And Wonders of His Love

The morning light is filtering through the windows, the orange glow fading to a cool blue. Bean is sleeping soundly on my chest as we rock quietly to the Christmas carols sung by the Mormon Tabernacle Choir. In the corner of my eye, the tree sparkles. Christmas feels magical this year, much like it did when I was a child. R let me sleep for six hours, and now it’s my turn to watch over our fitful sleeper. When I lifted Bean from her arms, I felt the weight of her tired little body. She’s here. No longer imagined. No longer out of reach. What a gift.

Merry Christmas to you and yours.

You have to believe

Bean is a month old, and I’ve clearly been slacking on the blogging front. I hope you’ll forgive me. I continue to marvel at the fact that a 19-inch 7 lb human can command the full attention of two adults. It’s remarkable, really.

Bean is a spirited child. She reminds me of this line in Shakepeare’s A Midsummer Night’s Dream 

Though she be but little, she is fierce.

Her ferocity has served her well in her short life. She gave us another scare two weeks ago, when I found her flailing in her pack and play. She was red-faced and not breathing. She had foam coming from her mouth, and I thought she was either seizing or choking. I ran upstairs with her and asked R to call EMS. I turned the baby over and gave her a few back blows and she let out a little cry. All told, the episode probably lasted only a minute, but that minute felt like an eternity.

The immense responsibilities of parenthood lend a false sense of control that comes crashing down in ambulances and emergency rooms, where parents who were trying to do everything “right” wonder what went wrong. While we sat in the ER waiting on the pediatrician, R looked up at me and tearfully said, ‘I just really want to keep her.’ It was a simple synopsis of my swirling emotions that ranged from desperation, fear, guardedness, anxiety, love, shock, protectiveness.

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It’s terrible to watch your child suffer through medical procedures and to worry incessantly that she’ll stop breathing when you aren’t looking. But it also forces you to come to a truth that is perhaps better realized early in the parenting journey – you really aren’t in control. The truth is that things go wrong sometimes, and in ways that are unavoidable. To be a parent is to forever risk the most devastating heart break, while firmly believing that joy and wonder will win the day.  

When I was struggling under the weight of Bean’s sickness and my fears about it, a dear friend sent me the best advice I have received so far in my short parenting career. She said,

Remember when you were a little kid and something bad happened or you were sick, and how your parents told you it was going to be okay? That made things better because you believed that they believed it and you had faith in that. You are the parent now, and you have to believe baby Bean is going to be okay because she needs you to believe that.

I’ve clung to these words for weeks as we’ve slogged through NICU and pediatric ward stays, apneic episodes and choking spells. In her own good time, Bean has learned to coordinate her breathing and manage her reflux more easily on her own. We just stand at the ready, calmly telling her “You’ve got this, babycakes.”

And she does.

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All Queens Make a Grand Entrance

Dear friends,

Please excuse my long absence. I know so many of you are patiently waiting for the details of Bean’s arrival. Here they are.

On Tuesday morning I skipped work to tie up a few loose ends, just in case the biophysical profile indicated a problem that required intervention. I tidied the house, fed the cat some extra food, scooped the myriad litter boxes, put a few lamps on timers — just in case. I picked up the car seat, and said a silent prayer that we wouldn’t leave the hospital without a baby in it. I had this weird sense of foreboding that I kept pushing further and further down my throat.

We arrived at the doctor’s office and “Mercedes” (Favorite Dr. M’s best sonographer) was quiet while she performed the exam. She didn’t smile at our little coos over the baby’s movements and features. She didn’t smile at all, actually. She said Bean’s amniotic fluid levels were low enough to be concerned about her oxygenation in utero at that point, and she prepared us to hear that favorite Dr. M (henceforth – JM) would want to induce. We sat nervously in the exam room waiting on JM. The nurse said the doctor would be right in, “she’s just finishing with a patient.” R and I said we’d expected to see JM, not LM (his wife). We were nervous that LM wouldn’t know our history as well, and wouldn’t be as cautious as JM. We were wrong.

