth was “the clock.”  I assumed I would be on a timetable and expected to make progress within a certain amount of time.  I imagined myself being glued to watching each second go by.  Nothing about our experience could have been further from this reality.  Yes, it was a long labor.  BUT, while we were in the zone, hours felt like minutes.  I never watched the clock once.

By this point, James was a master at providing counter pressure on my back during waves.  We resumed our routine of standing, dancing, and resting on the birthing ball.

Around 12pm, I received the second steroid shot to help mature our baby’s lungs.  I commented that the waves are “doozies!”  Jen noted that I started shaking from all the hormones surging in my body.

12:20-2pm- More of the same: Standing, slow dancing, and sitting on the birthing ball.  My parents picked up lunch in this time frame and James quickly ate a sandwich.

At 2pm, Jen suggested that I rest by lying on my side in bed.  It felt good to stop for a moment and just attempt to rest.  The waves continued to get stronger.  By 3:15pm, I was exhausted and started crying and quietly confided to James that I don’t think I can do this.  Jen noted that my contractions were very long at this point (several minutes) and I was shaky.

When an internal exam revealed I had just a lip of cervix left, Jen and Emily encouraged me to try the hands and knees position.  It seemed like I was so close to the pushing stage but so far away!  My contractions were incredibly intense by this point and I was moaning.  Jen reminded me to lower my voice to make the moans effective.  I spent 10-12 contractions in this position.  They wanted to be sure that the next time I felt the urge to push, I could.  This portion of time felt never ending.

At 5pm, I was complete and at a +2 position.

I pushed for approximately 51 minutes.  I didn’t know what to do at first.  The urge to push didn’t happen immediately for me and my early attempts weren’t quite effective.  I was also afraid that I wasn’t pushing fast enough.  I was so grateful that the doctor was patient and let me figure things out on my timetable.  Finally, at the tail end of one of the contractions, my body kicked in and the pushing became primal.  There was a huge difference between me attempting to push and allowing my body to push.  Now, as I think about this portion of my experience, Cindy Crawford’s birth story from the movie The Business of Being Born comes to mind.  She explained that she wished she had listened to her body’s cues and trusted its timing instead of just starting to push when she reached 10 cm.  Her body simply wasn’t ready and the first hour of pushing was completely ineffective.  I can completely understand this abstract concept now.  When your body kicks in, you can’t help but push.

For some reason, it seemed like the space between each contraction was enormous- these lulls were filled with anticipation.  I was grateful for the break but also dreading the next wave of pressure.  According to Jen and James, however, there was hardly any time in between these rounds of pushing (long enough to take a drink of water).

I do remember that there was an incredible amount of people in the room- James, our doula Jen, the OB Doctor, a set of nurses for me and another set of nurses to attend to Olivia.  I had quite a cheering section.

Do I remember the ring of fire?  Yes, it is very aptly named!  And, then, it was over so quickly.  All the discomfort, pressure, and pain literally evaporated when Olivia was born.  It really did feel like she came out in a gush – what a weird feeling!  James cut the cord quickly and they placed her in a warming bed to assess the state of her health.  I’m so glad someone in the room focused my attention on the fact my baby girl was crying.  I couldn’t really see anything from my position on the bed so hearing her cry was amazing.  The nurses allowed us to take a few precious photos before they whisked her away to the intensive care area.  They refused to let me hold her but I did get the opportunity to reach out and touch her tiny, perfect hand.  Prior to her delivery, I repeated to James several times, “no matter how this ends- natural delivery or c-section- promise me that you will stay with the baby.”  Unfortunately, this wasn’t possible when they took her from the room.  They wanted only medical personnel present to assess her breathing and create an immediate treatment plan.

My placenta came out quickly after.  I was surprised how strong the contractions were to expel this organ.  I relied on James, squeezing his hand, to help me cope as my body was literally shaking from all the hormone surges.  I had read that women can experience an emotional high after giving birth- full of incredible energy after an exhausting labor.  So true.  After all the medical personnel cleared the room, I felt really good despite the fact that I had just spent 20 hours in fixed concentration working through pressure waves.  And, then the emptiness set in.  We were so happy and so, so alone.  We weren’t snuggling with our precious newborn.  We never had the opportunity to memorize the tiny features of her beautiful face.  We completely skipped over the part where a new family bonds together.  Our sweet girl was literally fighting to breathe at the other end of the maternity wing instead of safely wrapped up in our protective arms.  It was all so surreal.

