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.

the NICU post

(Are you a new NICU parent? Read here for tips about what to do during your baby's NICU stay.)


I go more in detail into the birth in a previous post, but I'll start here with a quick recap: Rosemary was born at 33 weeks gestation. With the full moon, my body tried to push her out. The doctors were able to stop the contractions, but my liver fought back in the form of HELLP Syndrome, demanding that the baby get OUT. Start up the pitocin; my body couldn't handle being pregnant anymore. That's how my baby was born.

She had received the steroids for her lungs while she was still in utero, so she came out with a healthy cry. At least three of the many people in the operating room focused on her as soon as she came out. Is she breathing? How's her heartbeat? Any liquid in the lungs? Very fast-- within a couple of minutes-- she was cleaned up, wrapped up, and brought over to me (though still out of reach) to see that sweet, tiny face for all of one second. Just as fast as they brought her over they took her away, out of the room, down the hall, to NICU. Senpai asked if he could follow, and then my family was gone. Being left behind, without either my husband or newborn baby in the delivery room was an intensely lonely feeling that tasted bittersweet. My thoughts were along the lines of, "I carried this baby for seven months, I've been in pain for her, I just delivered her, and now... I can't see her." I clung to the image of her little red face, already fading in my memory, as I was taken back to my room and monitored by the nurses. She had been born at 9:29 pm. When I still hadn't seen her two hours later, I demanded to be taken to her. I touched my baby for the first time at 12:20 am.

First trip to the NICU.

Entering the NICU, it was so uniquely different from the rest of the hospital. People had to be buzzed in, signed in, watches and jewelry removed, and hands and arms scrubbed with disinfecting soap up to the elbow (I just remembered the smell of the soap). Children, the little germ harvesters that they are, were not allowed in. Parents and two family members (that you choose, but must specify on a form) were the only people allowed to see the baby, but only two at a time.

The NICU was divided into different sections with varying levels of care, labeled from A to G. Rosemary started out in an open bed in the last room, G. After the first night they then moved her to an incubator (they call them "isolettes" these days) against the wall to the right when you walked in the door. The first time I saw her in the NICU, she was on her stomach in her open bed, breathing with the help of a respirator tube. I wasn't worried. I knew she had received the steroids for her lungs, and I had heard her healthy cry after she had been delivered. I think I was also too tired to be worried. I was just so elated to finally see and touch the tiny 4 lb 13 oz little girl that had made my uterus her home for so long. I was taken back to my room after only about 20 minutes because I was starting to fall asleep in the wheelchair.



I was not one of those Moms who spends every minute in the NICU. I was still healing for one, very exhausted, trying to get my body's systems back to normal, and two, I believed that the doctors and nurses in the NICU were taking good care of my baby. She wasn't sick, she just wasn't meant to be out in the world yet. All she needed was to grow and learn how to eat, otherwise she was a healthy little camper. She would forget to breath sometimes, and for that she was put on a daily caffeine injection. I never saw her get stuck with anything. I would see the aftermath-- a new IV line in her head, little red spots on her hands-- but the nurses did the dirty work when the family wasn't around. I'm sure seeing her in pain would have broken my heart in two.



Senpai got to hold her first. I wasn't there to see it, but he came back to my room looking so excited. The first time I held her, maybe two days after she had been born, was so magical. She was itty bitty and warm, and red like a little lobster from the jaundice.



Under the bilirubin lights.

I think it was the fourth day when Senpai came back into my hospital room after visiting Rosemary in the NICU and said, "They want to start putting clothes on her." I looked over at the duffel bag we had packed with things from home, inside of which I knew was a teeny-tiny sweater I had crocheted while I was still pregnant. I had followed a pattern, but even with using a larger hook size the gauge came out incredibly small and the sweater looked like it could fit a doll. I had shaken my head at the microscopic sweater when it was completed, wondering how it would ever fit a full-term baby. There in my hospital room, I felt foolish all of a sudden for wanting to put it on her. Senpai had asked me before if he should bring it over to the NICU, but I hadn't wanted him to, I don't know why. It wasn't until the "order" as it were came down from the nurses that I knew she needed that sweater. We went right over, me clutching the smallest little sweater in the world, and miraculously, it fit her. That sweater I made was the first piece of clothing my baby ever wore. There was a matching hat, too, but it wouldn't fit over the IV line they had just put in her head.