LM came in and said “You’re done. It’s go time. This baby needs to come out.” She said we could get some food and fresh air, but we wouldn’t be able to go home that night. She explained the plan very clearly. R was not dilated at all, and her cervix would need to be “ripened” for labor before the doctors could induce her. She’d get cervidil in the early evening, get a good night’s rest, and have the medicine removed in early morning. She’d have 30 minutes to shower and prepare for induction, and then around 6 am the doctors would start a pitocin drip to induce labor. I was relieved to get an overview of the plan, and felt good about it.

R wanted to get a little bit of food. I wanted to go straight to admissions. We compromised by getting ice cream sundaes and taking a short walk around the hospital (which seemed interminable to me).

Around 4 pm we checked in to our amazing labor suite. To say it was luxurious would be to understate the facts. I present the evidence.

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We turned over all our legal paperwork to ensure that I could make decisions for Bean and R, in case of an emergency. We made sure people understood we were both the moms and were to be treated as such, and really, that explanation wasn’t needed. Everyone treated us with so much warmth and respect.

Around 5 pm, R’s nurse, Andrea,  inserted cervidil to start ripening R’s cervix before inducing labor. She was not dilated at all. Andrea encouraged R to rest up for the big day ahead, and warned us that a typical course of cervidil-pitocin for first time moms would result in a delivery about 30 hours after the start of cervidil. We were ready to settle in for some rest and relaxation.

Around 11, R became increasingly uncomfortable. She shook uncontrollably and was writhing in pain. All the crap we learned in childbirth class was difficult to access and none of our planned comfort measures provided any comfort. I felt so helpless. It was miserable to watch my wife suffer so much, and to know it was expected to drag on for 24 more hours. By 1 am Wednesday, R was sweating and sick with pain. I called the night nurse, Traci, who offered some Tylenol for pain. I asked if the staff would check R again for dilation, and Traci said, “No, not unless you get to the point where you think you just can’t take the pain anymore. Then we’d check you to see if you made any progress.” R looked a little deflated. She was terrified that she’d get to the 5:00 am check only to find she’d made no progress at all. She continued to push through her pain without any meds.

By 3 am, I couldn’t take it anymore and asked Traci to help us figure out a new pain management plan. She said that R could try a little morphine and see if that would take the edge off until morning. I asked if she could check for any progress, and she discovered R was at least 4 cm. R really wanted to get to active labor before starting an epidural, so we debated the pain control options. Finally I suggested we go with the epidural.

By the time the epidural was in, R was already 7 cm. She’d only been in active labor for 2 hours. The baby’s heart rate was decelerating at regular intervals, and she appeared stressed. The nurses had prepared us a little bit for this possibility; many small babies have some trouble during delivery. Traci enlisted a few more nurses to help out, and two of them never left our side. One watched the monitor while the other turned R from side to side to try to relieve the stress on Bean. They started oxygen and IV fluids, and repositioned R repeatedly. I saw Traci come in and out, talking quietly to the other nurses. Soon the emergency on call physician was in the room, sitting quietly in a corner watching. Two other nurses came in, and readied the delivery trays and added equipment to the infant warmer. Our physician was on her way, but apparently had been in a deep sleep when she was paged. Traci told her R was almost ready to push, and Dr. K said “I already delivered that baby!” Apparently Dr. K dreamt she’d delivered Bean during the night. When she arrived, she still had pillow marks on her cheek and couldn’t stop yawning. I nervously asked how the dream delivery had gone. She smiled.

Dr. K suited up and soon R was pushing. I looked up and realized there were about 7 people in the room. I asked if there was always such a crowd for a delivery, or if we were just special. The nurse asked me if I really wanted to hear the answer. I said I guessed I did not want to know.

