A glimpse into the life of a very blessed, large, Episcopal clergy family through the eyes of one hopelessly romantic mother
Wednesday, April 14, 2010
Joshua's Birth Story
I had an appointment with my midwife at 8:30 Friday morning - April 2nd. We left the office at 11. Long story short, I walked out of there with plans to be induced Saturday morning at 6 am... Not in my original plan...
I go in for the NST (Non-Stress Test - which I have been having weekly since 36 weeks, due to my *ahem* advanced age), and they have a new girl doing it. She can't seem to get a good read on the HB, and won't let me show her where a good spot is. So, even though the baby is moving around, the HB isn't registering much. The tech leaves with a look of panic on her face, and gets the mw. They send me back to the waiting room to wait for the appt. Waiting... Waiting... And then, a girl comes in with an emergency (we *think* she was losing a baby - which kind of puts things in perspective for us).
So, everything kind of stops while they see her, and take her to u/s. After about 20-30 minutes, the nurse comes back to me and tells me that they are waiting for u/s to clear, and that's what's taking so long. I look confused, and she asks me if they told me I was having an u/s. I told her, no, they told me I was waiting to see Beth (the mw). So, I ask her if there's a problem, and she says, well, Beth will talk to you about that, but you are having a BPP (bio-physical profile - basically, to see if the baby is still doing well inside). But, first, we need to take your BP, b/c it was high on Tuesday. Yeah. And THIS news is going to make it much lower, now... *sigh*
So, we wait. And wait. And wait some more... Hannah and David are starting to get antsy... FINALLY, they take me back into a conference room, and Beth comes in. She explains that the baby wasn't very reactive for part of the NST, so b/c my BP was high, they want to to the BPP. I ask how the rest of the tests were (because my BP had been up on Tuesday, Beth had ordered a battery of tests, convinced that I had pre-eclamsia, even though I had no other signs), and she tells me everything was normal. DUH... But she is obviously distracted by what's going on with the other girl, and can't remember the details of my appt earlier this week. So, she tells me they want to take my BP and send me to u/s. So, they put me in a little room, and take my BP - it's HIGH - 157/98 - GO FIGURE... The u/s tech calls me back, and so off we go...
And, by now, the baby is napping. He was nice and active earlier... And I haven't eaten anything either, b/c we generally go out for breakfast after an early appt like that... But, by this time, it's like 10 am, and all I've had is a handful of almonds that I ate to get the baby moving for the NST. And, the baby isn't moving. Practicing breathing, but sleeping. The tech is getting concerned... They need 3 movements in 30 minutes, and baby has had only 1 so far. After about 20 minutes, I remember that I have some Cadbury mini-eggs in the diaper bag, so I have Brian fetch them for me, and I munch away. Within about 2 minutes, baby starts moving. A lot. Yeah - just like mama - baby likes chocolate... So, we finish that, and I go back to a room. And they have me lie down, and tell me they are going to do another BP reading.
We wait. AND wait. Finally, a nurse comes in and does the BP - 128/78. Thank God - A MIRACLE!!!!!!! So, we wait some more for Beth to come back in and discuss things. I can tell from everyone's tone that this is not promising. Eventually, she comes in, and tells me that the baby scored 8/8 on the BPP, but my fluid is low, and since they didn't like the heart tracings on the NST(he didn't have enough variation in his HB), she wants to induce NOW. So, my score on the BPP was 8/10 (and the BPP measures fluid level, and I got a perfect score), and I need to have this baby NOW???? Not buying it.
So, I ask her if we can put it off until tomorrow am. She says that she'll have to run it by the OBs, but she *thinks* it would be okay. Not ideal, and not what she would do, but okay. She explains that she thinks, between the BP and the low fluid (!), that things aren't going well, and my placenta is aging, and throws out the "dead baby" card - if you go now, and everything is fine, you won't have to ask yourself "what if" - if you wait, you might." I'm talking waiting less than 24 hours. Just until tomorrow morning. ???????