The first way her Daddy and I got to care for her was to change her diaper. I don't know about Senpai, but I felt odd doing it at first, like it wasn't my place. I thought, "The nurses handle everything, feeding, diapering, changing bed linens, etc... Who am I to care for my baby? Wait, I'm her mother. I'm supposed to be doing this anyway. But she's in their charge; they make the important decisions, not I. Oh well, just change your baby's diaper, already!" That's how my head struggled with the facts. But the more we did it, of course, the more comfortable we became being Rosemary's parents.



My Mom and Dad drove up from Florida after Rosemary was unexpectedly born. Mom was able to stay Easter weekend, but she had to return back to work after that. Dad is retired, so he stayed with us the entire time I was in the hospital and even later. I was discharged after a week, but Rosemary was still in the NICU. It was strange.. I was discharged home without my baby. I am so grateful to both of my parents for being there for me when I was weak. Senpai, too, of course. But it would have been really hard if Dad hadn't stayed longer. He helped around the house, drove the 26 miles when I was too tired to do it myself, and kept me company while Senpai was at work. He was glad to help, but he was also happy when Rosemary finally came safely home, so he could return home, too. Thanks, Dad.

I pumped breastmilk to go into her tube, but her little body needed more nutrition than I could provide at first, and she was given formula as well. It was actually more like she was given formula plus the little bits of colostrum that I produced. I put my heart and soul into pumping, waking up every three hours even into the night, trying to rev up production. It wasn't until after I had been discharged home that my breasts finally produced enough milk so the NICU staff could feed her breast milk alone without formula. I was so thrilled to get to that point. I worked with a lactation consultant to try to breastfeed, too. One day I was trying to breastfeed Rosemary behind a screen when I could hear the doctor going over Rosemary's chart with the nurses. A male nurse relayed that Rosemary didn't tolerate formula well, and the doctor got the wrong idea, thinking that I was stopping giving her breast milk. The female doctor became all bullish all of a sudden, "Where's the mom? She's here?" and she poked her head over the screen, while I had my baby to my breast, and demanded to know why I wasn't breastfeeding. I just looked at her incredulously. It's humorous now. I'm glad they had Rosemary's best interests at heart.



Even though the breastmilk was there, getting her to ingest it for herself was a tall mountain to climb. She was born before her sucking reflex had developed. Every day the nurses, Senpai, and I would try to put a bottle in her mouth, just to have her mouth form an "o" from which she would poke her tiny little tongue out. It was the cutest thing in the world. I said, "That's adorable, Sweetie, but it's not going to help you eat." When she finally did learn to suck, it started as only one or two little sucks and then she would stop, mostly from exhaustion. The rest of the bottle had to go down her feeding tube. Gradually she started to drink more and more, still never finishing her bottle. She was just too short on strength and energy. When she had been there for 18 days, I finally broke down. When I got there I learned that the nurse that day had put an entire bottle down her tube, without even trying to get her to drink it. That was the standard procedure-- If a baby doesn't do well for one feeding, just tube feed the next-- but I was ready to punch her. They wouldn't send Rosemary home on a feeding tube, and she wouldn't be rid of the damn thing if they kept using it without even trying to get her to drink the milk for herself. I expressed my concerns to the nurse in the nicest way possible without actually punching her. She went and found the doctor-- a nice Asian fellow, not the bull woman from before-- and after hearing what happened he changed Rosemary's feeding schedule from every 3 hours to... whenever she was hungry.



This simple directive made an unbelievably profound difference. What a brilliant idea! Feed the baby when she's hungry! And, oh man, she ate SO WELL after that. It turned out that every 5 hours was her personal schedule. The NICU staff squirmed at that timeline, not really liking the idea of pushing feedings beyond 4 hours, but it was so good for her. She wasn't eating at 3 hours because she was still tired! She was supposed to be sleeping then according to her own schedule, but here were these nurses prodding her awake and forcing a bottle in her mouth, expecting her to chug it down. But when she was hungry, 5 hours later, she finished the whole bottle, every single one of them. She was discharged a day and a half later.

 

Good Blood

"The tests came back negative. You are fine," says the Indian doctor with her beautiful accent.

"So, from your standpoint, I'm not likely to get HELLP again in a future pregnancy?" R, learning to sit upright on her own, holds onto my hands and sways unevenly on my lap.

The doctor looks at R. "You are planning to have another?"

"Yes."

"You had HELLP before, so there is a 15% chance it will happen again. But you have no Lupus, no protein s deficiency. Your liver levels have recovered. It probably came from your diabetes."

Yeah, like that's going away...

"Talk to your endocrinologist. And wait. What is her name? R? What a pretty name. Wait until she is two years old."