Around 4:15 am, R pushed through 5 sets of contractions and Bean emerged. It was the most amazing, awe-inspiring few minutes of my life. My love for R and pride in her swelled. I thought I would throw up from excitement and nerves. Dr. K handed Bean to R. The first thing I noticed was the meconium staining Bean’s bottom and her legs. And then I noticed the silence.

The silence was deafening. Bean was blue and limp. She did not cry. Dr. K calmly instructed me to cut the cord. It took me three tries. I couldn’t stop staring at the baby and wondering why she wasn’t crying. I began to cry. The nurses calmly scooped up Bean, and took her to the warmer. There were at least 10 people in the room. I saw the code cart. I heard people talking. I saw my baby, limp, lifeless, and unresponsive to stimuli. The respiratory therapists, neonatologist, and neonatal intensive care unit (NICU) nurses took over. R asked if everything was okay. I don’t know if I answered. I begged the nurses not to let the baby die. They brought me to the warmer, and let me talk to Bean and hold her arms down while they tried to push air into her lungs. She never drew a good breath. She made little grunting noises, and pinked up a little bit but her heart rate and oxygenation were dangerously low so the team put a tiny breathing tube down her trachea and placed her on a ventilator to force air in and out of her lungs at a normal rate.

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One of the NICU nurses hugged me tight and told me the baby would be okay, she was just a little stressed and needed extra help. I totally lost it, friends. Not a shred of composure. R was calm and collected. I like to think she was riding the high of maternal hormones. I, of course, had none. I was a helpless bystander, a little too informed (I am a nurse by training) and totally powerless. I was torn between comforting my wife, who just finished the most difficult physical task of her 36 years, and keeping vigil over my baby as a team of skilled providers attempted to rouse her to life. R told me to stay with Bean, and I did.

I tried to calm myself and talk to Bean, just like I did when she was in utero. I tried to cue up a soothing voice as I choked on my own tears. The doctors placed Bean in an isolette and wheeled her to R’s bedside so she could touch her before they rushed the baby to the NICU for further intervention. R reached her hand in, and then we pulled the isolette away. I walked out with the team, trailing a ventilator and an assortment of life-saving medical equipment.

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On the way to the NICU I called R’s sister and my mother, and started to rally the troops that we’d held at bay hoping to have the first hour alone with Bean to initiate breastfeeding and bonding. How different that first hour was.

In the NICU I held the baby’s tiny legs while the nurses tried to get an IV in her. It took them six tries to get a line in our sweet girl. By then she was mad. One of the nurses stepped aside to fashion a pacifier that would fit underneath the baby’s breathing tube. I held it in Bean’s mouth – a pathetic attempt to provide what little maternal comfort I could in midst of several steady hands working on our baby.

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My mother arrived by 8 am, and I just fell into her. I was so tired. I hadn’t slept for 27 hours. I left mom in charge of watching over Bean while R and I slept for just one hour. We woke up and walked down to the NICU to see the baby, and she’d already been extubated and removed from the ventilator. She was on oxygen, and had a nasogastric tube to drain her stomach. The doctor said she’d practically extubated herself.

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The nurses gave Bean prophylactic IV antibiotics to ward off infection in case she inhaled any of her first stool during the birth. Her tiny arm was wrapped in a stiff cuff to hold her arm still. There was tape all over her face, and her limbs were bruised from all the attempts to get an IV line in her. She was dehydrated, and so small. She looked like a little old man! But she cried and fought with the nurses, who all noted her fighting spirit. I think it’s pretty clear she’s feisty.

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By Thursday, Bean was ready to try breastfeeding, and she latched on like a champ. The lactation nurses helped us tremendously, and we felt so fortunate to have such wonderful support for breastfeeding our little girl. Through the weekend, the NICU nurses gently coached us through providing progressively more care for the baby. We started tentatively, overwhelmed by the tubes and the machines that blared every time we held the baby or moved her. Bean’s heart rate and oxygenation occasionally dropped precipitously, which made caring for her a bit frightening but eventually we learned to trust our girl to weather the stress of feeding and changing and she got stronger by the hour.

