Lucky Number Seven: Aftermath

At the end of my post about his birth, my son was teetering on the edge of life and transferred to a hospital 60 miles away from us. It took a month of hospital treatment for him to be sent home, but he is currently nursing like a normal two month old, happy and healthy. We have a few more tests to run, but everyone suspects they won’t turn up much. In all honesty, we don’t really know why this happened, which is somewhat maddening. I would like to make sure this never happens to me OR anyone else ever again, but that is beyond my power, because we aren’t exactly sure why it happened in the first place.

BABY 

Baby boy was diagnosed with respiratory failure at birth and born with swelling alllll over. Ascites, extra fluid in the abdomen, hydronephrosis, swelling in his skin. This condition is called hydrops. The doctor told us not to Google it because it’s scary, so I did because I’m not a very compliant patient, and it turns out it’s quite fatal. There are also a million things that cause it. It’s more like a set of symptoms than an explanation for anything. They suspected an infection was what caused the condition, put him on antibiotics, and tested him for every virus and bacterial infection under the sun.  

He was intubated for several days. His oxygen saturation remained lower than it should be for too long and his heart wasn’t working well for a couple reasons. One was called a “diabetic heart.” I was confused by that, because I haven’t had any babies with heart issues, and was surprised to hear about this common condition that I’d never heard of. They said it was “floppy” and “too big,” something about insulin being a growth hormone, causing the heart to be oversized and not contracting as forcefully as it should. The cardiologist said it was a thickening of the heart muscle which has now resolved. I still have questions.

The placenta pathology showed that there was extra knotting in the blood vessels, indicating that *maybe* placental insufficiency was an issue. But the OB also said it looked like a pretty normal placenta when she pulled it out. There were no calcifications, and his size (30th percentile) indicated adequate blood flow for most of the pregnancy.

The swelling resolved over a few weeks. His platelets were very low for about ten days and he required four transfusions, but no test for infection turned up positive. His head ultrasound was fine and they figured that he didn’t have any brain damage because he was doing all the normal newborn things. He handled initial oxygen weaning well. He was discharged from the far away hospital after two weeks, back to the local hospital, and there he was weaned off oxygen all the way and taught how to feed by mouth. I’ve been measuring his weight at home with a Walmart baby scale and it’s increasing normally.

Just so you’re aware, one of the painkillers they give babies in the NICU is sugar water. That’s right! Narcotics and sugar water on pacifiers are among the pain management tools for babies. So next time your toddler freaks out about the cookies you won’t give her, just remember she’s in withdrawal and you’re staging a necessary intervention.

Besides placental insufficiency — which just sounds awful, like I’m an inadequate mother, though I know that’s not what anyone means by it — he did flip breech at some point during the last 48 hours of his womb stay. He had been head down for months, so the breech presentation, especially just two days after an ultrasound showing vertex presentation, was very odd. I have to wonder if he flipped and his new position pinched the umbilical cord, cut off blood flow, and all the rest of the drama followed from that. But it is truly hard to know. If I’d come to the hospital twelve hours later, it likely would have been a stillbirth.

MAMA

C-sections are weird. It turns out that they remove your uterus to scrape out the blood and sew it up, which is neat, and helpful for controlling postpartum bleeding. But also, the scar and the skin around it is completely numb on the outside for a few weeks. It took a full 12 hours before I could use my legs to get up and go to the bathroom, and the process of sitting down, standing up, crying too hard, laughing too much, or lying down was a burning, searing kind of painful for the better part of a week. I was mostly worried it was going to rip the wound apart again, and that anxiety made me kind of lightheaded. But as long as I stayed still and didn’t get too emotional, I felt fine. The wound did not pull apart. I was discharged after some drama about a breast pump, about 48 hours after delivery. I was pumping, but also got plenty of rest during those hours, since I had only myself to care for, no baby.

I couldn’t walk very far for about a week postpartum either. I think that probably would have been similar with a vaginal birth, but I don’t recall having so much trouble with past births. The reason it bothered me so much this time was because I had to walk a good ways from our car in the parking garage up to the NICU floor where my son was being treated. Wheelchairs were available, but people to push them generally were not; technically my husband and I were not allowed in the NICU together. Only one parent at a time, per COVID19 protocol. Painfully, once I got up to the NICU, even the bathroom was almost too far down the hallway for me to walk.

After a day or so at home, I developed postpartum preeclampsia-like symptoms. I had a headache. My blood pressure readings, taken with a cuff at home, were borderline high (150/100 was the highest they got). I was nauseated. I kept calling the OB but got different answers from different doctors about when I should be concerned. Finally, one doctor told me that 160/110 for multiple readings was the cut off for treatment, and a friend told me later that treatment itself (magnesium drip) is pretty uncomfortable, so I’m glad I didn’t need it. But my friends, helping me with the kids at home while my husband stayed with the baby, were worried about me, and so was I. I do not know if these symptoms were related to my age, my multiple autoimmune disorders, the c-section delivery, or the fact that I was so distraught at not seeing my baby. It only dawned on me slowly that he could die without me ever having a chance to hold him, and that made it impossible to relax, which was the only treatment prescribed by my OB. My realization of this fact grew and my own physical discomfort increased. 

