Wednesday, April 18, 2012

Ellie's Birth, Part 3: She's Finally Here!

If you're just joining us and want to catch up, in Part 1 I labored for days at home, and in Part 2 we went on in to the hospital and did some laboring there. When we left off in Part 2, I had just gotten my epidural and was finally getting some sleep for the first time in three days.

Thursday, March 29, 2012 Continued...

Just before 7:30 a.m. on Thursday, another doctor from my practice, Dr. Migliaccio (a/k/a "Dr. Mig") came to check my progress. Even though I had continued to have good, constant contractions all night (sometimes an epidural can cause them to stop, but not in my case), I was only eight centimeters dilated and 100% effaced. Dr. Mig then suggested breaking my water and starting me on Pitocin for a few hours in the hopes that my dilation would finally speed up so I could be in a position to push by late morning. He anticipated it would take me an hour to dilate per centimeter, so with only two centimeters left to go, we hoped I'd have the baby by lunchtime (and Eric texted our families to tell them as much).

Eric got a kick out of watching my contractions peak on the monitors

Morning message to family

Dr. Mig also went over the results of some blood work I had done over night. He explained that my blood platelet count was extremely low. He said that my platelets were around 60,000 when I was admitted on Wednesday morning, but had fallen to an alarming 43,000. He said that I would need a blood platelet transfusion before I could deliver my baby, but that he would need to order the blood platelets from the blood bank, as they are not kept at the hospital. He also said he wanted to start me on Sol-Medrol, which is a steroid, although I can't quite remember what its purpose was.

After the doctor left, the nurse came and put a hep-lock in my other wrist so they could do the blood transfusion and have access to another vein in case they needed it later. About an hour later, they began the transfusion of three units of blood platelets. While this was going on, Jess arrived back at the hospital after fighting through bad rush hour traffic. We filled her in on what was going on and then just basically waited to see what would happen.

Dr. Migliaccio returned later that morning to check my progress. At that time, I was nine centimeters. That is when he first started talking to us about HELLP syndrome. He explained that it is a progressive disorder of the placenta and that it is in the same family as preeclampsia but a step more serious. It is diagnosed based on blood platelet levels as well as liver and kidney function. (The "H" in "HELLP" stands for hemolysis, the breakdown of red blood cells; "EL" is for elevated liver enzymes; and "LP" is for low platelet count.) This syndrome occurs in about 1-2 of every 1,000 pregnancies, and the only cure for HELLP is delivery of the baby. Dr. Mig informed me that my platelet count was extremely low (hence the need for the transfusion) and that my liver and kidney numbers were either at the high end of the normal range or just above it. He told me that it would be far safer to deliver naturally because of the potential blood loss and the concerns over my body's ability to clot. I felt relieved about that because, I thought, there was no way I could end up with a c-section after having gone through so many hours of labor. I just couldn't let it happen. Either way, however, I needed the blood transfusion to be successful for delivery to be safe. Before he left, Dr. Mig turned down my epidural so that I would be able to help push when the time came. We were still holding out hope that lunchtime would be go time.

[Side note: After the fact, I came to realize that my regular discomforts - the shortness of breath, heartburn, nausea, etc. - were early symptoms of HELLP that I just didn't recognize. The doctors dismissed them because my blood pressure was not abnormally high, and frankly, they just sound like pretty normal end-of-pregnancy complaints. Fortunately, I went to the hospital when I did, where they could do blood work and understand what was going on.]

As we waited to see if the transfusion worked, the nurse would come in pretty regularly to check my vitals and ask if I was having any pressure or feeling the need to push at all. She was very sweet and was really pushing for me to have the baby naturally and soon. They also started to express some concern about dips in the baby's heart rate, and made sure I kept my oxygen mask on. They also had me lay on my side and every now and then would have me flip to my other side.