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The nurses stood by as needed, and offered really helpful suggestions for keeping her soothed and peaceful despite the noisy environment. We were lucky to deliver at a wonderful hospital, where all NICU rooms are private and have a day bed for parents to sleep on, plus closets and storage space for clothing and personal items. The unit had a little craft room where we made decorations for the baby’s door, which provided some respite for us.

Over the course of several days we saw each of the docs from the OB/GYN office. All of them took the time to hug us and talk us through what happened during the delivery. They answered all our questions, and helped us process the trauma we experienced so unexpectedly. They could neither explain the reason for Bean’s slow growth in the last four weeks in utero, nor the reason for her distress at birth. The working hypothesis is that the labor was too rapid for the baby to prepare herself, or maybe her cord was repeatedly compressed during labor and that restricted blood flow and oxygen which caused her distress. In any case, it was helpful to work through the events of the labor and delivery so that we could move forward.

Bean continued to improve, and had fewer and fewer periods of low heart rate and decreased oxygen level. On Saturday morning the doctors asked us if we were ready to take her home. We were terrified. What would we do without the machines to reassure us that she was getting enough oxygen and her heart rate was stable???  The doctor told us we had to stop relying on the machines and start relying on the baby to tell us what we needed to know. We all agreed we’d give it one more day to be sure the baby didn’t have any more “episodes.”

We got to bring the baby home late yesterday afternoon. She’s still a little vulnerable because she’s underweight and she had a pretty stressful first few days. We have to limit the number of people who handle her, because she gets stressed when she’s transfered from person to person, and because she’s more vulnerable to infection than babies who had a more typical start. But seeing her home, surrounded by the things that friends and family so lovingly made or purchased for her, has really helped me set aside the events of the last few days. I’ll process them more, later. For now, I want to enjoy my sweet girl.

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I told one of my dear friends the baby’s full name, and he said it was fit for a queen. He’s nicknamed her “Queenie.” He said like all great queens, she made a grand entrance.

Anticipation

We spent another two hours at the doctor’s office yesterday, and our favorite Dr. M was on duty again. He’s clearly decided he wants to deliver Bean, and I’m glad about that. Once again Bean earned high marks on her tests – 8 out of 8. She’s still only measuring at the 12th percentile, but she’s gained a little bit of weight or is at least stable. Dr. M was encouraged by the biophysical profile report, and checked R’s cervix to decide whether we should plan on an induction this morning. After some finagling he finally admitted “Well, I really can’t get past the cervical opening, though you probably feel like I’m up in your tonsils about now.” We all laughed nervously, but heartily, and agreed to recheck Bean in a week. With no appreciable cervical dilation an induction would considerably increase the risk of C-section delivery, so we’ll give it another week. We go back midday on Tuesday, and if there’s the slightest hint of dilation we’ll be headed for an induction Wednesday morning, which happens to be favorite Dr. M’s on call day. I really appreciated his careful consideration of all the risks and benefits to taking action or not. He even offered to have us come in on Friday for a non-stress test if it would ease our worry over the weekend. While my inner voice said, Yes, please! My outer voice said “We don’t want any unnecessary exams.” This is me, practicing calm. Practicing rational. Practicing trust.

So we drove home and brought our hospital bags back in the house, once more. The last couple of weeks have been almost magical. It’s a special window of time between our life as a couple and our life as parents, and I’ve really enjoyed it. Despite the painful struggle through three years of trying to conceive, I’m so thankful for our many years as a duo because I think they provide a healthy foundation for our family.

 

Boobs are Awesome

Folks, the human body is amazing, and the process of preparing mother and baby for feeding is no exception. Here’s 10 stunning facts about breastfeeding that I learned this week in our Lamaze class.

