Held Up

So today was interesting. I'm sure you're dying to hear all about it.

It started with frustration as I sat in my car behind a dirty old pickup truck that couldn't decide what it was doing. The hospital's parking garage, which is usually metered, is currently free due to construction. In order to make way for a golf cart shuttle to/from the hospital's front entrance, and also to prevent people from taking tickets when they pull into the garage, the formal entrance is blocked off, and cars are directed to enter one of the exit lanes. The driver of the truck couldn't get it. He just sat paused in front of the exit lane, looking like he really wanted to go up the entrance if only it wasn't blocked off. I audibly sighed when the reverse lights blinked on. I was right behind him, with now a couple other cars behind me; where did he think he could go? Realizing that any attempt of escape was futile, the reverse lights blinked off, and the truck edged forward little by little until we were finally in the garage. You would think then that the driver would easily figure out how the parking garage worked and set about using it, but no, he still inched forward slow as molasses with the rest of us just wanting to hurry up and park already. I was thrilled when I spied an open spot on the third floor's exit row, and even more thrilled when the truck slowly rolled up to the fourth floor; I could both park and not have to follow the slow truck anymore, yay! I ran down the steps instead of waiting for the elevator.

When I made it up to the fifth floor of the hospital-- severely delayed thanks to Mr. Truck-- I picked up the phone outside the NICU and waited for someone to answer. And waited... and waited... and waited. The phone was ringing for a good two minutes before I finally heard a welcome, "Hello?" I gave the name of my baby and the voice on the other end said, "Ok, come in." I hung up the phone and waited for the doors to open. And waited... and waited.. and waited. Another two minutes later, I picked up the phone again. After a couple of rings this time, the voice on the end answered, and I asked, "May I come in?" The doors immediately opened. The receptionist at the desk claimed she had forgotten about me. Okay, whatever. I was late to breastfeed Poppy and had just about used up all of my patience for the day (though I would still need more later).

The good news is that Poppy was awake and ready to eat. She ate well! Senpai arrived for morning rounds. Poppy has a new attending physician today, and we wanted to find out what his philosophies are. Not that it matters much since she'll have another new doctor tomorrow. They're currently trying to fill in scheduling gaps. I'm just waiting for somebody to say the magic d-word sooner rather than later. It wasn't today's doctor. Will it be the one tomorrow? I can hope!

We went out for lunch. When we returned, we got on the elevator to go back to the fifth floor, but the elevator went down instead of up. The four other people on the elevator with us (two smokers expecting their first grandbaby, an elderly woman, and an older lady going to visit her sister in the ICU), were just as surprised as we were that it decided to do that. We laughed it off when the elevator took us to the basement, and then the sub-basement, but no one laughed when it stopped and the doors didn't open. No amount of button mashing did anything; we were stuck. Senpai and I still had cell phone coverage (yay, Sprint!), though no one else did. I called the NICU to let them know we wouldn't make it in time for Poppy's noon feeding. Senpai lent his phone to the older lady to call her family in the ICU. Senpai also leaned over to use the emergency phone that had been installed in the bottom of the elevator's control panel. Help was on the way! Twenty minutes later (there's that patience again), we occupants were relieved when the elevator started moving up to the third floor. It stopped there and opened its doors. Senpai and I dashed out, taking the stairs the rest of the way.

Poppy's noon feeding was delayed, but thankfully we hadn't missed it. She ate well again! Without a nipple shield! Her eyes were even open: two beautiful dark eyes that we hardly ever see. Rosemary's eyes were dark in the NICU, too. They're now gray, so who knows what color Poppy's eyes will be.

When Senpai was leaving, he noticed his wedding ring was missing from his pocket. You aren't allowed to wear jewelry in the NICU. I had taken my wedding ring off when my pregnant fingers got too swollen for it, and I'm not bothering to put it back on until Poppy comes home because I don't want to risk losing it. Senpai has no reason not to wear his aside from the NICU, and he isn't there nearly as often as I am, so he just sticks it in a pocket. We searched the floor of the NICU, and were resigned to going back to the lunch restaurant where he had pulled something else out of the same pocket, when it occurred to me: the elevator! He had to lean over to use the emergency phone, and the ring had been in his chest pocket. We  pushed the button and waited in front of the bank of three elevators. Would the middle elevator-- the one that had trapped us-- be the one to open? More waiting, and yes! The middle one opened. Senpai jumped in and found his Tungsten ring obscured against the carpet. He immediately jumped out. Having enough to do with that particular elevator, we took the stairs down.

