Saturday, August 5, 2017

The eventful birth of Evan Robert

For months I have thought about the day that I would sit and write Evan's birth story. I wanted more than anything to peer into a crystal ball to get a glimpse of the day after he was born, that way I would know that (hopefully) everything turned out alright. The countless appointments and never ending worrying because of the VCI became such a heavy burden, especially the last month of my pregnancy and the only way to cure the worrying was to just have the child already. There were moments where I would be folding little Evan's laundry and honestly wonder if he'd ever come home to wear them. That's a dark and painful thought to admit, but an honest one. Since his birth I have felt a tremendous weight lifted from my shoulders, not that its been easy to get thrown back in to real life with three kids, but little Evan and I came out of the other side of a dark and scary place of uncertainty. Even with how stressful and exhausting every day life has now become, we are all accounted for and are doing great.

It's been a month since his arrival so we all know this story ends with this:

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But this kid didn't come out without giving us all (OB, L&D nurse and NICU nurse included) a handful of good scares. During 7 of the 9 hours of labor I was exasperated and confused about how nothing was going according to plan. "Not going to plan" seems to be the theme for Evan's entire pregnancy and birth- I am crossing my fingers that it's now all out of his system and it seems to be so far.

The day before Evan was born was the Fourth of July so we had no problem keeping extremely busy. Fourth of July breakfast? Check. Parade? Check. Baseball game? Check. BBQ? Check. Lucy's pizza? Check. Neighborhood firework show? Check. Staying up wayyy too late when you have a 6am induction the following morning? Triple check.

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{Last day as a family of 4 on the Fourth of July}

We were told that the Fourth of July is usually pretty busy in the Labor and Delivery ward because a lot of women get dehydrated from the hot outdoor festivities (and I can see why because boy, being 39 weeks pregnant in 95 degree heat is not at all comfortable), so they advised us that we should call before we made our way to the hospital. Austin was convinced that there was no way they would actually be ready for us at that time, so I haphazardly set an alarm on my phone for 4:45 am. Before I knew it that cruel alarm went off. I called Labor and Delivery and sure enough they were ready for us- take that Austin! We quickly showered, put a couple of last minute items into our suitcase and snuck into the girls' room to kiss their heads and tuck them in (again).  I grabbed a greek yogurt, put a handful of berries on top and ate it as we drove to the hospital. It was so weird to have things so calm- it helped that my sister, Katie, flew in a few days prior to take care of the girls. I knew they were in good hands so that made leaving so much easier. It was just a matter of hours before I would finally hold my sweet boy.

We checked into the hospital, got gowned up, answered a bajillion and one questions, met my awesome nurse (who's one and only job that day was taking care of me) hooked me up to all of the monitors (the blood pressure cuff felt pleasant on my sunburned arm- ouch!) inserted the I.V port (she got my vein first try, so I knew she was good) and then after a quick cervical check (a 1 but fully effaced) it was time for the dreaded pitocin drip. It got started and within 10 minutes I started to contract. Within 30 minutes I was having regular contractions 3-4 minutes apart. Every 20 minutes or so my nurse would evaluate if we should or need to up the pitocin. She started it at a level 2 and explained that the average amount women need to keep a steady stream of contractions is around a level 12, but usually maxing out at 20. Slowly but surely she upped my pitocin levels to an 8. Around 8 am my OB came in to check in on me and see how everything was going. He had clinic patients to see at his office (right next to the hospital), but would come back around noon to break my water. We had discussed in his office in the weeks prior to the birth that it would be a smart idea to get an epidural before my water was ruptured. Once my water was broken that's when things could get dicey without having the protection of the water around his cord, so it was important to be in a position where we could have a potential c-section quickly in case of an emergency. So they set a 11:30 time spot for my epidural. An hour or so after my OB left, my contractions were getting strong and fast. I felt like such a wimp because there I was already super uncomfortable and I had only been in labor for a few hours- pitocin doesn't mess around! When my nurse came in I asked to be unhooked to my monitor so I could use the restroom (but really I just wanted to walk around for a bit). When she came back in hook me back up I asked if I could walk around for a bit longer and that's when she offered to hook me up to the glorious portable monitor system- thank goodness! I walked around and it was lovely. Austin and I turned on the tv and started some Alaska show on the Discovery channel... Alaska Homicide maybe? We also got an hour or so of HGTV.  It was fun to watch actual tv for once and not just streaming services or watching our usual shows (let's face it, The Office mostly), but sheesh we don't miss the commercials haha! Austin ate breakfast while I got cozy in the rocking chair and rocked through my contractions. I started to think that I wasn't contracting anymore and almost called the nurse to up my pitocin, but Austin said my contractions never slowed down- he kept watch of those strips the whole time. Its amazing that I was having the same intensity of contractions, yet when I was moving I could hardly feel them, but being on the bed I had to be breathing through them. I stayed in the rocking chair until 11 o'clock when my nurse came back in. She explained that the baby had had two heart rate decelerations right after a couple of back to back contractions- which isn't normal. During a contraction it's completely normal (within reason) for the heart rate to dip, but right after is a good indicator of cord compression, which made my nurse uneasy especially because that's one thing we really needed to keep an eye on due to the velamentous cord insertion. The nurse wasn't too worried because it could have been a bad reading from the monitor, but she did say she wanted me to get back into bed and lay me on my left side and see if it was a fluke or not. I was bummed to be back in the bed, but I only had a half hour to kill until the anesthesiologist was scheduled to come in so I knew that was doable.

