This Week In Utero: 37 - The Redundancy

Hmm...

Your baby is officially baked this week! That means you could literally give birth at any given moment. A terrifying, exciting and overwhelming concept, all rolled into one. Your partner is undoubtedly having the same emotional roller-coaster ride, so be sure to share your feelings and enjoy these last weeks (days?! hours?!) together...BLAHBLAHBLAH say good bye to these weekly posts and the creepy foetal pictures in the side bar!

Yeah, well, Sam decided to arrive 24 days early, so we already know how terrifying, exciting and overwhelming the concept is in reality.  I swear the last week has been as much a rollercoaster as the previous three months were with all their ups and downs and hospitalizations and almost constantly changing situations.

Back in July with the first abruption, it really wasn't clear how long Sam would keep cooking.  We'd been told there was a 50-50 chance of getting to 36 weeks, so every day was fraught with hyper-vigilance, every pain Ericka felt, every sensation of indeterminate origin set off alarms for us as we wondered whether our luck had just run out.  Two more hospitalizations made the fear more acute each time.

Then all of a sudden, last Friday we find ourselves astonished that it was Week 36 and we'd apparently made it out of the woods.  I guess that doesn't count as "beating the odds" but it felt like we'd busted the house in Vegas.

Alas, our celebration only lasted until the baby doc appointment that afternoon.  Ericka's blood pressure had jumped dramatically since our last visit and there was indication that she had developed preeclampsia.  Blood work was good, but we still got to enjoy a weekend with The Big Jug o'Pee.

As an expectant father, I don't get to experience the joys of nausea, contractions, back pain, etc, nor truly enjoyable things like feeling fetal movement.  Naturally I felt disconnected from a lot of the process--which is why I really appreciated being able to go to every doctor's appointment, save one while I was in Palestine--and rather helpless.  Having Ericka on bedrest at least gave me some sense I was doing good, despite the extra stress of having to maintain a household with eleventy million hairs shed every day, laundry and dishes, hurriedly making last minute preparations for Sam's arrival, etc.

We were joking with our favorite resident at the last clinic visit on Monday that in many ways, I am redundant and unnecessary.  I don't gestate the fetus, and pretty much I'm not even needed these days to make the baby in the first place.  I was unable to do much to make Ericka comfortable as she endured more pain in her feet, back and tummy.

But at least with bedrest I really was doing something tangible, and even being the Pee Boy running between the fridge and bathroom with the jug made me feel more valuable.  Yes, it's all about me, of course (hey, get your own damned blog).

So Monday...just a few blurry days ago?  Back to the doc for a BP check and a look at the pee.  Mild preeclampsia (there appears to be some correlation with abruptions, shockingly enough).  Discussions about planning to induce in a week and a half, with close monitoring for the duration.  Extra NSTs and ultrasounds scheduled, yadayadayada.

Ericka had been feeling "funny" all day, with continuing signs of early labor, but there really wasn't much worry.  We headed home, dropped by the Town Clerk's office for some tax stuff, got to the house and let the dogs out to pee.  Time to settle in for another day of rest and prep.

I started fixing some sandwiches when Ericka called from the bathroom, "Todd, I think my water just broke."  Okay, nothing is urgent, but let's start thinking about what we need to do.  Consume half a sandwich (Kayla stole the other half of Mommy's).  Oh yes, rather definite confirmation now, call Labor and Delivery, load up car and head right back to the hospital.

Premature Rupture of Membrane, along with infection, is the big risk associated with chronic abruptions.  Lots of women have their water break of course, but usually it's associated with organized contractions of latent labor.  The issue with PROM is that the uterus still isn't entirely coordinated with effective contractions that change the cervix enough for active labor, and there is increased risk of infection over time, so we were required to go in despite Ericka's irregular, mild contractions.

The view from Delivery Room 8 just after Ericka was checked in.  Not my best rainbow shot, but I took it as a good omen.

So at 355pm, GAME ON!  Despite having to go back to the house for my forgotten wallet, we had an uneventful and brisk drive back to town while Ericka called our doula, NTodd's Pa, her folks and her BFF (Sam's special godmother recently diagnosed with breast cancer and for whom he now carries the additional middle name, Loren).

I admit to taking more than mild umbrage at being told I was driving too fast, following cars too closely, etc, but we made it safely in good time and all that was forgotten until just now when I paged through my grudge diary.  At this point we're on autopilot, having done similar drills 3 times already: plop Ericka in a wheelchair (I'm proud that my piloting of those has improved), cruise over to the McClure building, 7th floor, pass NICU on the way to L&D, buzz the nurse's desk, check in, strap on monitors, expectantly wait.

In movies liked Knocked Up they tend to show an unrealistic--GASP!--labor process.  It's long.  It's mostly boring (at least for Dad who at this point really can't do a damned thing).  Punctuated with brief activity, nurses checking vitals, doctors coming by to see how Mom's doing and whatnot.