Trying to breathe in lots of oxygen for the baby while I wait

The transfusion did bring up my platelet levels (to a safer but still less than ideal level), but I was still progressing very slowly. Dr. Mig came back to check me again around 12:30 p.m. By then I had almost made it to 10 centimeters, with just a rim of cervix left on one side (that's less than one centimeter in about two hours, not exactly the "one centimeter per hour" rule of thumb we had been hoping I'd follow, even with the Pitocin). However, at this check, Dr. Mig saw that the baby had passed meconium, a sign of possible distress. But, we thought we were so close to being able to push, it wasn't yet a major concern. Dr. Mig turned down the epidural even more at this point so I would be ready to go. I was really starting to feel the contractions again and was very uncomfortable, as I was forced to remain in bed now and the contractions were coming fast and strong. I was starting to feel mentally and physically fatigued again but was hopeful that the end was in sight. I kept holding on to the encouraging thought that we were pushing for a vaginal delivery because a c-section wouldn't even be safe.

We thought I would be pushing soon, so we took a last picture as a family of two while we waited!

At 2:00 p.m., Dr. Mig again came to check me. He told me he was really hoping I was ready to push because he had seen "some things [he] didn't like" on the monitor and had been "sitting on [his] hands." However, when he checked me, I had lost ground. He said this time there was a full rim of cervix, and I was really closer to nine centimeters than 10 centimeters. At that point he moved to the other side of the bed and sat down next to me. As soon as he sat down, I knew what he was going to say. I just knew it was coming. He was going to say c-section.

Sure enough, he started off by saying, "you're not going to want to hear this." He then explained that the transfusion had brought my platelet levels up for the time being, but we had no idea where they would be in a couple of hours. If I had been ready to push at that time, we would have been in good shape. But because I lost ground, we had to think about how things would ultimately play out. Because I still needed more time to dilate before I could push, by waiting for that to happen we would run the risk that my platelet levels would drop again and I would need another transfusion. In that scenario, I would not be able to push until the transfusion was complete, which could take a couple of hours. Because he was now seeing signs of distress in the baby, that did not seem like a good option. Rather, he thought it best that so long as my levels were relatively stable right then, we should just do an emergency c-section and get the baby out.

As he said it, I cried. I just couldn't believe it was going to end that way. I kept thinking, "I went through all this...all these days, all these hours, all these contractions...for a c-section. If only I had known it would end this way, I could have just called and scheduled myself for a c-section on Monday and saved myself all this effort." Jess then asked him if there was any harm in giving us a little more time, perhaps only 30 minutes, to see if I could get to 10 centimeters.

Dr. Mig, Eric and Jess were all looking at me to say something, but I just didn't know what to say. Dr. Mig could see me battling through the contractions and asked if I would like him to turn my epidural back up to take the edge off the pain and I said yes, even though I knew that both his offer and my answer basically meant that no matter what we discussed, it would be a c-section. Dr. Mig turned the epidural up (to a level higher than it had been overnight), then left us alone to talk.

Jess, Eric and I discussed everything that was going on. Eric said that because Dr. Mig had offered extra time, that we should take it. Even though he could see I was struggling, he thought that looking back it would be important for me to be able to say that at the end of the day, we tried every single thing we could and fought till the bitter end. I told them I just didn't think I could do it. I told them I didn't know that I still had it in me to push. I knew in my heart how it would end up. However, I agreed with them that we should ask for one more half hour. I didn't want to look back and ever wonder, "well what if I had just...?"

When Dr. Mig came back in around 2:40 p.m. (already 30 minutes later than the last meeting), we told him we wanted him to check again when he was ready to see if I had reversed course and might make it to 10 centimeters. He agreed to come back at 3:00 p.m. I remember looking at the clock and thinking how far away 3:00 looked. I wasn't sure how I would make it.

Although I knew how it would end, that half hour or so was actually a good time for us to try to wrap our heads around the idea of a c-section and sort of get used to the idea. Jess kept telling me how strong I was, although I was having a hard time believing it. I do remember feeling relieved that it would all be over soon, even though this was not the outcome I wanted.