I was more than a little shocked that I did not need any pain meds stronger than ibuprofen, and even that I did not take round the clock past my hospital stay. I took it about twice a day for the first few days home, then once a day for a few more days after that. I was mostly taking it for the headaches, not the scar pain, and I never wanted anything stronger. The pain was not my biggest problem. My biggest problem was overall weakness and emotional distress. 

Pumping is not the same as breastfeeding. Pumping is only painful, whereas breastfeeding is both painful and relaxing. His nursing was slow at first, because they never really let him get very hungry in the NICU. He nursed weakly and for a short time, sometimes refusing to latch at all. Things took off within a day or so of being at home, however, where we weren’t under so much anxiety-inducing scrutiny. He got hungry and had to work a bit harder for his food, and he did.

Emotions ranged from irritability at my inability to be a mom to every one of my children when every one of my children was not in the same place, to despair about ever seeing the baby or breastfeeding, to fear for my own health, to shame about having postponed an induction that could have spared us all this drama and needing so much help.  

HOSPITAL

My first son also had a brief NICU stay for a possible infection. One notable difference between that first stay more than ten years ago and this one was that there was not any significant accommodation for the comfort of parents in either hospital this time around. A decade ago in St. Louis, I was put up in a postpartum recovery room for the week that my son was hospitalized for IV antibiotics. I don’t remember how we did meals, but I do recall that friends brought food one night. I know that others like my mom and husband were allowed to visit us both. 

This time, my husband had to sleep in a recliner, the bathroom was outside a locked door and you had to get permission to get back into the NICU when you were finished, and no food was allowed in the room. I assume a lot of these things are COVID19-related. Some of them may very well be practical and useful for preventing spread of viruses. But I would suggest that it’s time to revisit that particular policy. It made the whole stay more brutal than it needed to be and I really don’t think that it reduces viral transmission by much to have parents sleeping in a recliner versus a bed. Especially not parents who have just tested negative for COVID19 a few days prior and haven’t been anywhere except the hospital since then. 

NICU nurses are great people, and I’d love to be one when I grow up (or when my kids do).

I had some trouble contacting providers at the faraway hospital and this increased my anxiety. On the one hand, I’m glad they protect the limited time they have for evaluating each baby and making good decisions on how to care for them. On the other hand, not being able to discuss these matters with them directly added to my misery at not being there.

The discharge criteria — a certain amount of weight gain over a few days and amount of milk consumed in 24 hours — was a difficult criteria to meet for a nursing mom, and basically requires bottle feeding for a baby of his age. This was frustrating because it left me feeling like they didn’t trust me to feed him, like my body was just going to be inadequate for nourishing this child forever and always. Placental insufficiency, breastfeeding insufficiency, insufficient weight gain...what other insufficiencies might he suffer at my hands when I took him home? I suspected I could feed him if left to my own schedule. I just couldn’t do it on an every three hours’ schedule, because my body doesn’t make milk that way, and because a breast pump is not as effective as a baby nursing. I also think weight gain is normally more uneven for babies, rather than a certain number of grams per day. I think my experience since leaving the hospital proves these points, and some of the nurses recognized that the criteria is difficult to meet. As one nurse told me, “Just play the game so you can go home, you can do whatever you want once you get there.” I needed to hear that to know that I wasn’t crazy for thinking that I would never be able to meet the criteria for discharge with nursing. After that, it was easier to wait and bide my time to work on nursing at home.

COMMUNITY

My mother in law flew all the way across the country to help us with the kids and wore a mask while she was here, just in case. My brother and sister-in-law watched the kids for several days while I was at the hospital. The obstetrician cut me open and got him out, then sewed me up again, and the anesthesiologist made sure that wasn’t a more awful an experience than it needed to be. One of my husband’s colleagues cleaned our house (and caulked the toilet!) while we were gone. Many people gave us gift certificates so we could have food delivered from local restaurants while staying at the hospital. Local families brought meals to the house. People unexpectedly sent us money. Friends took care of our kids while I was somewhat disabled the first few days home from the hospital. I got rides to the faraway hospital from friends and family, since you’re not supposed to drive for a couple weeks after a c-section. Our baby’s godmother brought me two laminated pictures of him that I could keep near my breast pump to help with nursing. Several people picked up our groceries. Two different priests brought me holy communion when I couldn’t sneak away to the church at Mass times. My husband’s students gave us the gift of their time and took the kids down to the playground. A young woman from our parish gave us a relic of St. Philomena with which to pray. Mom friends brought emergency breastfeeding supplies and post surgery underwear. Lots of phone calls, emails, prayers. A friend from far away sent flowers and toys for the kids and diapers. My husband sat in the car in a cold parking garage all day so that I could spend a few hours in the hospital with our little man. Did I mention there was a small army of nurses who fed him, changed his diaper, gave him meds and baths, and held him when he cried, round the clock, for weeks?