View of UVM and Burlington from the labor lounge as the sun dips below the Adirondacks.

Petocin's on.  Contractions get closer and more painful.  Start at 1cm dilated, 70% effaced.  2cm, 90% effaced..  3cm, 90%.  3cm, fully effaced.  3cm.  3cm.  3cm.  Progress stops.

We'd crashed for a bit after 1am Tuesday.  One of the residents on duty during a check at 4am starting expressing concern about Sam's heart decelerations that coincided with Ericka's contractions.  Indication of pressure on the cord, probably wrapped around his neck.

No worrisome fetal distress at that point because recovery was quick and then the usual variable rate returns.  But over time, that takes something out of the fetus and can cause problems if labor continues for a long time.

So while I'm still asleep and Ericka is stressed, groggy and in pain (despite an epidural), they discuss an amnioinfusion--pushing fluid back into the uterus to mimic amniotic fluid and its cushioning to help relieve the umbilical.  Nice idea, trying to reduce the need for a C-section, but wasn't sure to solve the problem and as we know ended up prolonging labor and still ending up with surgery.

I did wake up and slide my glasses on during all this, but the procedure was already a fait accomplis.  This and subsequent events brought to mind The Thinking Woman's Guide To A Better Birth.  It's a little dated, but the overall observations are still important.

There are a lot of things we still really don't know about pre-natal care and labor--f'rinstance, it's not clear what causes spontaneous abruptions, nor we do we get how labor is initiated.  And while there have been great advances, such as those steroid shots Ericka/Sam got in Week 25, it seems there's not a whole lot that can be done to treat various problems.  So you get bedrest for just about everything that crops up, and the only cure is birth.

But there is an illusion of understanding and control, created by The Machines That Go PING!  Fetal heart monitor, contractions monitor, oxygen saturation monitor...lots and lots of data that usually tell everybody to hurry up and do nothing.

That may sound glib, and I'm not in any way denigrating OBs.  Really, the staff here has been absolutely wonderful, going all the way back to the first hospital stay.  Everybody has been excellent and professional, and while we have definitely found certain favorite nurses, residents and attending docs, we respect and appreciate all the staff we've worked with.  Some have better bedside manner, some communicate critical information more appropriately, some are better able to appreciate our concerns, some are more efficient, some are more comforting, all did their jobs so very, very well.

The big issue is that attempts to tinker with the natural process--sometimes necessary because of real problems--can create a cascade of other complications.  We saw that in action: need pitocin to stimulate contractions; said contractions are more painful than normal because the synthetic hormone administered by IV, in contrast to natural pain reducer oxytocin which is made in the brain, can't pass the blood-brain barrier to reduce stress hormones and pain sensation; pain leads to request for epidural; epi lowers blood pressure and requires even more monitoring, causing more stress; add a drug to raise BP; etc.

And you just can get caught in the trap of paying too much attention to the fancy screens and lights and beeps, and accepting guesswork as medical certainty (despite the caveats given by the medicos, which are still given with a sound of authority).  So Ericka didn't really want the amnioinfusion, but at the time it was being debated she was alone, since my support was still frolicking in dreamland, vulnerable and while not pressured to do anything, still felt pressure to go with whatever the doctor ordered.

We're fairly intelligent people who are our own best advocates in most venues.  We've educated ourselves quite a bit throughout the pregnancy, especially since we first heard of placental abruptions, and we've read books like A Thinking Woman's Guide and know our fundamental rights as patients.  And yet we succumbed to a procedure with questionable benefit.  It wasn't harmful, don't get me wrong, and it did do some moderate good short-term, but it wasn't something Ericka really wanted and ended up delaying the inevitable while putting her through more difficult, painful labor.

The dynamic changed when we called in our wonderful doula, Allison.  First of all, she's a lovely, loving, positive woman--as you'd expect in her job--and immediately relieved our tension.  She began to take care of both of us: telling me to get some food, reminding me to rest, massaging Ericka, setting up a calm, dark environment for us to relax in, etc.  She also gave Ericka the strength she needed to stand up more for her needs.

So the staff was telling us at 1pm that we should let things go on for another 2 hours or so, then if there was still no active labor (organized contractions, roughly 4 or 5 centimeters dilation) we'd head for surgery.  Ericka was done.  Demoralized by a total lack of progress after so many hours of discomfort.  Emotionally and phyiscally exhausted.  "I want a C-section now."

By 130 she was in a blue hat and wheeled away.

Reflecting my confused, blurry experience waiting in our room to be called into surgery.

I was told it would be "a few minutes" before somebody would come get me.  "But don't worry if it takes a while."