"Oh," I say. Please say her name again, you make it sound like music.

"But you are fine. I don't need to see you again." She walks me to the checkout counter and has the nurse make me a copy of the blood test results. I buckle R into her carseat and smile inside knowing that she has a chance for a sibling. Someday, hopefully not too far away. <3

Tomorrow: A Loaded Word

I go to the hospital tomorrow to have blood drawn for a test that will tell the specialists if I'm predisposed to get HELLP again in subsequent pregnancies. I only want one more, just one more, but I'm scared that I may not be able to have another child. It's not that I can't conceive the child-- Senpai and I had no problem producing Ms. R-- it's just that my body couldn't carry her full-term, and if that's the case for a future pregnancy, then the docs won't allow me to get pregnant. And I should listen to them, because they have my best health in mind. But... I want another child.

Growing up, it was always so reassuring for me to have my brother. I was so shy and had a hard time making my own friends, but I didn't feel alone because he was my friend. I'm sure there must've been times when he'd wish I would just leave him and his friends alone, but I wanted to play, too. And he let me. I have wonderful childhood memories because of my brother. I was (still am, I guess) a "one of two" child. I don't know how to be an only child. I can't relate to R if she has to be an only child. I really want her to have a sibling.

I want a son. I am so thankful to have my daughter who looks like me; I want a son who looks like his daddy. Black hair, deep brown eyes, olive skin... our little boy. I know adoption is always an answer, but I foresee so much stress and anxiety with that choice. I don't handle stress well at all. (Umm... why am I having kids? nervous laugh..) Sigh...

Tomorrow. Blood gets drawn. Wait. Results known later.

The stress is already here.

She Grieves

Even though I have no reason to be up this late anymore, tonight I just can't sleep. I learned tonight that a pregnant friend had attended a Le Leche Club meeting, and it was an emotional tipping point for me. I have not yet grieved for my inability to breastfeed. It stabs me in the heart each time I hear about my friends breastfeeding their babies. I really wanted to be able to do it, too... I really wanted to do it. I sit here trembling and tearing up over the injustice of it, and I need to let this go. Just let it go.

I couldn't help that R was born premature. Before actually going through it myself, I had thought that the women who developed preeclampsia had been under too much emotional or work-related stress. I thought if I just quit my job and took it easy during pregnancy, then preeclampsia couldn't happen to me. I mean, I was a massage therapist for all that matters! Aren't massage therapists supposed to be the relaxation EXPERTS?? But even though I had stopped working and wasn't under emotional stress, I hadn't considered physical stress. I've been a type 1 diabetic for over 20 years. Poorly controlled. I may have a clotting disorder called protein s deficiency [Update: the test for protein s deficiency came back negative. See here]. Hypothyroidism. Even though I try to eat well and exercise, you can't call me healthy. So this time around (it's not for certain that it'll happen again) my body could not handle pregnancy. HELLP Syndrome manifested, and that baby had to get out... to save us both.

Instead of staying in my bed after birth, nuzzled up against my chest, learning how to suckle from my breast, R was in an isolette in the NICU, being reminded to breath with caffeine, and receiving her nutrition from a tube down her throat, while I was in my hospital room, sleeping all day long and recovering from a taxed liver. I was able to pump breastmilk, the supply was there for her, but she was just as tired as I was. Getting her to drink from a bottle was such a challenge. The strength and stamina simply were not there for her to breastfeed. As she grew, I started working with a lactation consultant at the hospital, and we thought we had it. We really thought we had it. Until she came home.

I was so tired of pumping, and so thrilled to have my baby home, that I did not want to continue. No more pumping for me, I've got my baby now!! So I stopped pumping, and I did not give R supplementary bottles. She's breastfeeding! She doesn't need bottles. After a rough week of endless feedings, nonstop for hours on end, and a disgruntled and very sleepy baby, I called the lactation consultant and she said R was still too weak to breastfeed. I needed to wait at least until her due date, which was three weeks away. That was not what I wanted to hear... it was back to pumping, back to bottles, and even back to formula since my milk supply had diminished.

By the time R's due date came around, she had completely forgotten about my breast. Plastic was more familiar to her than skin, and bottles delivered the milk so freely and easily. She didn't want to breastfeed. I made an appointment with another lactation consultant. This woman helped me get R to latch on, but she also propped me up with lots of pillows and took care of burping R who was just getting into her colic. There was hope during the appointment, but it was so hard to then take R home and do it all by myself. I had to squish the pillows underneath R who was already in my arms, hope I had the positioning right, try to calm her down, and then toss all of the pillows aside so I could stand up and bounce her to try to settle her/remove gas. Wash, rinse, repeat... give up, give the screaming baby a bottle.

