Sunday, February 11, 2007
Sunday was pretty easy, really. At about 7:15pm we loaded up the car and headed over to the hospital (Kaiser Permanente Santa Clara). Heather had her full support team - Me and Crystal for the delivery room, her Mom and my parents waiting outside for moral support.
Since they knew we were coming, they were ready for us. It didn't take long for them to get Heather hooked up to a variety of devices. First, they strapped two monitors on to her belly - one to measure the fetal heart rate (FHR) and one to measure contractions. Next, they wrapped a blood pressure cuff around her arm and set it to check her blood pressures automatically every 15 minutes. Since she was going to have an IV and be on some drugs, they didn't want her up and about, so they hooked up a Foley catheter (tube to her bladder). Then they hooked up an IV and started some Magnesium Sulfate (a medication to prevent seizures in patients with preeclampsia - "when we start the mag, you'll feel like you're on fire from the inside out"). They also drew some blood and informed us that they'd be back every six hours for more. Lastly, they inserted a Misoproxin suppository that stimulates the cervix.
Then the wait began. So, as you can see, that wasn't all that bad.
Monday, February 12, 2007So there we were, a little after midnight (early Monday), staring at the FHR and contraction monitor, waiting for something to happen. Being the middle of the night, this seemed like a good opportunity to get some sleep before the fun really started. I pulled out the chairbed-thing a bit and climbed on. Crystal curled up in a regular chair (good thing she's small).
Everything might have been fairly peaceful if not for a few distractions. For one thing, the blood pressure monitor was going off every 15 minutes. It's not that entirely annoying really - just a low hum as it fills the cuff. The real annoying part was the alarm it triggered nearly every time. You see, one of the signs of preeclampsia is high blood pressure (which is why they constantly monitor). The doctors don't seem to get really worried until it gets above about 160/105 or so. Now, that's pretty high blood pressure for a normal person. Heather's BP had been around 150/95-ish. Sometimes it was lower. At any rate, the BP machine has this alarm that, as far as I could tell, was triggered by a diastolic pressure of more than 90 mmHg. Since Heather's BP was regularly higher than that, the alarm regularly went off, requiring me to sit up and press a button on the machine. Nope, the nurses didn't care or need to know. It shows up on their screen outside anyway, and those pressures were within the comfort zone.
Probably one of the worst initial issues for Heather was the drawing of her blood. Normally, she doesn't have much trouble in that category, but that day her veins were just not cooperating. Nurses would repeatedly push a needle in only to declare that the vein had collapsed and they'd have to try another one. And another one. And another one. That's when the parade of nurses came through, each one supposedly better than the last at drawing blood. "Esther can do it, she's been here like 20 years." "Hmm, maybe we should call anesthesia, they're good with difficult veins." Eventually they found a vein on the underside of Heather's wrist (probably about where she wanted to slit herself at that point). That worked for the moment.
And so that continued all night and for much of the morning, getting blood drawn every six hours, a new Misoproxin suppository every four hours, someone coming by to drain her bladder and measure her urine every couple of hours, and the BP machine going off every 15 minutes.
Sometime in the middle of the day a nurse came in and said to Heather, "we need to put you on oxygen." The nurse proceeded to put one of those tubes up to her nose and pretty much left. WTF, you might ask? And so we did ask. It turns out that the FHR was dropping lower than they liked. Typically it drops a little during a contraction, but the then Fetus Reuterskiold's heart rate was dropping after the contraction, and taking it's time coming back up. The doctor came in to explain all this and let us know that if the oxygen didn't improve things, a c-section was in order. They replaced the tube with a full oronasal mask and helped Heather to change positions in bed. That all seemed to improve the situation for the moment but left Heather with yet one more connection. This is when we began to refer to her as the Science Experiment.