I was just following him out because I needed the exercise. I was going to stick around the hospital for Poppy's next feeding, but I was alarmed to discover my blood sugars rising in a scary fashion. I drained a large cup of water in the cafeteria. The numbers kept rising. My heart throbbed in my chest and I knew ketoacidosis was starting to set in. What to do, what to do? There were no lemons available to neutralize the acid flowing through my veins, I had no extra needles or insulin on hand to deliver a saving bolus of medicine, and I was certain that the fresh infusion set I had inserted this morning was bad. I trudged up the five flights of stairs, needing the exercise then more than ever, and was relieved when Poppy was too sleepy to breastfeed. I had tried to put her to my breast, but she stayed in her dreamland. I laid her back in her crib and let the nurse gavage the entire feeding.



It was difficult to drive home. I was so thankful to pull into the garage, and even more thankful when my Dad handed me a large mug of freshly prepared lemon water. I was able to inject insulin via syringe, put in a new infusion set (the one from the morning's catheter had kinked inside me), and gradually get my blood sugar back under control. I missed out on the trip to take Rosemary to Monkey Joe's, but I appreciated the opportunity to finish "Catching Fire," the second book in the Hunger Games trilogy.

So those were today's adventures. Maybe tomorrow will be.... less interesting?


In other news, yesterday Poppy was moved to the isolation room. A swab culture found MRSA inside her nose. She is not infected, herself, but as a carrier, she still needs to be separated from the other babies. I am less than thrilled with this development, especially since over the last few days she had been cared for by nurses who also tended to the isolation room babies. Where did the MRSA come from, hmmm? She now has to stay in the isolation room for the remainder of her stay in the NICU, and Senpai has to wear a gown and gloves to hold her. I would scratch eyes out if someone told me I had to wear a gown and gloves to touch Poppy, but since I breastfeed her, they figure there's no getting around it. I just have to wash my hands really well before exiting the room. I am not pleased with this development. More reason to get out of there fast.


"H" is for "H'isolation Room."

19 Days

Yesterday was 18 days, the time when Rosemary's feeds were changed to "On Demand." Tomorrow will be 20 days, the day on which Rosemary was discharged.

I was really hoping that Poppy would be out of the NICU sooner than her sister. I thought Poppy's larger size and already having a sucking reflex would accelerate her discharge, but unfortunately, it's the opposite. Her excess weight makes her sleepy as her brain tries to catch up with her size. Her sucking is disorganized. The Cookie is not ready to be placed on feeds by demand and certainly isn't ready to come home.

How much longer? It's all up to her. She had done really well last week, waking up to receive at least partial feeds most times. Over the weekend, though, she conked out. The nurses said she ate during the nights, but she slept through all of the daytime feeds. I couldn't help but cry. It was so hard to see her get ahead and then stop. The doctor reminded me that she's still growing and needs to conserve her energy to do so. The doctor also gently hinted that maybe I needed to take more time away from the hospital for myself. She's right. At least until Poppy starts consistently waking up, I don't need to be there so often. It's hard to stay away, though.


Our Sleeping Beauty

Empty Arms

Poppy is 35 weeks old today. Look, isn't she beautiful?


I've lost the pep in my step. Tears spring up in my eyelids and I blink them away. When I'm smart, every meal includes coffee, not only to keep me awake, but also to inject some life back into this empty shell. Mostly, it just makes me feel jittery. But that could be the low blood sugar.

Walking by pamphlets displayed on the wall, "Heart Screening, Schedule Yours Today!" My heart is on a schedule. Hold and try to nurse Poppy at 9:00, noon, and 3:00. Turn off my heart while I pump, use the restroom, and eat something in the hours between. Go home. Light up at the sight of Rosemary lighting up for me. Figure out dinner, pump through the night, then start again the next day. This is getting old.


The variety in my day comes from choosing which restroom to use.

"It won't last forever," my Mom tells me over the phone. I know. That's the thought I pull my strength from. But it's 4:30 and Poppy is wide awake and actively rooting. This is a problem. It isn't one of her doctor decreed scheduled feeding times. As a mother who chooses to nurse on demand, it kills me. She was sleepy and did not eat at the previous three feedings that I struggled to give her (please just suck, baby, please), and here I see her, practically begging to have a nipple put in her wide mouth, and I'm not allowed to. I put my pinky finger in her mouth and gently stroke the tongue to help her learn how to coordinate her sucking while my heart shatters on the floor.