1. During pregnancy, the nipple and surrounding tissue darkens to allow the infant (who has poor vision at birth) to see her “target” clearly.

2. The oxytocin released during labor and delivery causes contractions not only in the uterus but also the muscle cells around the milk-filled alveoli, which subsequently release milk to baby.

3. The baby is typically most alert in her first hour of life. She arrives “on empty” and is ready to eat. Just like other mammals, human infants can find their mother’s breast all on their own. Newborns have stepping and crawling reflexes that allow them to shimmy down mom’s chest and latch on all on their own. In the process of creeping down, they push on mom’s uterus and help with the process of uterine involution. Here is a beautiful (albeit a bit slow) video of a newborn crawl. (NB: YouTube thinks the video may be inappropriate for children, so you must sign in to view it.)

4. Frequent feedings in the first 72 hours of baby’s life signal the brain to release prolactin, which causes more alveoli to grow, ensuring adequate long term milk supply. The first 72 hours are critical for establishing supply for the baby’s first year.

5.  The breast produces different types of milk that match baby’s nutritive needs and stomach size. For example, on the first day of life the baby’s stomach is no larger than a marble, and can only hold a teaspoon of milk at a time. On the first day, the breast produces colostrum, which is thick and sweet and the baby doesn’t need much of it to keep her blood sugar level stable. As the baby grows, her mom’s breasts produce a higher volume of milk with different nutrients that match baby’s stomach capacity and nutritional needs.

6. In the first few weeks, baby should be fed on demand. She’ll lick or smack her lips and use her rooting reflex to let you know she’s hungry. If she doesn’t make these signs, she should be offered the breast every few hours. Infants may nurse for 10-40 minutes, 8-12 times per day. I’ll spare you the math and tell you that means that in a 24 hour period of time, mom will nurse a minimum of an hour and a half to a maximum of eight hours. That’s a huge job!

7. Breastfeeding is not supposed to hurt. I know so many moms who found breastfeeding terribly painful, and I just assumed pain was part of the process. So it was really helpful to hear that pain may signal a poor latch or some other issue that could be addressed, rather than endured.

8. It’s important to break suction before removing baby from the breast. This makes perfect sense, but I’d never heard it before. When mom takes baby off her breast she can put a clean finger in the baby’s mouth to break suction, thereby preventing painful, sore nipples.

9. Draining one breast at a time helps baby get the most nutrients from the breast milk.  During the first part of the feeding the baby receives foremilk, which has more water content and quenches her thirst. Then the baby gets hindmilk, which has higher fat content and promotes brain development and weight gain.

10. Breastfeeding is hard work and partners can play a big role by encouraging mom, keeping her hydrated and nourished, watching for baby’s hunger cues, and observing baby’s latch (since mom can’t see it very well).

I’m so glad we have access to help and encouragement for breastfeeding. Our hospital has lactation nurses, a 24 help line, and a twice weekly breastfeeding support group. I don’t think our moms and grandmothers had the same support, and we are lucky that times have changed. As further evidence of that shift, there were five fathers in our breastfeeding class!

Good Catch

I survived the patient-doctor trust fall. (Hmm, just realized  I’m not the patient! No matter!)

We had a really great appointment today. Bean scored so high on her biophysical profile that we didn’t need to do the non-stress test. Her heart rate and blood flow were perfect and she was moving, breathing, and had normal fluid levels. She scored an 8 out of 8 possible points. A high achiever already! Dr. M (the other Dr. M’s husband!) was personable and informed. He was really reassuring without being flippant. I felt much better and the rest of the day felt like a gift.

We had our last prenatal class tonight. I’m so glad we attended the classes, and I’m honestly not sure how people manage birth, newborn care, and breastfeeding without taking a class. I guess they read books, or talk with other parents. But for me it was much easier to have dedicated time for learning from trained experts who didn’t mind a barrage of “dumb” questions. It’s hard to know what you don’t know. Turns out I don’t know much at all about newborns!  We learned so much tonight and I am grateful we had the opportunity to prepare for the first few weeks of parenthood.