At 3:00, another doctor from my practice, Dr. Moon, came in to check on me. He said he had been called in for the day and was going to check me while Dr. Mig assisted in another birth (in retrospect, we got the impression that Dr. Moon had not actually been "on call" but had been called in specifically to assist Dr. Mig with my c-section). When he checked me, he immediately said, "we need to do a c-section now." We asked what the status was, and he told us I was basically back at 7 centimeters and he was sure the umbilical cord was wrapped somewhere around the baby.

All of a sudden, it was chaos. They started disconnecting monitors and unplugging IVs so they could wheel my bed out to the operating room. Someone told me I had to remove my earrings, but I only had time to get one off before they were ready to take me out so they just put tape over my other one. I realized I did not have my glasses on and had Eric hand them to me as we got moving - I wanted to be sure I could see my baby when they held her up! They gave me a hairnet to put on but I had a hard time getting it over my head by myself, so it was barely on. As they rushed me out of the room, Eric kissed me and told me he loved me. He wouldn't be able to join me in the operating room until the doctors gave him the okay.

Our room was very close to the OR so we didn't have far to go. When they wheeled me in, they put my bed right next to the operating table and had me help scoot as much as I could to get over onto the table. They stretched my arms straight out next to me and put up the sheet so I couldn't see anything. The anesthesiologist started doing his thing and fussing with my tubes. I laid there on the operating table, looking up at the big, circular, bright lights and listening to the flurry of activity going on around me and I lost it. I was so scared and it was all happening so fast. I started sobbing uncontrollably and actually wondered if I might start hyperventilating. I felt very alone and it all felt very surreal. Both Drs. Moon and Mig were in the room at that point and Dr. Mig must have noticed my panic attack because he joked, "Don't worry, we do this all the time. Well, except for Dr. Moon over here. He's a first-timer fresh out of med school." I couldn't help but chuckle and I really appreciated that my doctors were trying to keep me calm.

Of course, jokes only go so far and I was still so scared. I don't think I stopped crying until Eric was able to get into the room. Until then, I tried not to think too much about what was going on around me. At first I felt like I should pray, but I was too frightened to know what to say, so I just said the Lord's Prayer. Then I sang the prayer my family used to sing at bedtime when I was a child: the last verse of "Away in a Manger" ("Be near me Lord Jesus, I ask Thee to stay close by me forever and love me I pray. Bless all the dear children in Thy tender care, and take us to Heaven to live with Thee there.") Then I started forcing myself to stop thinking about my fears and instead think about Ellie. Through the latter part of my pregnancy, I had been singing "You Are My Sunshine" to her, so I started singing that over and over in my head and under my breath. I sang and sang until Eric finally could join me. It felt like it took forever but it was probably only about 15 minutes.

Before Eric was able to come in, the doctors explained that I would feel a lot of pressure, tugging and pulling, but nothing sharp or painful. They tested this to make sure I couldn't feel anything by first pushing on my belly, then pricking me with something sharp and asking if I could feel it. I felt it at first but the second time they tried it, I didn't feel anything.

Meanwhile, back in our original room, Eric was given a pile of scrubs to put on while he waited (coveralls, shoe covers, hat and mask). Before he got dressed, he broke down. Jess gave him a hug and said that everything would be okay and he was going to meet his daughter soon. But all he could think of at that moment was me. He remembers the only thing he could say was that it wasn't fair. We had spent so much energy avoiding a c-section and tried so hard, that to be in this position was too much to deal with.

Eric got dressed and went to wait into the hallway to be called into the operating room. In the meantime, Jess grabbed her own set of scrubs (despite having been told she could not come in the OR). Luckily, she also thought to grab the camera before joining Eric in the hallway. Before putting on his mask and being told he could come in, Eric sent another message to our families.

Another update to family

Finally, Eric was able to join me and Jess followed him in (I did hear the doctors say it was okay if she came, too). As soon as he got to my side, Eric pulled his mask down and kissed me and told me he loves me. I told him I was so scared and asked him to hold my hand. I also told him about singing "You Are My Sunshine" to Ellie in my head and he had a hard time holding back tears even though he wanted to seem strong for me.