Senpai's boss gave him the day off today. I must admit I am jealous. I don't get days off from this. Looking forward to the day when I can bring my work home with me.

The Long Drive Home

Emotionally I'm (mostly) okay with Poppy being in the NICU, but physically I'm getting worn away at the seams. Today was tiring. From the four hours of sleep last night (gotta wake up to pump), to a sibling meeting with another baby in Poppy's section gone awry ("I don't like my brother!"), to a neurotic nurse who is seriously OCD, and feeding disagreements with the doctors, today has been a loooooong day.

When it came time to go home, I made it back to my car in the parking garage, sent Senpai a text asking him to take care of dinner, and then.... I dropped my chair back and took a nap. Senpai called an hour later, "Are you out of the city yet?" Umm, not exactly. I worked the kinks out of my neck, raised the seat up, turned on the engine, and started the long drive home.

9-5 NICU Mom

Here she is!


I'm settling into my new gig of being Poppy's NICU Mom. Every morning I drive through rush hour traffic into the city, scramble to find a spot in the parking garage, rush to Poppy's bedside, then start the routine of feed, pump, and eat that cycles in three hour increments throughout the day. It's quite enjoyable, actually (minus the commute), but I should really bring my phone charger; my poor phone's battery can't handle being my sole source of entertainment all day!


I've got to say, I feel like an old hand at this. Senpai feels it, too. We've got a "been there, done that" nonchalant attitude about Poppy being in the NICU (we earned our stripes with Rosemary after all). I was not thrilled with the spinal tap, but otherwise, Poppy's development as a preemie is right on track. Since I've got experience to share, I figured I'd put together some pointers for new NICU parents.


GUIDE TO BEING A NICU PARENT

When it comes to premature babies, the goal of the NICU is as follows: intervene as medically required, and then slowly remove those interventions until baby can thrive on his own. The three things that all babies must be able to do before they will be sent home are:

1. Control their own temperature.
A baby should do well to be lightly dressed in a 70º room. Preemie babies initially need help holding their temperatures, especially in their hands and feet. They will be put on warming beds or into isolettes until they've got it down.

2. "Nipple" all feedings.
Nipple in this case is used as a verb. Whether the baby takes her food from a breast or a bottle, she must consume enough calories around the clock to meet the final goal.

3. GROW
Eating and controlling temperature use calories. The baby must have enough food in his tummy to do both those things, and still have plenty to spare to grow big and strong.


Here are some tips that will help you feel more involved in your baby's stay.

1. Know Your Nurse
So what do you do while in the NICU... just stare at your baby? Well, yes, depending on baby's level of prematurity. Even if baby is in an isolette, you may be able to at least change her diaper. Just ask the nurse. The worst she can say is no, but she might even say yes. And guess what? Every nurse is different. Just because yesterday's nurse said no, doesn't mean today's nurse will, too. Doctors make the orders, and it's up to the nurses to follow those directions, but not everything (such as being able to hold your baby) is set in stone.

2. Know What You Want and Tell Everyone
Let's say that it is very important to you that baby learns to breastfeed. If you're a regular reader on this blog, you know that to be true for me. What am I doing about it? I am telling everyone. Every nurse, doctor, and lactation consultant in this NICU knows about my struggles with breastfeeding Rosemary, and my desire to get it right this time with Poppy. I may sound like a broken record to myself, when I think of all the times I've had the same conversation with a different person (Poppy hasn't had the same nurse twice yet!), but I would much rather that than the alternative of nobody knowing and my wishes not being granted.

3. Talk to the Doctors
This point seems obvious, but I'll be honest with you, I did not do this so much with Rosemary. I would hear the doctor's orders from the nurses and then leave it at that. I assumed that the doctors' wills were set in stone, and nothing I could say would change that. That is not at all the case. In this NICU stay, I have already convinced the doctors to not add a mandatory bottle after a breastfeeding session, have increased the number of breastfeeding sessions, and turned down a spinal tap. They ended up talking my husband and I into the spinal tap anyway, but at first I said no. Do you see the pull you can have in your baby's growth and development? All of this is possible because I am there for the morning rounds (see below), I put a sticky note with my contact information on Poppy's bed, and I give every opportunity for these dialogues to happen. You should, too.