 

Trust Fall

Tomorrow R will be 37 weeks, full term. I don’t know where the time has gone.  In the last 9 months we’ve engaged in some pretty major life changes. We endured IVF, and it worked.  We prepared for the joys and challenges of twins. We celebrated. My mom bought matching red and grey owl onesies. At the beginning of the second trimester,  Peanut got terribly sick, and we lost her. In midst of our grief, we moved forward with our plan to get legally married on our seventh wedding anniversary.  Not long after that, we sold our house, I defended my dissertation, R quit her job, and we moved to Indiana.

The move required starting over in so many ways. Leaving behind our beloved friends and R’s sister and her husband. Saying goodbye to the mountains and waterways that brought us so much joy.  Stepping out of the political safe zone of the “Left Coast” and into a blue city in a red state. But the thing I’m really hung up on is the change in providers. As I mentioned, we started off at Indy’s urban hospital but decided to switch at 34 weeks. It wasn’t a big deal because we’d only seen the urban hospital doc twice. But the new office has four providers and requires expectant parents to see all four of them prior to delivery, which means that we see a new doc each week because we joined the practice so close to R’s due date.

On Thursday, we met Dr. M for the first time. Our primary OB in the practice, Dr. K, ordered an ultrasound for the visit but no one else seemed to know why. The sonographer thought she was doing the 20 week anatomy scan. We told her R was almost 37 weeks, and we’d already had two anatomy scans. She left the room to inquire about the purpose of the scan, and came back and said it was just for a check of the baby’s growth. When she measured Bean’s head circumference and femur length I noticed the estimated gestational age was 32 weeks. I was perplexed but figured she was still getting the right angle or something. But when we met with Dr. M, she said, “Okay, so have we been monitoring the baby because of her small size?” R said, “You tell me. I don’t know why Dr. K ordered this ultrasound.” We told Dr. M that Bean has always measured large for her gestational age. At the last ultrasound she was nearly a week ahead. Dr. M told us she was measuring two weeks behind, and was in the 15th percentile for her gestational age. At the 10th percentile, she’d meet criteria for Intrauterine Growth Restriction (IUGR), which warrants early induction of labor.

Cue the terror. Cue the PTSD. Cue the loss of any sense of control. Even though I could hear Dr. M reassuring us that the baby does not meet criteria for IUGR, and would simply need extra monitoring, I felt the panic rising in me. Dr. M said we’d need to return on Monday or Tuesday for additional testing. R asked why we couldn’t do it right then. Dr. M looked as though this had not occurred to her, and went to check with the sonographer. We sat quietly in the room, and were relieved to be sent back to ultrasound for another look at Bean. The sonographer checked the blood flow through her cord, and determined it was adequate. The amniotic fluid levels were normal, and Bean’s heart rate was strong and regular. Dr. M told me not to worry all weekend, and dismissed us until Monday.

Her tone was confident and cautious, and she even told us that her own daughter was delivered a little bit early (just shy of 37 weeks) for low amniotic fluid levels and IUGR. She’s been there, so she errs on the side of caution. She even referred to herself as “anal.” R and I agreed that we prefer anal doctors. I made a mental note that it sounded a bit funny to say that aloud. While Dr. M was competent, I didn’t find her particularly compassionate. What she failed to understand, and I failed to articulate, is that the appointment was not routine for us. It was not the news we expected, and for me it had echoes of earlier trauma with Peanut. We have been planning and hoping for this child for three and half years and we’re entrusting her to a perfect stranger. It reminds me of the trust fall, a team-building exercise during which one person stands backwards on an elevated platform with her arms crossed, and falls backwards into the arms of strangers. I never really enjoyed the fall.