I’m only just now beginning to catalogue the many, many kindnesses shown to us and it is rather astonishing and lovely. I’m going to use this list to go back and write thank you notes, so I hope I didn’t forget anything! I feel incredibly unworthy of it all. I occasionally still feel depressed about the fact that we can’t hang out with friends for COVID19 infection prevention reasons. I will likely always have some regret about the fact that there are so many things I am unable to do for and with my kids, like go to the zoo and museums and other interesting places, or enroll them in music lessons and take them ice skating and skiing, or let them join a soccer team. Expressing gratitude to friends and family has always been a helpful way to remind me of what we do have.  

LESSONS LEARNED

My big “hindsight is 20/20” lesson from this experience is to just take the induction at 39 weeks, and do the kick counts. I’m glad I was not induced with my first. I’m glad I was allowed to take my time with most of the others, too. I don’t even regret pushing for a little more time to finish out my pregnancies, especially with my first, because it may have helped me avoid other harmful interventions. And if I’d followed all my doctor’s recommendations, the world would be missing seven awesome little people. But since we aren’t sure why this happened, I am trying to let the weight of this experience teach me to accept synthetic oxytocin with less misgiving. Now that it has happened once, it seems more likely that it could happen again. 

Of course, kick counts *really* saved the day. This is precisely what they are for, to detect a problem that cannot be detected by ultrasound or any other test. We are so, so fortunate that my OB instructed me well, that our little man made it very obvious he was struggling, and that I listened when he did. Many nurses told me that they personally did not pay that close attention to their baby’s movements, that other women they know have not paid that close attention to the movements and lost their babies at the very end. Please understand that I do not say this with an ounce of pride about my own superior attention to detail, only with gratitude that things aligned the way they did. I may even have Type I diabetes to thank for my close attention to what is happening in my body — close blood sugar management teaches you to feel things and pay attention to things happening in your body in a way that other people might not. “Listening” to my baby’s movements was similar to “listening” for signs that my blood sugar is getting high or low.  

But if there is one lesson that I hope remains in my heart from this experience, it is not to take life for granted. All the lives that touched ours during this crisis — nurses, doctors, friends, family — are ones that we are so glad were there in ways big and small. I hope they were glad to help our little baby! May God grant that we remember this lesson always. 

Lucky Number Seven: Birth

A few weeks before our seventh son's birth, I invited friends to a birth blessing over Zoom. A birth blessing is kind of like a baby shower, but with prayer instead of gifts. I think I’ve mentioned them before, associated with my fifth son’s birth. I was especially fortunate because these ladies, in addition to praying for me lots, sent me diapers in the mail, too! 

Afterwards, I wrote my story for them, because I wanted them to know how their prayers had assisted me during birth. The prayers of friends are always important for me going into labor, but they were especially important this time because of how dangerously close my baby came to dying in utero. 

Like I said at the end of my post about the pregnancy, and as you will see from the story below, it was not fine like my others, and like I assumed it would be. 

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Friends,

I want to make sure you know the happy effect of your prayers on the day of our son’s birth. Even before I could feel my legs again — the lack of feeling in my legs was deeply disturbing to me for many hours on the Friday he was born — and before I was reasonably confident that Ignatius would survive, I knew that it was an event graced by God. There are so many things that have been so sad, frightening, and disturbing about these last few weeks. And still, it has been graced by God. 

On Wednesday that week, I started to notice that the baby’s movements had become weaker and less frequent. As he’d always been a VERY active baby, this was immediately noticeable. I continued to gather information by counting his movements, as instructed by my OB. My monitoring on Wednesday showed a more or less normal baby, though his heart did seem a little distressed by the single contraction I had while hooked up to the monitor. Movement in the evening and overnight was active and reassuring. 

By late Thursday evening, however, just 24 hours later, I was very concerned. He was not moving on his own at all. I had to push on him from the outside to stimulate any movement from him. The nurse told me this pushing was technically acceptable for a fetal kick count, but I suspected, at this point, that something had changed for him. I hoped maybe it was that he was hunkering down for labor to begin, but I also feared that his health could be in decline. 

I woke up early Friday morning and felt for his movements. Now, I could not even get him to move by pushing on him — hard — with my hands from the outside. So not feeling anywhere near enough movement, quite in contrast to other nights where I’d woken up to visit the bathroom in the middle of the night and he seemed to be dancing a jig inside me, I called the OB. She told me that I would only be able to get monitoring by coming into the hospital. She seemed somewhat doubtful that I would want to do this, but I was not in any doubt. I could only get him to move once or twice in 30 minutes by pushing on my belly so much that it hurt. I drove myself to the hospital and my husband stayed home, waiting for further word from me. 