And, so begins another story: Olivia’s time in the Special Care Unit.  James was allowed to visit her approximately 45 minutes later.  I had to wait an additional 2 hours in “recovery”… quite possibly the longest 120 minutes of my life.

James' PerspectiveDid you think Candice was going into labor?

We were both really hoping that she had accidentally peed her pants.

Biggest surprise?

The umbilical cord was incredibly thick and strong.  Definitely not what I was expecting when I cut it.

Biggest bummer (aside from the fact she was born so early):

From the beginning, we had hoped to delay cord clamping so Olivia could receive all the stem cell rich blood in the umbilical cord.  When we realized this wasn’t an option, we asked that it be donated to our local Cord Blood Bank.  The medical team informed us that only blood from pregnancies week 34 and older was eligible for banking.  We missed the window by 3 days.  What a waste.

What was your mindset going into this experience? 

I was ready for a fight.  I expected the medical team to try and push various interventions.  I kept a close eye on Olivia’s heartbeat and was prepared to argue to keep at least some of our natural birth plan in place.  Fortunately, after the nursing shift change, we were left alone for the most part.  I knew Candice could birth our baby naturally if given the opportunity.

Second biggest surprise? 

Despite my exhaustion, hunger, and the fact my arm was incredibly sore from applying counter-pressure on Candice’s back- hours still managed to feel like minutes.  I expected to be bored for at least a portion of our time at the hospital, especially given that we were there for 20 hours concentrating on only 1 thing (no TV, no radio, and endless hours listening to Hypnobabies scripts).

Any Other Difficult Moments? 

When Olivia was born, I really wanted to go with her as they assessed her breathing.  I also wanted to be able to stay with my wife, who was starting another round of contractions to expel the placenta- both of my girls needed me.  It was definitely a helpless feeling not to be able to be in 2 places at once.  For better or worse, the hospital made the decision for me and I wasn’t allowed to go with Olivia.

 

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Olivia’s Birth Story: Part 1

I wasn’t sure how much of this story I was actually going to share on such a public forum.  Why divulge the intimate details of such a meaningful and life changing moment?

Reason #1: One of the lines in this post resonated with me.  I could completely relate to Molly Mahar’s desire as a first time mama to read as many birth stories she could find.  Mainstream media is flooded with so many negative and dis-empowering statements  about the process of birth.  While I was pregnant, I loved hearing stories of positive, natural deliveries where women trusted their bodies and were surrounded by a fabulous support team.  That being said, I wholeheartedly agree with Molly’s opening statement that “there is no right way to be pregnant, give birth, or parent your child.”  Each life is so dear and full of unique experiences.

Reason #2: I have been overwhelmed by all the love and prayers that have been sent our way over the past couple of months from family and friends.  Some have asked questions, some have heard the intimate details, and others have quietly offered their support from a distance.  I am so grateful for your support in how our story unfolded.  Each of you have played a part… now, here is the whole:

Olivia Birth StoryAt about 9 pm, I went upstairs to listen to a relaxation script as part of my Hypnobabies childbirth prep homework.  Lexi, our Shih Tzu puppy, snuggled next to me and we both started to drift as the familiar relaxation music and soothing imagery played in the background.  I remember hearing Lexi’s soft snores.

All of a sudden, still in a light sleep state, I felt a gush of something fill my pants.  I literally threw the covers off of me and sprang out of bed.  When I realized what might be happening- what it just had to be- I went over to the door and started screaming for James who was in the basement.  Fortunately, he had just finished up his work and was heading upstairs so he heard my cries immediately.  James was so calm and collected.  I told him in between panicked sobs that I think my water broke… every couple of moments, more trickled out, which only served to confirm my theory.

James quickly called my parents to let them know we were heading to the hospital while I changed into another pair of pants.  I don’t remember much of the short car ride to the hospital other than talking to my parents and asking them to call the doctor’s exchange since I didn’t seem to be able to locate the number in my phone.