It was so hard to keep trying because she escalates so fast. She doesn't just cry, no, she'll cry for all of one second before suddenly she's screaming at the top of her lungs and I'm wondering where the mute button or at least volume controls are. I'll be deaf before I know it. Breastfeeding this baby is nothing short of impossible. It will take a miracle. I don't know where to find a miracle.

If I were Pollyanna playing the glad game, I can be glad that R is healthy. I can be glad that R is getting my breastmilk. I can be glad that R has learned to drink from a bottle. But my heart still grieves the lost and missed experience of breastfeeding. It's the one piece of the puzzle that somehow doesn't even fit anymore. I wish it would.

The Birth of The Cupcake

On Friday, March 26th I ate a large, late (9 pm) dinner, and I knew that it wouldn't let me sleep while it was still digesting. Heartburn hit, so at midnight Senpai went to bed and I stayed up. At 2 am I woke up Senpai with some alarming news, "We need to go to the hospital." A blue moon was on its way and contractions had started.

It had happened before: I had started contracting for 30 seconds out of every minute on Thursday, February 26th. On another full moon. You can’t tell me that’s not weird. The baby was 29 weeks old then. The cure at that time had been IV fluids because I must’ve been overly dehydrated. I am fully convinced that if I had not delivered Rosemary in March, contractions would have started up again on the next full moon in April.

We went to Belleville Memorial, the hospital in our area that I had planned to deliver at. A pelvic examination found me to be 2 cm dilated and 50% effaced. They injected me with one of two doses of a steroid to help baby's lungs develop, just in case. Since the pregnancy was only 33 weeks along though, by 11 am Belleville had put me in an ambulance to transfer us to St. Mary's Hospital in St. Louis, because they have a NICU. Once at St. Mary's, a team of doctors named Bulgar, Wheat, and Vlastos diagnosed me with something called HELLP Syndrome. Dr. Vlastos described it as two steps above pre-eclampsia. I was started on an IV drip of Magnesium Sulfate to act as a muscle relaxer for my uterus, and also to prevent the onset of seizures. It also made my skin hot and gave me double-vision. I was put in a small room (it had originally been a closet) with every intention of being watched for the next couple of weeks until I'd be more ready to deliver. Senpai and I buckled down for the waiting game it seemed like we'd play. I honestly hoped it wouldn’t be too long, though, because it was very hard to entertain myself by reading books or watching movies with blurry, double-vision. While at home we had been watching "Avatar: The Last Airbender." We were so very close to the end of the series and Senpai insisted we continue watching the DVDs in the hospital, but I could only get through an episode or two before my eyes gave up trying to focus. On Sunday morning I got the 2nd dose of steroids for Rosemary's lungs.

Sunday night, leading into Monday, I did not sleep a wink for thrashing around on the bed, moaning and screaming like a banshee. My liver felt like it was going to explode and there was nothing the nurse could do for me. The funny thing is that Senpai did not stay with me that night. He had called the nurse's station in the morning to ask how I was: "Oh, she's fine," was the answer, of course. I called him at work at 7 am with some different news, "Come! Now!" was pretty much what it boiled down to. I had hoped to catch him before he left for work that morning, but, in my pain and delirium, that did not happen.

On Monday morning the doctors all conferred and started up pitocin; the only cure for my pain was delivery. After the hellish night I’d just experienced I was in no mood to go through labor. I REALLY wanted a C-Section, against my better judgement, but my platelets and other clotting factors were not ideal for major surgery. If you look up HELLP Syndrome on Wikipedia, it’ll tell you that the most extreme classification is when the patient has a platelet count of less than 50,000; I got as low as 15,000. I was at a loss: I could barely suck in a full breath of air due to the liver pain, and they wanted me push a baby out?? Somehow it did get easier to breath, and I slept away the first labor pains in the new, large room they had moved me to; I was too exhausted to let those little contractions bother me. Later in the day, after I woke up for good, I moved over to a birthing ball, and that helped me through the rest of the contractions. My laptop was playing my soothing Tibetan Singing Bowl music. Senpai asked if he could turn on the TV. Ha ha, no.