But, we can tell she is visibly flustered from whatever was happening with this other girl... (one reason I prefer midwifery care is that they do seem to take every patient's situation personally, although in this case it *was* a bit annoying, but I'm sure the other girl got excellent and compassionate care from Beth) I stand firm with my decision to wait until Saturday - I've lost my plug, and have been spotting since yesterday, so, it *could* happen anytime, anyway... She asks what I was at my last check, and I tell her I haven't been checked yet. So she checks me - a good 4, still thick, but 50% baby's head isn't engaged, though... She said they would most likely need to use pit, b/c she wouldn't feel comfortable just breaking my water with teh baby so high and still floating like that.
She tries again to convince me of the NEED to be induced NOW. And I'm still not buying it. She said that the baby isn't moving enough (on YOUR timed tests - my baby passes it's kick counts at home, thankyouverymuch), and b/c you've kept me here ALL MORNING WITHOUT FOOD, it's not going to be very active, now, is it????
So, she offers to strip my membranes, which I gladly agree to (knowing it may or may not work), but at least I will have tried everything to go naturally. She does it, and tells me she'll set things up for Saturday morning, but that if I change my mind, they'll fit me in today.
I continued having contractions on and off. So, I figure it's *possible* that I could go on my own at any time, but I wasn't holding my breath.
I HATE pit. Can I just say, I HATE PIT. I felt like I'd lost complete control of this birth, and I was scared of having another awful experience like I had with David. Maybe I AM too old to be doing this...
But at least the kids would be home on Saturday, and hopefully, this could go off in a relatively orderly manner, and I would be able to get all the last-minute loose ends tied up (haircuts, setting out Easter outfits, etc). It would suck that I wouldn't be able to be at home for Easter, but I would just have to deal with that.
So.... We decided to just get up and go to the hospital whenever we got there. We spent the rest of Friday finishing up the last-minute baby preparations - installing the carseat, getting a new boppy, packing my bag, preparing the kids... And went to bed. Hannah had a rough night, though, and wound up in bed with us. She obviously picked up on our level of stress... Poor thing...
I was having some contractions, on and off, all evening, and had some bloody show, which had increased since Beth had stripped my membranes earlier at the appt. The contractions continued into the night - not regular enough to do anything about, but strong enough to wake me up. Definitely noticeable. I didn't sleep a whole lot - between the contractions, nerves, kick counts, and wondering if I had made the right decision, I was pretty much a bundle of nerves... Brian set the alarm for the regular school time, and we slowly got up and got ready to go. By the time we got everyone settled for the morning and headed out the door, it was about 8. Sarah and Amanda came with us to the hospital, and Nathan was watching the little ones. I was nervous, but still a bit hungry, so I ate about half a bowl of granola on the way.
We get to the hospital, and head up to L&D. It's quiet, and no one is even a little upset that we hadn't gotten there at 6. That made me very happy with our decision not to rush that morning. I had a GREAT nurse - her name was Anne. She got the abx hooked up right away, and asked all the admission questions. The girls and Brian settled themselves on the couch. Everyone was relaxed and in a good mood, and I started to settle down, too. They hooked me up to the monitors, and Anne went to let the mw , Pam, know that I was there and ready. Anne went ahead and brought in the pitocin and stuff. Blech. We waited for the abx to go in, and just chatted. Once I was done, Anne got Pam. Pam was GREAT. We had gotten along so well during the few visits I'd had with her during this pregnancy - and I had actually prayed that I'd get her when I went into labor. She asked how things had been overnight, and I told her that I had been having some contractions, and she decided to go ahead and check me,even though Beth had said that she wouldn't feel comfortable just breaking my water, b/c I wasn't far enough along, and the head was still high. BUT... Lo and behold, those contractions overnight had done enough, and I was 5-6, 80%, and baby was at +1 station. Good enough for her to just break my water, and go from there. So, she did - that was at about 10 am. They needed a few more minutes on the monitor, so I had to