The next 15 minutes or so are a blur. I just remember Dr. Mig finally telling me the baby was about to be born, and I felt a big bout of pressure then a release and then she was here, merely 91 hours after labor began. Elizabeth Alice was born at 3:27 p.m. on March 29, 2012. As soon as they said, "Here she is!" both Eric and I were completely overcome. I just wept instantly. Then I heard her cry and I cried even harder - it was the most beautiful sound in the whole world. It was by far the most emotionally intense moment of my life, so much so that I can't even describe it. Dr. Mig held her up and Eric was able to see her, but I wasn't able to catch a glimpse of her over the sheet before they took her away to clean her up and check her out. (I won't post it here because it's a little "messy" and graphic, but if you want to see one of Ellie's first fresh-out-of-the-womb photos, click here.)

As it turned out, despite being in perfect position until the very end of my pregnancy, Ellie had turned posterior (sunny side up) at some point and her cord was wrapped around her body. Her head had gotten stuck which had caused the swelling that caused me to basically un-dilate at the end.

When they took the baby, Eric went with her over to the far corner of the room. Jess then came and took his place holding my hand. As the doctors kept working on me, Eric would call out Ellie's stats from across the room and Jess would relay them to me if I couldn't hear them myself. He also took pictures and videos of her with our camera and then passed the camera off to Jess so she could show me the pictures of Ellie. The first time I ever saw my daughter's face, it was on our camera screen. I was so grateful for those pictures, though - I had Jess scroll through them over and over again and just kept saying how beautiful Ellie was and how much I loved her.

This was one of my most favorites.

My sweet girl 

Finally, they brought Ellie over to me. The first thing I did was kiss her when they put her by my head. I said, "she's perfect." And she was. I finally realized my arm wasn't tied down so I pulled it in so that I could touch her, and I was talking to her and telling her I love her. Eric came in so we could take our first family photo, and then they took Ellie away again and Eric went with her.

Me with my daughter

Our happy family

Jess stayed with me while the doctors finished working on me. I felt lots of tugging and pulling. Dr. Mig told me that they stitched me up in way that would enable me to go for a vaginal birth in a subsequent pregnancy if I so choose, and I thought that was so kind of him to think to mention that to me - like my preferences were never far from his mind, regardless of how this pregnancy turned out. They also explained that they had to use staples on my incision instead of stitches so it would be easier to monitor and address any internal bleeding. It took them about an hour to finish up with me.

Meanwhile, Eric went with Ellie to the nursery and took picture after picture of her. He started to get more comfortable touching and talking to her as no one ever really said what he could or could not do. At this point, no one had said whether Ellie was okay or when she could go see her mom, so he wanted to make sure he had enough pictures for me to look at. After about half an hour, Eric left to go find me in the recovery room so he could drop off the camera. When I wasn't there yet, he went back to the nursery to talk to the baby and take more pictures. He also got to watch them weigh and measure her. She was 8 lb, 7 oz and 21 inches long. The nurse told him he should take pictures of the baby being measured and actually ended up using his picture to confirm her weight when the machine lost the last reading! After this, the nurse gave Ellie a bath and a shot, which she handled very well. Eventually, Eric left again to try to find me.

Being weighed

Tiny foot

Precious little hands

Showing off her blue eyes

They wheeled me out of the operating room and over to recovery, where both Eric and Jess were waiting for me. Eric then left me with the camera to look at the photos while he went to the nursery to get Ellie. Luckily, despite having passed meconium and being distressed, Ellie came out perfect. She didn't need any extra observation or time in the NICU or anything, which was such a blessing. I was so excited when I saw Eric coming with her bassinet. He held her first, and it was so sweet. Then it was my turn. I was so exhausted but so relieved that it was over and she was finally here. I put her on my chest and held her there for a bit, then Jess helped me get started breastfeeding. Right away, she latched on like a champ and ate for 25 minutes. Eric said she was born hungry - as soon as she came out of the womb she was rooting, looking for some food! My hungry girl! After she ate, she and I both dozed off a bit. Jess left us shortly after breastfeeding was under way.