I cannot say enough about how your prayers enabled me to recognize the danger of this situation. My doctor gave me good instruction on fetal kick counts, and the baby himself communicated loud and clear that he was not OK. But even the fact that I woke up when I did during the night, and had enough presence of mind to do kick counts, could reasonably be attributed to Divine Providence. These things, along with what happened next, saved his little life. His decline was so rapid that I shudder to think what would have happened had I not woken up when I did. Only half of babies born with hydrops survive. 

I underwent monitoring and ultrasound at the local hospital. It took a long time. His score on this test Wednesday morning, at my OB’s office, was 8/10.  His score at this time, very early Friday, was 2/10. His heart was distressed enough during contractions that an induced labor was off the table. I needed a c-section as soon as possible. My doctor said she was quite sure he would survive, but she also said that if our conversation had occurred 12 hours later, she would not be so confident. 

Preparations took about an hour. I tried to email you all when I found out about the need for surgery, but things moved so fast that I barely had time to call my husband. One nurse saw my rosary beads fall out of my pocket when she moved my belongings to the recovery room, and instead of leaving the rosary beads with my other things in the recovery room, she brought them to me as I lay on the operating table. I cried a few tears of joy, because I knew that this little act of kindness from a stranger, too, was a gift of God. Another nurse offered to take my phone so that she could get a picture of the baby before he was whisked away to the NICU. That picture consoled me through many hours of grief in the days that followed! The same nurse also told me she was prepared to baptize him if necessary. The anesthesiologist saw how terrified I was, and became an unexpected, calming companion through the whole surgery. 

One of the most frightening parts of the procedure was feeling like I was struggling to breathe. The spinal block extended all the way up to my lower rib cage, which meant that I could not breathe deeply into my lungs. My chest felt very heavy. This was alarming, but the anesthesiologist assured me that “if you can talk, you can breathe.” I did not know who to talk to — my doctors were busy making sure that the baby and I didn’t die and were therefore not in a position to chat — so I started to pray the Rosary quietly but aloud. 

I couldn’t see anything beyond the drape, so several minutes passed before I knew what was happening. I’ve been told it feels like a lot of “pressure” when they pull the baby out during a c-section. But to me, that part felt as though they were pulling my heart out of my chest. I think there must have been some suction which *actually* pulled at my chest, because I felt it all the way above the spinal block, right in the middle. I also felt cold, and there was a lot of shaking. At one point, the anesthesiologist came over and asked, “Are you praying the Rosary?” I told him I was. He quietly murmured, “That is so sweet.” 

After my son was pulled from my body, one of the nurses began calling out the seconds until he cried. It was 6:14 in the morning. He cried after 30 seconds. At this point, I rejoiced to think that we might be on our way home from the hospital in a week, because that wasn’t too long! I heard crying periodically as they examined him over in the corner of the operating room. My husband came into the operating room after the baby was taken back to the NICU.

I don’t remember a lot about the next couple hours except that I couldn’t feel my legs. As I mentioned, this was deeply disturbing. Even more disturbing, however, was when they told us that our baby would be transferred to a different hospital, more than an hour away. This meant his condition was quite serious — you don’t get transferred to a big city hospital for nothing — and I got scared all over again. The thing about my legs was exceedingly upsetting at this point because going to see my baby means moving, and lack of sensation in your legs means no such moving is possible.  

At this point, my husband began his fight to have our son baptized. It was unclear to me whether he was allowed to go back there to see him. I think he was initially told “no.” We asked that the Catholic chaplain come to baptize him. My husband went into the NICU with her, and from the sheet of paper she was using, it became apparent that the baptism she planned to give him was NOT valid. The prayers were heretical, and the form described on the paper did not involve enough water. My husband took over and did it himself, and correctly, but he still suffered some scruples about those heretical prayers.

We still don’t entirely know what happened, but it seems that the problems with his heart were related to my having diabetes, and that there may have been some placental insufficiency, too. These problems had probably existed pretty early in the pregnancy, and just didn’t show up on ultrasound or become apparent until very late in the pregnancy. The infection hypothesis seems less likely after all the tests they ran on him turned up negative. But it’s still something of a mystery. 

Thank you again, for your prayers. Each one is a treasure in the eyes of God, and they have held me up. I’ve had lots of big emotions, both negative and positive, over the last few weeks, so please forgive me if I have said something that hurt you. It was not my intent. I have prayed many prayers of thanksgiving for you over the last several weeks, and will continue to do so. 

By God's grace,

Beth

Lucky Number Seven: Pregnancy

Because it was unclear to us that the middle of a global pandemic was really such a great reason to avoid having another baby, we did what married people do, and then blushed our way through pregnancy announcements last May. IMPECCABLE TIMING. Life will find a way, you know?

As with past pregnancies, I had some crazy overnight highs right around implantation time. My typical problem, pregnant or unpregnant, is overnight lows. But I woke up two or three days in a row in the 300s. Crazy! I didn't think much of it at the time, but then my husband said I looked pregnant. (It is absolutely weird when your husband suspects you are pregnant before you do, especially when you know well what pregnancy is like because you’ve done it six times.) Then I started falling asleep right after dinner. Then, I took a pregnancy test, looked back at my NFP chart to determine the date of ovulation, and figured we were due for some intense pain right about mid-January.