wait a bit. While I'm waiting, they notice a bit of irregularity in the baby's HB strip. They call in the head nurse, and she says to watch it, but no one seems too concerned. The abx were done by then, so they unhooked me from the IV. YAY!!! I got a cup of RRL tea and honey that I brought from home, and drank that while I was waiting. Then, they unhook me, and Brian and are sent off to start walking the halls. After about half a lap, the contractions start, and they start regularly. And they are STRONG - by the time I finished that lap, they were about 3-4 minutes apart. I did another couple of laps, and had to come back to the room to get monitored. The contractions were pretty strong, and I was starting to get uncomfortable. Pam asked if I wanted to sit on a birth ball, and I said yes. So, she got one, and I rocked on it for a bit. But the contractions slowed, so after about 15 minutes, I decided to stand and walk. Almost immediately upon getting vertical again, things kicked back into rear. I would have LOVED to have gotten in the tub at that point, but I didn't want to risk slowing things down. So I paced around the room. Started to feel really bad - nauseous, and more pressure. Things were obviously moving pretty fast. I got on the bed, on hands and knees, to try to move the baby down a bit. I had started shaking, so I knew transition was starting. This was around 11, I think. Pam predicted I'd have a baby by lunchtime, and I could look forward to a lunchtray (yeah - as if hospital food is a reward of some kind... LOL). I stayed on my hands and knees for a while, until I had to go to the bathroom. Then, when I got back, Pam offered to check me. I was 6-7, maybe almost 8, and the baby was +2. But I still had a pretty good rim of cervix left. I was feeling A LOT of pressure, so she gave me permission to try to bear down. I did, for a few contractions, but it wasn't really doing much. So, I lay back down and rode out a few more. She had me turn onto my side, which was really hard, b/c the contractions were really coming one on top of another at this point, and were almost as bad as piggyback pit contractions. I was concentrating on breathing through them, riding them out like a wave. And, at some point, Pam thought that he might have flipped posterior, and that was why he wasn't coming down as fast as we thought he would be. I tried to push again, but it wasn't doing much, so I went back on my left side. I was pretty much convinced that I wasn't going to be able to push - it just wasn't working like I had remembered. And I rode out a few more contractions. And, then, all of a sudden, I felt him coming. I *think* he *was* posterior, b/c I felt one good back contraction, and then, I felt him coming down and twisting. And, just like that, he was crowning. And then, his head was out. I flipped onto my back while I felt him turning, and Pam caught him - head, and then shoulders, and then the rest of him. I really didn't *do* anything - when he came, he did it on his own. As they were lifting him up, I got to see that he was a boy, before anyone announced it. And how TINY he was. No wonder he just popped out...
Joshua Patrick McVey entered the world at 12:45 pm, April 3, 2010.
Sarah and Amanda, who had been down by the foot of the bed, came over, and we let them cut the cord. They were so proud and excited... They put him right no my chest - his apgars were 8/9. He didn't really even cry very much. I could't get over how SMALL he was... They let me hold him for a long time. It was wonderful. They were in no hurry to weigh him or anything... So, as Brian and Sarah were making the requisite phone calls, we didn't have his weight or height! He wasn't interested in latching on right away - just lind of sniffed and licked at my breast. But he was alert and looking around. He didn't even cry very much. I could already tell he was a pretty laid-back kind of guy... I passed him off to the girls and Brian While Pam finished checking me over. No tears or anything - of course, with him being so small that makes sense (hadn't weighed him yet, but we could tell he was WAY smaller than the 8 lbs 4 oz the u/s had predicted on Friday...). They hung a bag of pit, b/c with it being my 7th baby, there was a risk of bleeding. Turns out, there were no issues, there, either. Finally, after half an hour, we decided to give him to the nurse to have him weighed and measured, and to get the vit. K shot. And were we SHOCKED at how little he was! 6 lbs 13.5 oz, and 19.5" long! Almost *exactly* the same size as Sarah - but she was 3 and a half weeks early!!! No wonder he came out so easily! And no wonder he was spinning around so much when I was in labor...