Eric holding Ellie for the first time

So happy to finally be with my baby girl

Bonding time in recovery

Family time

Doctors and nurses were still fussing all around at that point. They were concerned about my blood pressure so they started me on magnesium. They also hooked up my pain meds and were checking on my kidneys and blood pressure regularly. Eric used our extra time in recovery to send one last group text message to our families. He sent them a picture, but withheld the name, which caused a bit of unrest among certain family members!

No name included - what a tease!

I remember being so, so thirsty. All I wanted was a huge glass of ice water, then a glass of orange Gatorade, and then a nice, cold Cherry Coke, exactly and in that order. I wasn't allowed anything to drink but Eric fed me all the ice chips I could possibly eat. I was so thirsty. I was thirsty for about 24 hours straight.

We had to wait for one of the bags on my IV to finish before we were allowed to leave recovery and go back to our room, but that happened to coincide with a shift change so we ended up staying in recovery longer. Finally, around 8:00 p.m. things got moving (after Eric kept getting ice to walk past the nurse's station and remind them we were waiting to move). We were told we would be kept in L&D that night so the nurses could keep a closer eye on me (apparently there are still risks associated with HELLP syndrome even after delivery, such as liver or kidney failure, but luckily that didn't turn out to be an issue for me), so Eric and Ellie went back to our original room to wait for me. A nurse came to clean me up and check me out and then wheeled me back to the room as well.

As soon as I got into the room, Eric was so excited to tell me about the great five minutes he had just had interacting with Ellie. He had been shielding her eyes from the light so she would open them up and look at him, and he was just so excited. It made me so happy to see that and hear all about it.

Eric spending some quality time with his daughter

When we were settled in a little bit, we started making phone calls to family to share the good news. We also uploaded pictures and sent out a small album to family. In the first five hours of Ellie's life, we managed to take over 350 pictures! Those few hours were really amazing - we felt on top of the world. I was so tired but so deliriously happy. We just couldn't get enough of our little girl.

As the night wore on I fed Ellie again and once again, it went perfectly. I was so relieved that we seemed to be having an unbelievably easy time with breastfeeding, considering that nothing else to that point had been easy! Finally, something was going right!

As we prepared for bed, we realized that we still had this baby but really no idea what to do with her. We felt like we needed some sort of orientation or something! Eric wasn't sure if there was such a thing and that we missed it because we didn't go to a postpartum room, so he went to the nursery to ask if there was anything in particular we needed to know. They seemed to think that was crazy, but hey, we're new at this!

And so, back in room 208, we began our first night as a family!

My sweetheart


Thank you again for reading - I know this has been epically long. Next time, I still want to talk a bit about my recovery and I'd eventually like to do a little debriefing. You all are so kind to indulge me!

I'm so glad to be able to show off my little girl to you at last!


Jessica Renee said...

WOMAN! You are amazing! I've so loved reading all about her birth story. I am just in awe and so so proud of all you did to get your precious girl here! I'm sorry it didn't go as you planned but making sure both of y'all made it through safely is all that matters!

And you know how we seemed to have everything in common throughout our pregnancies? I just noticed our girls were both born 2 days after their due date. Crazy! :) Tell Ellie that Violet says hi!

Tiffany said...

Congratulations to you! Thank you for sharing the birth story on your blog.

Lauren said...

Love how strong you were girl, great pictures of your sweet girl & you as a family for the first time :-)

Dad/Grandpa said...

blurry eyes

Nichole said...

Thanks for sharing your story! I'm tearing up reading this. Its so sweet and I am so happy for you and while I haven't been following you too long here, I think you are going to be a great mom (even if there isn't an orientation!)

Jessica said...

You are so strong Meghan! I'm so proud of you and proud of Eric for being such a strong support for you. The lengths you took to bring your daughter into this world safely is something to be proud of. Ellie is absolutely beautiful (and really looks like her Daddy!) Can't wait to hear how you guys are doing!!!

GAD said...

Such a PERFECT outcome from your eventful ordeal. You are a hero, Meghan. Ellie is so lucky she has the parents she does.

Anonymous said...

Sobbing happy & sad!

Love you,
Aunt Rachel