So I began my seventh pregnancy, this time with Hashimoto's and celiac and some other intestinal strangeness. I did not experiment with a fancy diet on myself, and will not promote a fancy diet to you, as the best suggestions I've heard seem to involve eating little more than roots and raw meat, and definitely nothing that could raise my blood sugar if I happen to give half a unit too much insulin. That’s not a great thing for pregnancy. 

One thing I did, as with last pregnancy, is to just be a bit more relaxed. This worked well last time. I already know how to keep meals under 50 carbs. I know how to say no to extra sweets. I know that I need to get up and check my blood sugar in the middle of the night. I know that an A1C of 6.5 is OK, and that my baby isn’t going to die if my blood sugar goes over 300 once a month. I know that I don’t need to panic if my two hour postprandial is above 140. I know all these things, now I just need to practice. I gained more weight than in previous pregnancies — 50 pounds rather than 40 — and that always causes some anxiety. I’m hoping it comes off like before. 

Another thing I decided to do was go back to strips rather than a continuous glucose monitor. In the first place, Dexcom treated me badly last time I tried to get supplies from them. I was so annoyed that I stopped using the monitor. But I decided not to go back on it, even during pregnancy, because the CGM made me paranoid. I was constantly watching it and getting anxious. I spent too much time trying to tweak my doses, rather than doing my best and trusting that everything would be OK. The CGM works off interstitial fluid rather than blood, and that means my blood sugar looks high for a really long time, even when it's not. The anxiety caused by that really messed me up.

I called my endocrinologist early on, and she prescribed levothyroxine. This was a hassle because she actually prescribed Synthroid, and insurance wouldn’t pay for Synthroid without paperwork that my endocrinologist wouldn’t fill out. (And insurance wouldn’t let me fill it out, either...ugggggh). It was kind of an emergency to get on the meds. My endocrinologist was worried about a miscarriage because of the thyroid stuff. I couldn’t really wait for the two week process that insurance required to get them. So I went on the generic levo. 

One thing that was GREAT this pregnancy was being able to do telehealth visits with my endocrinologist. I still needed to have the blood drawn in person, but if you’ll remember, I once had a doctor fire me because I wouldn’t come to the office for appointments, and I couldn’t come to the office for appointments because I couldn’t find a babysitter. (I also didn’t think I needed to put down the $$$ for them, and that doctor didn’t accept my insurance.) The babysitter and insurance problems remain, but now, I can have a video call with kids crawling all over me yet not breaking any medical equipment. One of the worst parts of pregnancy for me in the past has been the ridiculous number of doctor’s appointments they want me to come to. Telehealth made that easier. 

I felt movement from baby early again, and that was reassuring. I did not visit the OB until about 16 weeks. I did do the early fetal screening for abnormalities, but after a rather tortured phone call with my OB where I had to ask whether this information was going to help me make my baby healthier or help me decide whether we should kill it, I sort of regretted doing the screen. I guess the fact that I’m now having an old lady pregnancy — advanced maternal age and all that — got me kind of spooked. But as I’ve said before, I will know based on the copious number of ultrasounds that they do if there is really something wrong, and I will know well before birth. I don’t need to find out at 12 weeks. 

My 20 week ultrasound was normal, in an anatomical sense, but the baby was on the small side. This was OK, and I basically just felt less stressed about 191 mg/dl than I would have in other pregnancies. My thyroid numbers stayed good, dosage adjusted slightly. Baby kept moving. A1Cs dropped from 6.2 (I think) at the beginning of pregnancy to 5.7 (I think) closer to the end of pregnancy. Early on, I cut dairy out for a couple months to see if it would help with the pain I have in my belly, but it did nothing. Boy, was I glad eliminating dairy didn’t make a difference to my pain level, because have I mentioned that I love a little coffee with my milk in the morning?

At some point in the third trimester, baby’s growth looked to be worse. He had dropped from thirtieth to eighteenth percentile. In early December, the fluid levels were low. Doctor and I both immediately worried about intrauterine growth restriction and/or placental insufficiency, but decided that drinking water and waiting for one more ultrasound was advisable before doing anything crazy. 

It was extremely strange to have a baby too small. With a baby too big, I always felt like I could control that. I could eat less, eat different things, watch blood sugars like a hawk. Every day, there would be dozens of decisions I could make that would help keep my big baby’s size closer to normal. But with a small baby, there is apparently nothing you can do. You can’t make the placenta work better than it is once it’s not working well. There is nothing special you can eat, no meds you can take. It was frustrating, but also freeing. All I had to do was eat normally, drink water, and rest. 