Then, since things were winding down, Brian left to go get the other kids, and Sarah and Amanda stayed with me, and we got ready to move to the post-partum wing. I took a shower, and the nurse gave Joshua a bath. Then, while I was moving and getting settled, they took Joshua to the nursery to get checked over, and to listen to his heart.
And that's when my nightmare began...
Brian returned with the kids, right about the same time they brought Joshua back from the nursery - it's mid-afternoon by now. The nurse said that the dr would be in to see him later,that they would want to run some additional tests on him - an EKG, for certain, and maybe some other stuff. But they left him with us, and the kids all got to hold him, and there was much rejoicing, a few tears, and general chaos. After a bit, the nurse came back to say that the dr was there to take a look at him. It wasn't our regular family dr, who was on vacation last week, but his partner. Brian left to see what they were going to do with Joshua, and I kept the other 6 kids in the room with me. I expected them to be gone 20 minutes, maybe... But the longer they were gone, the more worried I was getting. And I'm trying to stay calm for the other kids, b/c I don't want to upset them. Finally, they come back - Brian wheeling Joshua and the dr to come fill me in. The dr tells me that they are sending the EKG results to Iowa City (University of Iowa hospitals - specialists and level 4 NICU) and they'll get a consult from the pediatric cardiologist. They are most likely going to want to do an echocardiogram to further investigate what's causing the arrhythmia. He's skipping every 3rd-4th beat, pretty regularly. It's possible that it could fix itself on its own - apparently, it often does - but it could also indicate a more serious problem with his heart. And, of course, I'm thinking immediately of Kristi and Gabriella, and everything that goes with that. The dr tells me that he will be back tomorrow to go over what the pediatric cardiologist recommends and to look at Joshua again. But he thinks that, if everything looks fine tomorrow, then they would clear us to be discharged on Sunday, with a follow-up at our dr's later in the week. So, the dr leaves, and by this time, it's getting to be close to supper time, and Brian needs to get the kids home to feed them. They leave, and Joshua and I are alone in my room. It was SO QUIET. AS I looked a him, he looked so perfect - it was hard to believe that he was such a sick little boy. He was strong, and eating well. His color was great, and he was already holding his tiny head up and looking around.
Then, just as I'm finishing up my dinner (hospital food - ick...) the neonatologist comes in to speak to me about Joshua. He looks him over for about 5 minutes - I leave to go pee, and he's still examining him. And, then, he starts. So, Mum, (he's Indian), how much coffee did you have while you were pregnant?" I stuttered... "You know - Coke, Mountain Dew..." I have been caffeine-free since 1994! Well, this kind of arrhythmia is caused most often by too much caffeine consumption by mum when she's pregnant. And, he proceeds to tell me that what he has is PACs, and explains how it's a misfiring of the chambers. And that it can develop into SVTs, which will lead to tachycardia (his heart rate would skyrocket to over 200 BPM), and tells me what to look for - sweating, not eating, general weakness and failure to thrive. And if any of that happens, we need to get him to the ER IMMEDIATELY. Best case scenario - his heart regulates itself on its own, but that usually takes 4-6 weeks. Worst case, he starts having episodes of SVT, and we'll need to discuss medications to regulate his heart, and go from there. But since it's his heart, it's VERY SERIOUS, and they are going to want to keep a very close eye on him.
And then, he wanted to talk about a couple of other issues that Joshua has. First of all, he has a penile chordee (his penis curves downward, like a candy cane), which means that we need to get a urologist consult, and will most likely need surgery to correct the curve. And, he said that we'd need to wait until we got the results of his heart tests, anyway, before we did anything. The next thing he brought up was the fact heat he has a raised ridge/bump on the back of his head, just above the nape of his neck, which no one noticed until the nurse gave him a bath. The neonatologist said that, most likely, it was b/c the bones in his head had fused too soon, and we'd have to get a referral to a plastic surgeon, but most likely a pediatric neurologist, and have his skull reshaped so that his brain would have room to grow.