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{Last bump picture}

Right before the anesthesiologist came in, my nurse did another quick cervical exam and I was at a 3. I felt indifferent about that, although I was hoping it would have been higher seeing how I was contracting like a champ. The nurse hoped that once my water broke I would dilate a whole lot faster than I had been. The anesthesiologist came in promptly at 11:30 and he was a wonderful, angel of a man. He explained that he does a different type of epidural called a combined spinal epidural (CSE). It's when a spinal block and an epidural mate and the result is nothing short of magic (my description not his hah!). It allows for the quick relief that a spinal block is known for, but with the slow dripping pain relief catheter of an epidural. Also, they use a fraction of the amount of pain killer, but keep it highly localized- so you are only numb in the lower abdominal/pelvic region. You can feel pressure and are able to move around completely normal (on the bed for liability reasons of course). My legs felt a tad heavy and at first a little tingly, but then eventually felt normal. I remember being scared of getting the epidural because I wasn't in enough pain labor wise to distract me from the massive needle going into my spine, but I felt nothing more than a small pinch. The anesthesiologist had Austin come around and watch while he explained and did the whole procedure. The whole thing was calm and fascinating. It was weird having the CSE because I could feel Evan kick and swirl around, but no pain of contractions- just a slight squeeze. It was mind blowing- I swore I wasn't in labor any more because I felt completely normal- no dead legs, no nausea, but maybe a tad itchy. Even though I was blissfully unaware, my contractions were getting a lot longer and closer together. My OB came back a little after 1:30 and broke my water. All our worries about this moment seemed silly in retrospect because everything looked great. No sign of torn vessels, no immediate fetal stress, no cord prolapse. I instantly felt relieved because I had been dreading the potential bad outcomes of that moment for a long time. Everything was going great other than just dilating slowly. My OB seemed a little concerned about those two dips in Evan's heart rate earlier so he wanted to monitor me from his office while he continued to work in the clinic for a bit. He had the nurse send over pictures of the monitoring strips and call with an update every 15 minutes so he could better anticipate a course of action. My contractions picked up big time after my water broke, every two or so minutes, but I was still pleasantly numb to any pain.  The nurse decided to hold off on increasing the pitocin drip because I wasn't having any troubles contracting (having already had two babies I guess my body seemed to know what it was doing haha) and she was worried about undue stress to the baby. She made a good call of not upping the pitocin because not an hour after my water broke we started to notice more heart decelerations, this time during the contractions which made us less nervous, but they were dipping quite a bit, more than what is deemed "normal". The nurse had me move around and switch positions frequently to see if baby boy preferred a certain position, but we weren't having much luck. Then it was time for another cervical check and I was only a 4!  What in the world?? We were all super confused about how that could be possible. During the cervical check, the nurse's face contorted oddly so I asked her what was going on. "I feel something..." her face looked super confused and then burst into laughter. "IT'S HIS EAR!! I have NEVER felt an EAR during a check before!" What!? How is that possible? "so that's the problem! Baby boy is sideways! Let's see if we can turn him". She explained that his positioning was what was to blame for the slow dilating because his head wasn't properly making contact with my cervix. So since his head was tilted, my body didn't have the stimulus to dilate properly. My nurse brought in "the peanut" imagine one of those big rubber exercise balls, but in an hourglass or peanut shape. We then draped my body over it and switched back and forth, left and right. I could feel little Evan twisting around which I hoped was a good thing.

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{Austin's addition to number 10 haha!}