James dropped me off at the ER entrance and suddenly everything was becoming very real.  The woman at registration asked “Can I help you?” as I walked in and I remember not being able to speak.  In between sobs and feeling more trickles, I managed to blurt out something to the effect “I’m 33 weeks pregnant and I think my water broke.”  By that time, James had parked the car and they both were assisting me to a wheelchair where I was whisked up to the Labor and Delivery floor.  Everything seemed to be happening so quickly.  James would later tell me that I called out to him at around 9:50pm and we were in a hospital bed by 10:04pm.

I was immediately hooked up to an IV and a continuous fetal monitor, 2 medical interventions that I desperately wanted to avoid.  My dream of having a private, home birth with little medical assistance was shattered.  My birth plan was safely housed on my computer and our birthing preferences were slowly being eroded in front of our eyes.  One thought was at the forefront of my mind, “Is she ok?”

The first couple of hours in the hospital were a bit confusing.  The on call doctor wanted to check my cervix (which was completely closed) and confirm that the fluid was indeed from my amniotic sac.  She also ordered a test to assess how mature Olivia’s lungs actually were at this point in the pregnancy.  It appeared as though it was one giant waiting game to see what was going to happen next.  We kept asking how long it would take to get the lung maturity test back from the lab- no one was able to give us a clear answer.

My contractions (or birthing waves in Hypnobabies lingo) started within a half hour of being at the hospital.  The nurses kept asking me if I felt anything and at first I told them no.  It wasn’t really a lie, per say, but perhaps a futile attempt to avoid the fact that things were progressing.  I guess I was holding out hope that the doctors would suggest some magic cure to fix the whole situation and guarantee the safety of my sweet baby.

My parents arrived at the hospital around 10:30pm.  My mom had a long tiring day prior to this event- both of my grandparents ended up being hospitalized after their doctor’s appointments earlier in the day.  Prior to my admission, she had already gone 10 rounds with coordinating hospital arrangements.  Now, her baby was in the hot seat.

While we waited, our wonderful doula (Alicia) stopped by the hospital.  We called her initially to tell her a heads up over what was happening and she immediately set things in motion to have her back-up doula join us at some point.  Alicia had just given birth herself 4 days prior to our surprise delivery.  It was such an incredibly nice gesture for her to come to the hospital to lend us her support.  She asked the doctors several clarification questions and attempted to give us some tips on how to proceed with our natural birth plan in our new circumstances.

Birth Story Fetal Monitor

When it became clear that my pressure waves were becoming more intense quickly, the situation in the room started to shift from one of “wait and see” to “she is having the baby now.”  I had heard that when a woman is hooked up to a continuous fetal monitor, a dynamic in the room shifts.  All eyes start to watch the monitor instead of the pregnant woman.  So true!  Our eyes became fixated on how our little girl’s heart rate was tolerating each contraction.  Was it going to stay within the safe zone?  I’ll never forget how after each intense wave, James lovingly reassured me that the baby was doing great.

Click here to read Part 2 of Olivia’s Birth Story

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The Day Time Stood Still

You might have noticed a bit of a time gap from my last post… our lives have been utterly transformed by one precious event: the birth of our sweet baby girl.  Olivia Rose arrived on December 28, 2013 at 5:51 in the evening…. almost 7 weeks premature.

First Family Photo

I am not the same person I was 3 months ago- I am stronger.  I am more grateful.  I am more aware of the precious and fleeting nature of each moment.  J and I have been on a roller coaster of emotions ranging from pure joy to sheer panic.  We were so unprepared for everything that unfolded: no hospital bags were packed, Olivia’s nursery was completely unfinished, and I was under the impression that I had approximately 7 more weeks to practice all the child birthing relaxation techniques that we had learned.

Welcome Olivia

These beautiful pictures were taken on the day Olivia was finally released from the hospital.  Our little girl has been through so much- time in the Special Care Unit, medical procedures to ease her breathing, follow-up appointments with different specialists, and continued metabolic testing.  I am so proud of her strong spirit.

Welcome to the world, dear Olivia.

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