And, then, he asked about his toes. Joshua has webbed toes - which is not uncommon in my family... I have them, and most of my other kids have it to some degree, too. But Joshua's are different toes (ours are all the second and third toes, on both feet - and only partially connected. His are the last two toes on his right foot only, and they are completely joined (I'll post pics at some point...). The dr asked to see my toes, and my fingers. I have a crooked pinky finger (also runs in the family). Apparently, the combination of webbed toes, crooked fingers, heart abnormalities, and the bump on this head are markers for a very rare genetic disorder. It also involves a boxy, misshapen forehead and droopy eyelids. So, the dr grills me about my kids, and how many of them have these symptoms. He comes back to the heart arrhythmia, and asks how many of them had it, and tells me AGAIN that it's caused mainly from caffeine consumption. He then asks me, after getting the ages of all my other kids, if they have the same father!!??!! I'm fighting back tears at this point, and getting pretty panicked, and praying for Brian to come back, b/c this is all just too much for me. Finally, he starts wrapping up, and tells me that he'll be in tomorrow to check him again, He furrows his brow as if he's forgotten something, and then asks me if Joshua has had a poopy diaper yet. I tell him no, and he gets all concerned again, and starts to look him over again, lecturing me that they like them to have at least one in their first 24 hours of life. Then, I explained that , seeing as it was just 6:45, that it had been only 6 hours since he's been born, and he said that he'd forgotten that he wasn't that old, yet. And he said that, even though I'd been told that we could go home tomorrow, that he thought that was premature, and it would be Monday at the earliest before he's feel comfortable discharging him. He finally says goodbye, and leaves me alone, again.
So, I'm trying to digest all of this. About 10 minutes later, Brian walks in, and I immediately burst into tears. So THIS is why women over 40 shouldn't have babies, I said, and proceeded to relate everything the neonatologist had told me. And I feel AWFUL, b/c it's obviously MY FAULT that our son is so sick. And I'm just crying and crying, and wondering WHY... And wondering what I could have done differently... Brian brought me a milkshake, but I don't think I tasted any of it... All I could think about was what the neonatologist had told me, and none of it was good. Here I had this perfectly healthy-looking baby boy, who really, by all accounts shouldn't have been conceived, suckling at my breast, and it was all so UNREAL.
Brian did his best to remind me that the other drs hadn't seemed that concerned, that they were just watching him carefully. And it began to dawn on me that, really, if things were really as dire as the neonatologist had said, that he would have transferred Joshua to the NICU, or at least hooked him up to a heart monitor - neither of which he did. But Brian had to go back to the kids, and so he left me for the night. I don't think I have ever felt more alone in my life. My mom had *just* gotten off a plane from Madagascar on Friday morning, and just couldn't get out here, so we were on our own. It was so hard - Brian and I were each having conversations with the drs, but never together. IT was just so frustrating... And I really needed him with me but it just wasn't logistically possible. We had people offer to stay with the kids, but they really needed someone familiar with them and their routine. So we made it work...
Joshua did well Saturday night - he ate a LOT. Every hour or so... But the little ones do eat more often... He was having some trouble settling down to latch, but he'd eventually figure it out. And, to allay the neonatologist's fears about his digestive system, he proceeded to poop about every 2 hours, as well... The nurses all kept commenting on ow easy a baby he was, and how easy I was as a patient. The staff was great - very supportive and caring. I was sad that I would have to miss church on Easter, but Brian was planning on bringing the kids over after the second service and egg hunt. Early Sunday morning, they came to do labwork on Joshua, and a hearing test. I thought it was very cool that they did all this stuff in my room - as a matter of fact, the ONLY time they took him to the nursery was for the drs to check him. And it occurred to me that, b/c hey weren't taking him away, that maybe he wasn't as sick as they originally thought that he was. Pam came back in Sunday morning, and gave me the okay to be discharged that afternoon, but I told her that they had said they wanted to keep Joshua until at least Monday b/c of all the issues. She said that she understood, and to just let her know if anything changed. She also said to keep her updated, and if anything happened, to call the practice, and she'd get the prayer chain going. My eyes welled up with that one... I thanked her again or everything that she did... She was the perfect person to have attended my birth.