During our attempts to move Evan into the right spot, he began to have even more heart decelerations, but this time dipping way lower than before. His heart rate normally hovered around the 135-140 beats per minute mark, but he dipped down into the low 50's. It was nothing short of terrifying hearing it go so slow and waiting for it to pop back up, hoping it would come back up. My nurse ran and called my OB to suggest an internal fetal monitor that way we would have an accurate reading on his heart rate. She was hoping it was a monitor issue, but she was nervous. The OB after seeing the strip decided to cancel the rest of his clinic appointments and come stay with me until baby boy decided to make his debut. While we waited for the OB to come and place the internal monitor we had a few contractions where we couldn't find his heart rate at all and that silence was torture. The nurse frantically moved the heart rate monitor around my belly when I would contract, desperate to find his heart tones, but was having a hard time. I was so scared because it was clear that something was wrong, but I wasn't having any bleeding or anything else to indicate a torn vessel or cord separation, so it was either cord compression or something else. I started to feel a crazy amount of pressure. Pressure I am all too familiar with from Ellie's birth, but seeing how I was only a 4 about 40 minutes prior I thought there was no way I could be much further along than that. But then I began to shake and I knew I had to be close. Austin kept asking if I was cold and if I needed more blankets as I shook uncontrollably and I mean massive muscle tremors and chattering teeth type shaking. I explained that I was confident I was in transition. I told the nurse and before she could do anything, in walked my OB. He started to unwrap the internal fetal monitor when he noticed my aggressive shaking and asked how I was feeling. "Pressure. Lots of pressure." I answered. He did a cervical check and he said "well Sammie you are fully dilated. Let's get this baby out ok?" me and the nurse jumped for joy. We both were so, so relieved (I'm sure Austin was too). My nurse immediately got into action of getting the room ready while a NICU nurse came in and introduced herself. She said she would be there for the birth and that because of his dipping heart rate, she had been monitoring Evan's progress. She wanted to be there in case he needed any extra help or if heaven forbid, help rush him to the NICU. My OB left for a few minutes to change his clothes while I sat there and tried with all my might NOT to push (so much harder than you'd imagine). In ran my OB and immediately we started to push with my contractions. Evan's heart rate was impossible to find and by the glances my OB and nurse were sharing, I knew it wasn't good. I was told we needed to get him out right away so I pushed longer and harder and didn't stop until I felt Evan's head come out. That's when the OB said "don't worry, but the cord is wrapped around his neck, I need you to stop pushing so I can get it off". He tried to wrap his finger under the cord to pull it up and over his head, but it was wrapped so tightly he couldn't even fit his finger in between the cord and little Evan's neck, so he had to cut it off right then and there. Evan wasn't even fully delivered (his body still hadn't even been pushed out) and already his cord had been cut. One more push later and Evan came screaming into the world and he. was. mad. I immediately sobbed from relief and happiness because it all had been so intense... going from a 4 to fully dilated in 40 minutes was insane enough, but having the cord so tightly wrapped around his neck that they had to cut it off was so, so scary! I just wanted everything to be ok and with every cry and whimper I knew he was ok. Better than ok... he was perfection... See?

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It was done! Thank goodness it is done! No hemorrhage, no placenta retention, everything was smooth from there on out. My OB and nurse were so relieved that it was over along with Austin and I. They admitted that I almost got wheeled out for an emergency c-section a handful of times, but thank heavens I was able to push him out fast enough. So after months of immense worrying, an intense and terrifying birth I was rewarded with a son- a beautiful boy and it felt so good just to hold him.

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When we switched to the recovery room I felt great- a little swollen from all the fluids they pumped through me, but it felt so good to have permission to be up and walking around. I'm actually surprised at how great I felt. Those new baby hormones (I call it the new baby high) do wonders. As I walked with our delivery nurse down the hall and Austin took Evan for his first bath in the nursery, I asked her how nervous she was during everything. She replied with "dude, I was scared the whole time! He was giving us trouble, good thing he's cute though!" she had a good game face during the whole ordeal though, which I appreciated. When Austin came back with our shiny new baby we started talking about how it felt so good to be done. It was such a tremendous relief to have had made it through unscathed. While talking about the labor and delivery I made a comment about how he seemed so calm the entire time, which is VERY unlike him because he's usually full of anxiety for things as stressful or unpredictable as birth (especially this one). I do pretty good at staying calm in most stressful situations, but I was a nervous wreck the entire time and my anxious husband was as calm as a cucumber- what sense does that make? When I asked him if he was actually calm or if he just had on a brave face for me he said stoically "no, I really was calm." I was so confused because I was freaking out during the entire extent of the induction because of all the complications. "Even when he was in the wrong position?! Or when we couldn't find his heart rate? Or the CORD WAS WRAPPED AROUND EVAN'S NECK sooo tight that the OB had to CUT it off!? How in the world were you calm during all of that??" Austin responded with "because I knew that they were ready for a c-section the entire time". That's when I started to laugh because the reason behind his calm demeanor was the exact reason I was a nervous wreck! haha!

Later that evening Katie, my sister, brought the girls to meet little Evan I'll do a whole separate post about that visit, but it filled me with joy to see my girls whole heartily welcome their baby brother. It was such a sweet moment.

The hospital staff usually recommends that you stay the bare minimum of 24 hours post birth or the more desired 48 hours. Austin thought the 48 hour stay would be "fun" and "like a vacation".  I tried to remind him how terrible it is to try and get any sort of rest in the hospital, but he was convinced it would be ok. After our night of being woken up by a nurse every 2 hours for uterine compressions, blood pressure tests, check ups for Evan and being bombarded with questions like "hows your pain level?" "When was the last time you pee'd?" "Any dizziness or headache?" Austin wanted out. I knew he would eventually remember that a hospital stay is far from a vacation. We were dying to get back home to sleep in our own bed. So as soon as we hit the 24 hour mark we high tailed out of there. While I will say I missed the quiet of the hospital, it felt so good to be home.

About a week later I got a nice card in the mail from the amazing nurses and kind staff that helped us at the hospital. I cracked up as I noticed what our labor and delivery nurse, Krista, said in the card (first note at the top)...

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He really was quite the trouble maker, but thankfully being born has calmed him down a bit. :)

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