Things were starting to look a little better. Contractions were coming a little more often and were apparently more intense and cervical checks showed that Heather's cervix was a bit more effaced. However, only Heather knew just how intense the contractions really were. You see, sometime before Heather had been started on Pitocin - a drug to induce contractions. Apparently, Pitocin induced contractions are a bit (understatement?) more intense. Of course, the external monitor does not accurately show intensity, so we (including the nurses) really didn't know what Heather was dealing with. Eventually, Heather called for the epidural (rating her contractions an 8 on the 0 to 10 pain scale). With all the other things she was plugged into, it seemed like a logical step.
And so the Science Experiment continued. The anesthesiologist came in, told Heather how the procedure would go down, and started to get to work. The events of the next ten minutes are unknown to me, as I left the room to avoid adding a third patient to the mix. When I returned, Heather was feeling a little better as she was now rating her contractions at only a 2 on a 0 to 10 pain scale. After a while more of these contractions, a cervical check showed that she was now 7 cm dilated and 90 percent effaced. This is good progress, but still a bit to go.
Only 30 minutes later at about 5pm, the FHR started to drop again, this time down to the 40 range. A very concerned nurse came in and started having a look at things. She then instructed Crystal to push the square red button on the wall that read something like "Emergency Call Button". In about 2.5 seconds, three doctors and three more nurses calmly but quickly filed into the room, making sort of an arc around the foot of the bed. A technician was sent to start preparing the operating room for a c-section. Some of the doctors and nurses were studying the FHR output, others were preparing to insert an internal FHR and contraction monitor. (In case you've lost track, here is a list of the things currently hooked up to Heather: IV, BP cuff, external FHR monitor, external contraction monitor, Foley catheter, oxygen mask, internal FHR monitor, internal contraction monitor, and epidural catheter.) As one doctor was inserting the internal monitors, the other doctor started preparing everyone for the c-section that was about to happen.
To our amazement, the doctor inserting the internal monitors announced that Heather was now 10 cm dilated (the magic number) and fully effaced and then said "Let's see what happens if she pushes" before going off to a c-section. And so the pushing began, and the doctor was pleased with the results. And then it stopped. You see, they don't want you pushing if there is no nurse or doctor in the room. Pretty much everyone had now filed back out to wait and see what happened. Heather will tell you now that this is the hardest part of labor - the NOT pushing when your body really really wants you to. And so this went on for an hour or so - pushing when the nurse was there (most of the time) and trying hard to not push when she wasn't. All the while the nurse is checking to see what station the baby is at so they can get the doctor in to catch her coming out.
It was during this time that we took a better look at the output from the internal contraction monitor. It was reporting contraction intensity that was off the scale. As the nurse takes a look and realizes that this is what the contractions were probably like before the epidural as well, she says to Heather, "wow, you must have a high tolerance for pain."
Preparations began for delivery. Normally, we would have been moved to a larger room for this portion, but apparently Carina wanted out now. They lined the floor with plastic, and in came a doctor covered literally head to toe in hospital garments. He was there to "catch". Of course, Heather and I being baseball fans (and apparently the doctor too) we had to make the obligatory baseball jokes. Doctor Schroeder called for a fastball. Heather nodded and went into her wind-up.
With one push, out popped the head followed by the rest of Carina's tiny body. The doctors seemed to think there would be a pause after her head came out and before the shoulders made it through. Nope. Fastball down the middle and there she was, all gooey and bluish pink, right into the waiting hands of Doctor Schroeder.
To be continued...
The last two weeks have mostly been a blur. Dave and I haven't gotten much sleep while we try to keep Carina well fed, dry, and comfy. Keeping her dry and comfy are no problem really. She is a very good baby so far. Keeping her well fed is another issue. Since she is so small she has some trouble breastfeeding. So, at each feeding we have to "practice" breastfeeding and then finger feed her with a syringe. I have to pump breast milk at each feeding in order to have some for next time. The whole process takes between an hour to an hour and a half. We do this about every three hours - so that leaves just about an hour and a half of "free time" between feedings. Luckily, she's super cute so it doesn't seem so bad. Also, it seems to be working...at her appointment on Friday she was up to 4 lbs. 13 oz. - that's two ounces more that her birth weight and seven ounces more than her lowest weight. She'll be a chub in no time!