And, so I spent the rest of the morning and with Joshua, waiting for Brian to come by with everyone - mostly so I could see how embarrassed I needed to be by what they had dressed themselves in for Easter... Yeah. I'm a bit anally retentive about things like that... Thanks, Mom!!! While I was waiting, the neonatologist returned. I wasn't very happy to see him, and my stomach immediately knotted up again. But his demeanor was completely different, and he was SO much more positive, even saying that if our dr agreed, he *might* be able to leave today. I wondered what had changed overnight... (I later learned that Brian had had words with him over his treatment of me, and how a more compassionate bedside manner might be a good thing for his career, among other things...)
Finally, after I had eaten lunch, Brian and the kids made it up. And, *just* as they walked in, they came to take Joshua to the nursery to see the dr, so off Brian went again. And I stayed with the older ones, and they told me all about their Easter baskets and about the egg hunt at church. Finally, Brian and Joshua came back, along with the dr. And, long story short, they CLEARED him to be discharged that afternoon!!!!!!!! So, I jumped in the shower while Brian was rounding up the kids, and had the nurse get in touch with Pam, so she could sign my discharge orders, b/c she'd cancelled them earlier, when we thought he'd have to stay. Brian had brought me Communion, and he anointed Joshua. So, even though we missed church, we got the next best thing... Brian then took the kids home, and had some errands to run, and the staff had some additional bloodwork that they needed to run on Joshua, but we figured I'd be home for supper.
We scheduled a check-up with our dr for Thursday, and an appt with the pediatric cardiologist on Friday. But his heart was beginning to regulate itself enough that they felt comfortable letting him go home, and he was thriving otherwise. He was down to 6 lbs 12 oz when we left, so he wasn't even losing all that much weight. Everything was looking good - dare I say, normal, in fact??? Brian came to pick me up around 5, and we came home. It was the most wonderful feeling in the world. And the perfect end to an Easter day...
I'm sorry it's taken me so long to get this posted... But it has been a lot to process, and it has been hard for me to write it all down. Kind of like putting it on paper makes it real. This has been the best and worst week of my life. I have experienced every single emotion that is possible. But I am so thankful and so blessed to have my sweet, precious boy home with me, in my arms. The kids simply dote on him... And he is such an easy baby. He passed both his appts last week with flying colors... Thursday, he was already 20 1/4" long and up to 7 lbs 2 oz - already passed his birth weight! So we don't have to go back for a 2 week check - just the 2 month appt! And the cardiologist heard NO evidence of any arrhythmia today. But he wants to do a repeat EKG at the 2 month check, but saw no need to do an echo. He looks simply perfect! And no one is concerned about the bump on his head - they seem to agree that the bones are not fused, and it was just most likely from him being wedged against my pelvic b9one. But we'll watch it, just to be sure. We're getting a referral for the urologist next week, and we'll tackle that next. And he thought that the genetic issues that the neonatologist was so worried about was a bunch of crap, and wasn't sure WHY he even went there... But it seems we are out of the woods...
Thanks for reading my novel, and for your support, even though you had no idea what was going on. I knew you all were thinking of me and sending all your prayers and PTs... And they worked!
And, if anyone is interested in Brian's perspective on this, you can read his blog HERE. He had a pretty incredible day on Saturday. It is what he preached on for Easter, and it really sums up what we celebrate this Easter season.
As I have pondered all these things in my heart over the last few days, I can see that God's hand has been in this from the beginning. Our blessing baby has turned out to be just that - a blessing. From the easiest pregnancy ever, to his safe and efficient birth, and his miraculous recovery God has been in control. He has indeed redeemed all things. Alleluia! Christ is risen!!! The Lord is risen, indeed!! Alleluia!!!