There I am in my blue scrubs (now my PJs), funny hat, mask, shoe covers, alternately sitting and pacing, trying to distract myself with my Crackberry, checking to make sure the camera battery was indeed charged.  A few minutes turned into a half hour (I learned later that the spinal caused some delay), then finally there's a knock on the door.

The operating room was bright, with lots of people in blue calmly going about their business.  I know this stuff is routine, but not for me, so I was overwhelmed by the activity and the sight of my beloved strapped down on table with only her head and arms emerging from a blue curtain.

212pm: Samuel Loren Thomas Pritsky was pulled from a very small incision in Ericka's abdomen (the attending made the chief resident make a smaller than usual cut, as he very proudly told us the next day).  18 inches long, 5lbs 5oz.  He belted out a good scream announcing his presence, but the docs had given us a heads up, "here he comes," so I could be ready to take pictures.

It was a little weird seeing my partner's body in such a state, but not as shocking as I'd expected.  I guess after all the blood and other fluids I've cleaned up after crises, all the answering of rote diagnostic questions, all the tests, all the doctors I've seen probing her vagina, now all the nurses and lactation consultants I've witnessed pinching her breasts...when it comes to medical procedures I've developed a sort of clinical detachment.  It's like I'm a med student getting to see a real life patient doing real life things.

In that context, I offer the public a chance to consume some crap I've posted.  I won't be a total schmuck though (a troll posted a mean comment the other day excoriating me for my sharing that I deleted) and put it on the front page in case readers' stomachs are a bit weak: here's Sam being hauled completely up and out (umbilical not cut yet), and here he is being shown to us for the first time before heading over to the pediatrics station to be cleaned and checked (Ericka completely missed it, however).

Anyway, emotional compartmentalizing aside, I stayed with Ericka, comforting her and reporting to her whatever I could see.  I was scared even though we'd been told what would happen with Sam after delivery.  Since he was late pre-term, he could still have lots of minor issues and they wanted to give him the once over to determine if he needed any special care at NICU.  I took it as a good sign that he was often breathing on his own and not always on oxygen, and that people kept telling us that he looked good, congratulations, etc.

Still, watching doctors listen with stethoscopes and shaking their heads did give one a rush of adrenaline and worry.  But when somebody told me I could go over there to look (I had that right already, but had thus far not exercised it), I decided things were at least under control.

So of course I took pictures, and chatted up the pediatric people.  What's that for, what is your concern about this, etc?  They gave me the scoop that he needed some help, but put my mind at ease.  I loved seeing my son more closely and cleaned up a bit (though he still had quite a lot of that cream cheesy vernix).  I returned to update my beloved baby momma.

All told, they spent about 23 minutes working on Sam over in the corner.  In the meantime, we hear the other docs chatting about what they're doing this weekend and such as they're putting Ericka's uterus and other tissues back together.  Surreal.

They brought Sam back over to us so we could have a few minutes with him, demonstrating that he was not in any major distress.  We shed some tears as we were introduced.  Even with creamy birth gunk still all over his face, Vitamin K rubbed on his barely open eyes, and his being swaddled up so he looked like a toy football, we fell in love with our little boy.

Then Dr Bob came over to give us his assessment and tell us they'd like to take Sam to NICU for a few hours of observation.  He was having a little difficulty transitioning.  Lungs were fine, but he was laboring a bit to breathe as evidenced by some teeny "grunts".  Temp was also a bit low given his lean frame.  Not surprising given his truncated gestation.

Sam is taken to NICU.

We returned to the delivery room to start Ericka's recovery and wait for our son to come back to us.  A little while later I got to visit him in NICU.  He was already improving, and right around the time we were discussing whether I would go back to see him, he was brought to us for the duration.  He did so well it wasn't necessary to admit him to NICU officially, thus he spent a total of two hours there and has been with us ever since (a few minutes here and there for weighing and tests notwithstanding).

After a move to another room because of swine flu concerns with our neighbors, we spent our first night together in L&D rather than down in Maternity--Ericka needed to get 12-24 hours of magnesium sulfate to cut the risk of seizures due to her preeclampsia and they're better equipped to do that upstairs.  Then Wednesday we moved to our current room.

The view from Ericka's bed.  That's the original Mary Fletcher Hospital, Vermont's first, founded in 1879.

And we're here at least until tomorrow thanks to Sam's elevated bili number.  Not a big deal, but something that needs to be handled and adds only a minor obstacle compared to some of the other things we've encountered.

Once again, thank you so much to everybody for their support over the last few months.  And thanks for the prezzies that keep coming in!  They are very, very much appreciated and while we're behind on the thank you notes, we will be getting the remainder out in the coming weeks.  In the meantime, please accept our electronic gratitude--not virtual, mind you, because it is totally real.

Now I have to take the dogs for a walk to make up for the benign neglect they've been suffering, then sweep and mop and take care of bedding and laundry and other sundry things.  Oh, and I desperately need a shower!

ntodd