One thing I did do was drill my doctor on how to do fetal kick counts properly. If we were dealing with placental insufficiency, I wanted to be sure I was watching for things to go south for the baby. When do I call? How many is enough? And his advice was good. He said to lie down after eating without any distractions, and count until I got to five movements. As soon as I got to five movements, I could get up. This was a real time saver compared to how I’d been told to do kick counts before, and good for a busy mom. I don’t have to lie there for an hour and count all 36 movements my active baby makes. I just have to get to five movements in 30 minutes. If baby is taking a nap — they don’t nap longer than 30 minutes before birth — then I could go for ten movements in a full hour. This baby never made me wait that long, though. He always gave me the five movements I needed in ten minutes or less.  

At the next biophysical profile, everything was fine. It was a nice Christmas gift. His percentiles were back up and fluid levels were normal. My movements got slower and slower, but he kept kick kick kicking. I kept doing kick counts, and he always passed with flying colors. 

Towards the end of pregnancy, as always, I was hoping that I would go into labor early. But, as always, I didn’t. I got to 38 weeks and my doctor very sternly insisted that I needed an induction at 39 weeks, because of the diabetes and the thyroid and the celiac and the old age. I was disgruntled at his advice. I have never consented to an induction at 39 weeks and always want to go to 40. I don’t know why... something about feeling that labor will go better for my tired uterus if I just give it an extra few days of warm up... like I will do better if my body gets to decide when we start... induction feels like a forced march rather than a leisurely stroll... and in general, what’s better for mama is better for baby. 

Of course, I’ve always said that if baby is in trouble, cut me open and get him out. I’m not going to quibble with that. But I get tested and poked and prodded all the way through pregnancy. I want my doctors to prove to me there’s a problem, not just say that there might be. I’ve been a happy nine-month home for seven babies now, and I resent being told that my baby is about to die just because I suddenly got to day 273. I resent this largely because I’ve been told by doctors that my body will never be a good home for babies, at any time, and they were wrong. Don’t rush me, don’t tell me I’m not good enough for my baby, and prove there’s a problem before assuming there is one. 

So I pulled a fast one and talked to a different OB in the practice and asked her if it was OK to wait just one more week. I explained to her about wanting to give my body time, my previous pregnancy experiences. She thought waiting until 40 weeks was an acceptable course of action. 

Of course, having taken this risk, I now felt even more responsible for my baby’s life. This is kind of weird, because I’d been 100% responsible from the beginning, and knew that I’d be 100% responsible when I brought him home from the hospital, too. And of course, I would grieve like he was 100% my responsibility if he died. Yet there was a heightened awareness that if he died during this week, I’d have turned down a delivery that might have saved him. I knew that I was asking for more time for my body, and they were telling me this might be a risk to my baby’s body. I didn’t want anything bad to happen to him, but I also didn’t want anything bad to happen to me. I didn’t want anything bad to happen to him, of course, but I also suspected it would be fine like it was in the past. I’d been told that the worst would happen so many times in the past and it hadn’t, so my history had led me to believe that everything would be fine despite dire predictions to the contrary. 

Ready for the birth story? Buckle up. Spoiler alert: IT WAS NOT FINE. 

The Birth of Good News

Our first little girl was born to us at 2:30 in the afternoon. She was 7 pounds, 10 ounces, 21 inches, 40w4d, and “born in the normal way.”

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I know I’ve talked a big game about induction in the past, reiterating some of the things I don't like about how it's used by contemporary OBs. I’ve mentioned that it can sometimes lead doctors and patients to a false sense of control about the whole process. I've talked about the fact that induction is, at times, used unnecessarily as a preventive measure, when in fact there was (or is) nothing wrong with the mother and baby. I’ve talked about how pitocin contractions, caused by a synthetic mimic of oxytocin, hurts a bit more than natural contractions, which is caused by oxytocin. 

Well, as much as I think that spontaneous labor is generally best for mom and best for baby, because I do believe both are more likely to be ready for the taxing event of childbirth when labor begins spontaneously, I was ready to eat ALL MY WORDS and do an induction this week anyway. I knew that it was a great compliment to my body that baby was still in there, but I was really tired of on again, off again labor. I was tired of extreme pain in my pubic bone every time I laughed, coughed, sneezed, got out of bed, or walked up stairs. And most of all, unreasonable as it is, I was afraid the baby would get too big. Medical professionals caring for diabetics during pregnancy, take note: we hear you loud and clear about our risk factors!

Besides the physical pains and anxieties of pregnancy, there were social complications associated with baby’s delayed arrival. My mother in law had arrived from the west coast, and I did not want her to have to go home without meeting her first granddaughter. My husband had decided to take these two weeks off work, and while I welcomed his help for pregnancy, of course I wanted his help for at least one week after birth, too. And I had scheduled a court date in the expectation that baby would already be here for at least a week by that time. 

On Monday afternoon, three days after my official due date and one day after the very latest due date I could have possible given myself, I was still as pregnant as ever, having contractions all afternoon and most of the evening every day, occasionally waking up with a painful one at night, too. But this night, the contractions were maybe a little longer, stronger, and more frequent than in days past. We decided to go to the hospital. Part of me knew that if labor stalled tonight, this would simply bump my scheduled induction date up by a few days.