4. Attend Morning Rounds
This is when the doctor goes over the notes from each baby and determines their plan of action for the day, such as administering which medicines and removing what aid. If the parents are present, the doctor gives them the opportunity to ask questions and ADD THEIR INPUT. The second part of that sentence is very important. You may not be a medical professional, but you are absolutely just as much a member of your baby's care team as everyone on staff. You have a say in how your baby is handled, so say it.


There you go. I know being a NICU Parent is not a job anyone would willingly apply for, but you don't have to feel helpless or out of control. He's still your baby, and you're still Mom (or Dad). Much love and strength to you.

Nippling Day

Today was a much better day than yesterday. I got to hold Poppy three times! Each time, we tried to breastfeed. I had the help of two different lactation consultants for two out of the three feedings, and the consultants were impressed with Poppy's latch each time, though the little lady quickly passed out before any breastfeeding was done. She isn't used to being held, and took a little bit too much comfort in it. :-)

Thankfully, the nurse today was extremely patient with us. Oh, how well a day goes depends heavily on the nurse! The nurse explained that Poppy is still getting a lot of nutrition from the TPN (electrolytes: baby Gatorade) and lipids going into her IV, and that will prevent her from being and acting hungry. So now we get to play the slowly-cut-back-IV-fluids-and-monitor-growth game, hoping that she learns to eat well enough to replace the IV fluids. I just hope we can find the point where she is sufficiently hungry enough. I foresee challenges in this arena...

Mother's Day

Today was my third Mother's Day. Out of the three, I can say with certainty that the first was the most joyful: Rosemary was home from the NICU and I was basking in the joy of being a new mom. Last year, tragedy struck and a massage school classmate (a mother herself) was killed by a drunk driver on Mother's Day. This year, Poppy is in the NICU, and not only that, but today she received a spinal tap.

I hate that it happened. The doctors and nurses used scare tactics, "Apnea! Brachycardia! She might have an infection! We need to rule out meningitis!" Yes, meningitis is scary, yes, it causes serious damage if left untreated. But did I honestly believe for a moment that she might have meningitis? No. The blood tests to rule out other infections came back negative. Though the results from the spinal won't be known for the next couple of days, the fluid itself was clear. I love how the doctors revealed AFTER the spinal that if there's no infection they'll just give her shots of caffeine. What??? Yes! Please! I would much rather have my baby hepped up on caffeine than have her stuck with a needle in her spine and the precious fluid pulled out!!!

Gah. It kills me. I just have to remember that little harm was done. Senpai was right there with her when they did it (Mommy hid in a back room pumping breast milk), and he said she barely blinked an eye. She was even more alert and active after the procedure than we'd seen her this whole time. The final clincher was when she started sucking on her pacifier. She had avoided it before, but today she kept working her little jaw and appreciated having something to chew on. It gives me hope that she might be able to eat sooner rather than later. I hope.

Happy Mother's Day.


UPDATE 5/17 - We learned today that there is no sign of infection in her spinal fluid. Caffeine was started the day after the spinal and she has not had any episodes of apnea since then.

Here We Go Again

The soft lullaby music plays in the background, and I cherish the moment I hold newborn baby Poppy in my arms, and stroke her soft cheek as she drinks hungrily from my breast. It's a beautiful moment, except that it hasn't happened yet. The soft piano music plays, yes, but it comes from the laptop computer on my legs, as I type a blog post with one hand and hold pumping apparatus to my chest with the other. This isn't the way I wanted it to be. I didn't want to be here again. But here I am.


Poppy was born at 33 weeks, just like her sister, Rosemary. There was no HELLP Syndrome this time, no pre-eclampsia, just a month's worth of contractions that had been slowly wearing away at my cervix. I created an excuse, any excuse, to go to the Women's Evaluation Unit (WE-U) at my hospital on Monday night and have them check me. Even though my doctor's office was happy with the results they got from my twice weekly non-stress tests (NSTs), I knew something was wrong. The contractions stopped with my Procardia medicine, yes, but they kept coming back when it was time for the next dose. They always came back. So I went to the WE-U with the concern of "unexpected weight gain." The nurses gave me incredulous looks.

"How far about were the measurements?"

"A week."

"So you're concerned that you jumped up 6 lbs in one week, using two different scales?"

"Yes."