Around dinnertime, at 6 cm dilation and 80% effaced, the doctors wanted to break my water. I knew once that happened things would start getting ugly, so I asked for Stadol. I couldn't have an epidural due to the steroids I was on, and I had psyched myself up throughout this pregnancy to not have one anyway, but I still wanted something to take the edge off. They broke my water (it was clear, yay!), I felt that first lousy contraction, and then they injected the Stadol into my IV line and I felt like Alice in Wonderland. It's hard to describe. It's not that I passed out, or went to a "happy place," but I drew away from the craziness and sucked on my reserves until I was needed... everything else just faded into the distance. The hard part was not pushing. Because Rosemary would need extra care once she was delivered, we had to wait for an operating room to be made ready for us, instead of just delivering in the room we were in. Once in the OR, Senpai said at least a dozen people were all gathered around the bed, waiting for the big show. Because I had not been given an epidural, exactly when to push was left up to me, which I very much appreciated. Little jokes were tossed around the peanut gallery between my efforts, but I barely noticed (Senpai said he had asked the docs, "So if you're all here, who's delivering the other babies?"). Each time I whispered, "Push," the nurses and Senpai had to convince me to tuck my chin to my chest; it was just so easy to let my head loll back against the bed. Finally, within only a half hour of pushing, Rosemary came forth. I felt her little body slide out of me with no pain whatsoever, only relief.

She was immediately taken to the other side of the room for close monitoring. It’s amazing how I was there, yet, through my position and exhaustion, I can’t exactly say I witnessed my baby being born. Senpai, wearing his blue scrubs, was able to go over and snap pictures (he tells me he cut the umbilical cord), while I still lay there with the doctors convincing me to deliver the placenta. I couldn’t pay attention to them because my heart was on the other side of the room. At the next contraction, it felt like someone actually grabbed the cord and ripped the placenta out of me. Whether or not that happened, I can’t say for sure, but it felt disturbing.



A nurse brought my baby over for me to see: she was bundled up tight in her wrappings, and all I saw was a red little face and lots of fuzzy hair under her stretchy hat. The nurse held her far enough away that I couldn't touch her. Within that short moment she was quickly whisked away to get settled into the NICU. Rosemary was delivered at 9:29 pm, and I didn’t get to touch her for the first time until 12:20 am. I was physically at the end of my rope, but, alone in the big room once again, I was determined to see my baby that night. After the nurses had checked me out and put me back together as best they could, I made them move me to a wheelchair and wheel me down the hall to NICU.

Rosemary was splayed under a heat lamp in a large, open bed. The bed was higher than my wheelchair; I had to raise my elbow over the edge of it to touch her. I don’t remember noticing it at the time, but in pictures of that night she had a breathing tube attached. We hadn’t been there for too long before I started to pass out in the wheelchair, and the nurses wheeled me back to my room. I’ll never forget the names of those wonderful ladies who took care of me that night: Susan and Yolanda.



The next morning, Tuesday, the day nurse learned of my intention to breastfeed. A breastpump was wheeled in and I was instructed in the use of it. From that point on, pumping 15 minutes every three hours would become part of my daily routine. I had trouble learning how to pee again. I was being pumped full of IV fluids, but my bladder didn’t want to empty on its own; my body was swollen as all heck. I was given a shot of something called Lasiks that helped me go again. Since the baby had been delivered, the doctors took me off the steroids they had used to raise my platelet count. That night I once again experienced the excruciating liver pain. Susan and Yolanda were at my bedside as I whimpered, "10! 10! 10!" This time they could give me morphine. The morphine melted the pain away within seconds, but it also disappeared after what seemed like only a minute; I was surprised at how quickly it wore off. They gave me two doses of morphine, then one dose of some other painkiller, before deciding to start the steroids again. The pain went away and I was able to mercifully sleep.

I was still in that big room in the Labor & Delivery ward. Every time a new day nurse took over my case, she was always surprised that I had delivered already. I was kept in that room sleeping, pumping, eating, and getting shot full of steroids until Friday when my platelet levels were finally good enough for my care to be downgraded. I was moved to a smaller room in the post-partem section. I had been with Rosemary in the NICU when my stuff was moved, so I had to call Senpai at work and beg him to come back to the hospital to help get the room together. The way I said it, "Everything is confused!" I was still very exhausted and it was hard for me to move around with the IV cords. Senpai quickly made the trip over and plugged in the breastpump, organized my pumping supplies, plugged in my laptop, put toiletries in the bathroom, and stowed other miscellenea into drawers. I have a hard time believing now that I couldn't do those simple tasks myself, but that just goes to show what sorry shape I was in.

I gradually grew stronger, and then I was discharged on Easter Sunday. Without her.


So that was Rosemary’s birth. Her stay in the NICU is another story.