Contractions slowed a bit because I got cold and nervous during the car ride, and the nerves had not worn off by the time we arrived. In fact, the nerves intensified, because I could tell the contractions were weakening. I didn't want to wait too long to "pull the trigger," so to speak, on going to the hospital, because I didn't want to deliver a baby into the passenger seat of our car on a cold November night with cars whizzing by us on the highway. I didn’t want to be sent home.  I didn’t want to not have a baby tonight. I didn’t want to be pregnant for any more nights, or days, or even hours.

We came up to triage and were found to be at 4.5 centimeters with a posterior cervix. (Translation: cervical checks hurt more.) We were given orders to walk around the halls for a couple hours. By now, tired, sad, and with contractions slowing all the time, we were admitted, but at a rather weak 5.5 centimeters with contractions about 10 minutes apart. When the doctor checked cervical dilation again following admission, we had reached 8 centimeters, but the contractions had slowed to a complete standstill. 

This was, at one and the same time, thrilling and unnerving. I was at 8 centimeters with almost no pain! Hooray! But the last two times I had been told I was at 8 centimeters dilation, I was mere minutes away from pushing a small human being out of my body. Now, I was painlessly walking and talking and wishing I could lie down for a nap. Was something wrong? Was the baby malpositioned for labor? She seemed like she had been head down, LOA, for months. Was my uterus just too tired to give birth? Well, that didn't seem likely to change much between now and when I was hoping to give birth, so how on earth was I supposed to get the pregnancy over with?

They asked if I'd like them to break my water. Usually this causes the baby's head to descend a bit, apply pressure to the cervix, and the descent + pressure combination has, in the past, gotten things going right quick. But that also meant I had to will myself through intense pain after being awake all night and exhausted. Is there a painless way to get through this part? No. No, there is not. I started crying. I told the nurse and my husband that I was not in any pain at all, but I was merely afraid of  the pain I knew was coming. No one ever talked about an epidural, and I'm sort of glad I didn't have to deal with the question. The epidural is its own sort of scary anyway, they don't always work, and once I'm actually in pain, we're only looking at an hour, tops. So I asked for a little while to think about it. I sent a text message to some good friends, asking them to pray for us, and lamented my sudden cowardice. I laid down to try to rest.

But you know what happens when you're staring down the chute at the most intense pain of your life? You're just not in the mood to take a nap. Every time I felt anything at all in my womb, whether part of a contraction or baby's reassuring kick that she was still alive and happy, I experienced a jolt of adrenaline that kept me wide awake. I thought about whether the contractions would start up again, how fast and how strong, how soon I would get to meet her, what would happen if they didn't? I thought about whether there was any hope that the delivery might be one of those painless ones I'd heard of and dreamed about. I thought about how this was the most natural thing in the world, and yet still so terrifying. I was afraid that if I went to use the bathroom, I might accidentally push the baby out into the toilet. I thought about how complicated the recovery would be if I had a c-section.

After a couple hours, I agreed to have my water broken, but contractions still did not begin as I expected them to. I knew the only option left was pitocin. It was like being at the top of the chute, but the slide is made for children not heavy pregnant women, and you can't gain enough momentum to actually get going down the slide. And you're just terrified to push yourself forward anymore, because you know there's pain down there at the bottom. I was getting hungrier all the time, feeling weaker, still exhausted, and still afraid. "This is not going well," my left brain thought. "I wish they could just put me to sleep like they used to and I'd wake up and have a baby," my right brain thought. After a while, the nurse asked about pitocin. I asked for a little while to think about it, laid down to try to rest, and found, again, that the same interior turmoil of before would not allow it.

Around noon, I agreed to start the pitocin. Contractions picked up almost immediately, but they weren't the kind of contractions that push a baby out. That was reassuring, because it meant that the baby would not be born without warning. At this point, labor felt utterly normal. The doctor had mercifully ordered only the very lowest dose, and it was enough. After a while, however, the contractions were so strong that I had to stop moving and couldn't talk when they came on. Between contractions, I was an emotional mess again. It hurts too much. I can't do this. The baby is going to get stuck. I'm too tired. ISN'T THERE ANOTHER WAY?!?

My husband reminded me that I couldn't get unpregnant if I didn't go through with it. "Good point," the left brain part of me mused. "What kind of lazy race of people are we that we haven't figured out a way to make this hurt less yet?!" the right brain part of my shouted. When I confided my fear of a too-big baby to the nurse, she looked at me as though dumbfounded, and tried very hard to be patient as she rattled off all the reasons that was unlikely. "You're right," said my left brain. "But what if it's not enough?" worried my right brain. I did a few squats, hoping to help the baby's head descend, because I knew that would speed things up. It quickly became too much effort to assume this position, however, and I climbed into the bed. I cried a little bit. I gave a few small boluses, but basically didn't worry too much about 130 mg/dL. I was alternately hot and cold. I was shivering. I was still scared.