They took me back to a room anyway and hooked me up to the NST equipment. A female doctor with dainty little hands checked my cervix and found it to be closed. She didn't know what to do except send me home. Thankfully, her shift ended, and a new doctor took over my case. This male doctor with long fingers wanted to check me again before sending us off, and he found me to be.... 3.5 cm. THREE POINT FIVE is a BIG difference from "closed." I don't blame the female doctor for her anatomical deficiency, but she was the same doctor who checked me when I went to the WE-U the month before, when the contractions had first started. What would someone else have found then instead of her? Would Poppy have stayed in my womb longer if we had known last month that my cervix was already starting to open? I don't know, but it rubs me the wrong way.

In the hospital

Poppy may not be so far away after all. It is taking every effort of my strength to type this as I am on a high dose of magnesium sulfate and currently resemble little more than a lump on a log. But this lump is still contracting fairly regularly and strongly. There is no sign of pre-eclampsia, no sign of HELLP Syndrome, but my body is still trying to push this girl out at 33 weeks, just like her sister. I'm dilated to 4 cm and 50 percent effaced. Please wish us luck.

SUPER MOON

The Super Moon is coming....

Image from geek.com

Yes, I am scared.

You can tell me that past events do not predict the future, but I won't believe you until this full moon is over. R was born on a blue moon at 33 weeks. Tomorrow, we have a super moon, which "will exert 42 percent more tidal force," and oh, guess what? P will be 33 weeks.

My blood sugars have also dropped as of yesterday, so I was online looking that up: Do a sudden onset of low blood sugars mean labor is about to start? The answer appears to be no; it's just the normal curve of insulin resistance in pregnancy that usually happens after 35 weeks. So why is it happening to me now?

I was at the doctor's office this morning for the second non-stress test of the week. My blood pressure was normal, but P's pulse was 10-20 points higher than it has been. The nurse considered it to still be within normal range and wasn't the least bit concerned, but I see it as one more thing that is "off." That makes me concerned.

Valid Reasons to be Concerned

First, we saw her face!!! Though she has been more than eager to show off that she is a girl, Poppy has buried her face deep into my pelvis during every ultrasound. Which is a lot. I'm up to weekly ultrasounds now, people. Well, Tuesday was a good day; the ultrasound technician printed off picture after picture of my girl's chubby little face. <3

This is the best one. Though she is squished up against the placenta here, at least her fingers aren't protruding from her forehead like demon horns. >:-(


Speaking of chubby.... girl's measurements are off the chart! My huge belly confirms this: Poppy is a BIG baby. This leads us to some problems with delivery, of course. My doctor's plan is to keep monitoring her growth (hence the weekly ultrasounds), and do an amniocentesis at 36 weeks to check her lung function. If her lungs show to be well developed by then, we'll be induced. If she needs more time to ripen, then I will most likely have to get a c-section closer to her due date. I've got my fingers crossed for strong, healthy lungs for the little miss (and I hope you do, too!), because I am terrified of getting cut open and having my milk be delayed coming in and ruining our chances of breastfeeding. This is my last baby... I really hope we can do it this time. Get it right this time. I hope.

In order to maximize our chances of breastfeeding, I wrote out a birth plan. I showed it to my doctor on Tuesday and she signed off on it, agreeing that the requests I made were do-able (under ideal conditions, of course). I asked for all the new age mom type stuff: no epidural, no episiotomy, immediate skin to skin contact after baby is born, don't cut cord until it has stopped pulsing, delay tests and evaluations by an hour, no eye goo, and no baths. I've done my research and all of these points make sense to me. I'm looking forward to my ideal birth scenario. I won't be crushed if complications arise and it doesn't happen all sunshine and roses as I'd like, but I do still like to believe it could happen this way.

An early delivery would throw a wrench in plans by adding a NICU stay to the equation. I got scared and freaked out on my doctor at the end of the appointment Tuesday. The nurse had reminded me that headaches and blurry vision were signs of pre-eclampsia, and wouldn't you know it, as I sat there under the fluorescent lights I started to get all fuzzy-eyed and tense in the brain. Compounded to those sensations are the facts that there will be a FULL MOON at the end of this week correlating with Poppy turning 33 WEEKS gestation (same conditions Rosemary was born under). Yeah, I was freaking out. My doctor talked me down, reassuring me that my blood pressure was still fine and there was no protein in my urine; everything looked good. She also reminded me that I can call or visit the office at anytime. She said most moms get jumpy around this time, but, being high risk, I have valid reasons to be concerned.

Lying here on the couch, gulping down water, waiting for the Procardia to erase these contractions that like to pop up every so often, yeah, I'm concerned.