After a little while, I told the nurse that I felt like pushing. She checked the dilation and said that the cervix was not fully dilated yet, but that it would be OK to push a little bit, just to relieve some pressure. They kept asking about whether I felt like I needed to push, and I kept saying 'yes.' My husband kept telling them it was close, and asking if the doctor would come in soon? Every time they left the room, I was gripped with anxiety and asked my husband if he was ready to catch the baby. He didn't answer. The nurse reassured us that the doctor was right outside and would be ready when the time came.

Suddenly, I experienced one big contraction in which the left brain part of me thought, "My cervix is posterior, therefore I need to lift up off the bed a tiny bit, so that I'm not pushing her out into the mattress," and the right brain part of me thought, "GET HER OUT! NOW! NO TIME LIKE THE PRESENT!" During this contraction, the following also happened: a) I could feel the cervix pull back around the baby's head, b) a pocket of amniotic fluid sprayed out and drenched the nurse, and c) an infant came out of my body.

Yep, that's right. All it took was one contraction, one push. The nurse was planning to help me push slowly to avoid tearing, but all she had time to do was tell me to put my butt back down on the bed while I was pushing so that the baby would have a big enough opening to come out. My left brain was mistaken about the posterior cervix, because it straightened itself out just fine! The nurse thought my hip-raising was a right brain response to the pain, but I tell you, it was utter determination to get the baby out before anyone had time to even think about shoulder dystocia. In any case, I still didn't tear, which really makes recovery a lot easier!

The doctor mentioned that the umbilical cord was short. This might explain why our little girl hadn't descended and applied pressure to the cervix, which probably would have sped things up some. This site says that prolonged labor (along with a bunch of other scary things) is a complication of a baby with a short umbilical cord. It probably also explains why the doctor swiftly put her hand up inside my uterus to be sure there was no part of the placenta retained. Everything stung or ached for about the next 30 minutes, I was trying to catch my breath for the better part of an hour, and one of the baby's nurses brought me yogurt parfait, a turkey sandwich, and something else which I devoured as soon as I was in my postpartum recovery room. I let my blood sugar rise to 270 mg/dL without an ounce of regret or anxiety for the first time in nine months.

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Our daughter is amazing. I know your baby is too, but I'm especially fond of mine. Even the two year old is in love, in spite of the jealousy that many parents fear and some kiddos experience. I cannot believe how small she is! I've always said that it doesn't matter how big the baby is, labor is going to hurt, but I do sort of wonder if the pushing was just really fast because of her (relatively) small size. And seven pounds, ten ounces, is not even all that small! The nurse seemed genuinely impressed with my "performance," but labor is almost as much something that happens to you as something that you do, so I don't think there's really much to be impressed by.

They gave me the dextrose drip by IV during labor, which I have never had before. My blood sugar was higher than during other labors, but hers fortunately never dipped too low. This makes me think that the theory about a diabetic mother's blood sugar being high during labor leading to an insulin response in the baby, which ultimately causes the baby's blood sugar to drop after she is separated from the mother's blood supply, needs some perfecting. At the very least, our definition of "high blood sugar during labor" should perhaps be relaxed from 70-100 mg/dL, which is where my blood sugar has often been during labor, up to 110-140 mg/dL, which is where it was this time. In any case, I was grateful that she nursed eagerly and frequently, and never got too sleepy, too cold, or too jittery. 

I think I basically ended up with an induction this time around, with labor stalling in the wee hours of the morning and requiring membrane rupture and pitocin to get going again. My fourth labor was a little bit like that. I wonder, if I had just taken another Epsom salt bath and laid down to rest like last time, would labor have started up hard and fast and left us catching our breath as we went from living room to car to triage to hospital room to baby is born? Perhaps. Maybe I could have avoided the emotional drama that sapped me of so much energy between 3:00 am and 12:00 pm. Either way, even a small amount of pitocin this time was more effective than spicy food, less violent than castor oil, and less exhausting than walking for miles and miles, so I'm OK with the way it all turned out.

We are poorer than we ever have been, and yes, I know this all just means one more mouth to feed. But we are so happy to have another baby, a daughter, and so ready to take on the difficulties we know will come, for the sake of our family. There are things we could wish for, things we could complain about, and things we regret, but the fundamental fact is that we somehow have hope that things will work out for the best, a chance to wake up tomorrow and discover something new together, and six loving, mostly healthy, innocent children with whom we can learn how to love God. We have discovered the Truth of Christ's teaching about welcoming the little children in His name, and we are still searching hard for the Way to follow Jesus through the wild thicket of their many childhoods. But we can finally say that Life itself has graciously entered our home, time and time again, in the form of an infant, a humble state which Our Lord embraced in both the pure womb of the Blessed Virgin Mary and a dirty stable two thousand years ago. May my body, our hearts, and this home be always ready to receive Him!