Unexpected delivery

8-14-2011

I woke up around 5:45 am on Thursday morning. I had noticed that I had passed a dime size blood clot and had passed two other spots of blood. I called my MFM doc and they recommended that I come in to be evaluated. As my husband and I were driving to the evaluation I had commented to him that we would be back home later today and that most likely the blood was from a broken blood vessel or something similar. Both of us agreed that would most likely be the way the day would go and we would need a good nap later in the day. When we arrived to be evaluated I was already assigned a labor and delivery room (must have been an omen). I was no longer having any bleeding and was confident of my departure to back home. Given our history of having the fetal surgery the doctor on duty wanted to keep me longer to rule out any of the possible risks of having the surgery done. I was given a pelvic exam which did confirm more bleeding and a pool of fluid- which turned out to be amniotic. I was also having some right sided pain but was unsure if this was related to the position of Rachel. To make a long story short- it turned out that my water had broke at some point but we are unsure of when due to my leaky bladder issues I had been having since the fetal surgery. The doctor suspected that I had a uterine infection starting- a.k.a. the right sided pain. Normally if your water broke they would try to give you steroids for 48 hours to help prep the baby's lungs and then deliver the baby- in our case it was determined that there was not time for the steroids and a c-section needed to be done soon. Interestingly- the OB doctor on duty had recently been to San Francisco to learn more about the fetal surgery for spina bifida and he was well educated on what could be happening and what needed to be done. (Turns out Children's Hospital is considering getting the education to possibly provide this surgery in the future). Also the previous day- our case was discussed with multiple doctors to prepare for our upcoming c-section in September. Talk about timing - especially with us receiving the NICU tour two days prior. Perhaps God had his plan for Rachel in motion.

There were 2 other moms scheduled to have c-sections then it would be our turn. My husband took this opportunity to drive home and let the dogs out and make arrangements for our girls (we had dropped them off at Grandma's for my evaluation). As Murphy's law goes- we did not bring our cell phone with and the phones in our room did not allow any long distance calls to be able to notify family. As Steve was gone thinking he had 4 hours until the c-section was to be done- the staff had come in my room and bumped up my c-section time- I had no way of getting a hold of him to tell him to get back to the hospital. Fortunately as they were getting ready to walk me to the OR suite- Steve walked back in and was given his "bunny" suit to put on. The moral of this story is - never be over confident- always take the cell phone with you and make sure you have your hospital bag packed weeks in advance. No need to ask if I had a hospital bag planned out and packed because I did not (now I am at Steve's mercy for whatever he brings for me to use- yep I will be sporting Betty Boop jammies tomorrow).

For the c-section I had received a spinal epidural and opted to have an injection of Duramorph instead of a PCA for pain control after the c-section was done. The Duramorph is suppose to last around 20 hours without making you feel groggy and does not increase the length of time it takes for the spinal to wear off. For me- the Duramorph worked wonders and I highly recommend it to other moms. For the c-section they were able to reuse the same incision that was used for the fetal surgery. The c-section was an interesting feeling to me- while you do not feel any pain- you can feel your abdomen moving around like it's jello swishing side to side in a bowl. You do feel a slight amount of pressure at times but again it is not painful. During my c-section it was noted that my bladder was slighly displaced and wedged tightly under my uterus- the cause of all of my leaky issues (made me feel better to hear the doctors noting the displacement as I had already began to mentally make an urology appointment for myself- happy to report I have had no more leaky issues since the c-section-TMI!) It took about 20 minutes from the beginning of the c-section until Rachel was born at 1:36 p.m. She came out crying- what a joyous sound! The NICU team immediately took her out of the room and began evaluating her- my husband was able to follow and one of the NICU doctors explained everything to him step by step as they were evaluating. I could hear her crying out in the hall while they continued to work on me. A few moments later Steve walked back into the OR holding Rachel in his arms- I got a brief 10 second peek at her before she was escorted to the NICU. It was hard to see her- I mainly got a peek at a little forehead. I opted to have my tubes tied during the c-section as we had decided several months ago that Rachel would be our last child not only because of our age (me 35 & Steve 38) but due to the possible risk factors in future pregnancies from having the fetal surgery done. From start to finish I was in the OR for about 2 hours- I was kept very comfortable and whenever I would feel any anxiety I was given something for it immediately. I do have to give a big shout out for the entire OR team that worked on me as they were all ladies! Rock on girls! I was in the recovery room for about an hour before being moved to my room on the mom/baby floor. Steve and our girls were able to visit Rachel right away and they got to visit me while I was in the recovery room. Breanne was very excited for her baby sister and Alicia kept commenting that she didn't think her baby sister was coming that day (either did Steve and I). We had not even picked out Rachel's middle name at that point but while we were in the recovery room Steve and I let Breanne and Alicia pick out Rachel's middle name- our only criteria was that it needed to start with the letter "M" like both of their middle names. They choose Marissa.

Rachel Marissa was 3 lbs 11 oz. We do not know how long she was- with her being in a breech position for so long she had also developed hip dysplasia preventing her legs from being stretched out to measure. (Poor Steve I think his heart was broken by this as he also was born with hip dysplasia and clubbed feet and had always prayed that his girls wouldn't go through what he did) Rachel has a lot of hair- (no I didn't get my redhead but that is okay) her hair is the same shade of brown as Steve's is. For the most part she has been able to breathe on her own- needing a small amount of oxygen via nasal cannula at times for apnea she experiences during deep sleep. She started feeding yesterday at 4ml per feeding and she now has worked her way up to 12ml. She does wake up on her own near each feeding time and shows signs of rooting. I have been able to breastfeed her a few times now and am pumping every 3 hours. To check that she is receiving enough milk while breastfeeding- she gets weighed before and after the feeding. The theory is that each gram equals a ml of breast milk.She has been urinating on her own- after each void she was receiving a bladder scan and all of her scans have shown her to be on empty- she did have her kidneys evaluated also and they look great. The urologist have cleared her at this time and she does not need to catheterized. Her bladder will be re-evaluated in a couple of months. She has been passing stool frequently and it has just changed over from the sticky dark newborn stool to stool of a newborn on breast milk. We are using Aquafor (I think I spelled it wrong) as a barrier cream on her bottom to prevent skin breakdown. She is so tiny she has no buns yet! Rachel's blood type came back as A+ (looks like all 3 of my girls share the same blood type). Both of her feet are clubbed. We have not seen movement at the ankles or toes but she will kick her legs if you touch her feet. Her calves are definitely atrophied in comparison to her quads. We will be meeting with the orthopedic doctor tomorrow to discuss future bracing and casting for both the hip dysplasia and clubbed feet. I believe she will also be getting an OT & PT consult tomorrow. Her incision on her back looks great. Her vents continue to measure normal and will continue to be monitored for any changes. She is jaundice and was started on her bilirubin light blanket yesterday. She has little eye shields that are put on and look like sunglasses- too cute!!! It is hard to imagine but her little fingernails are the size of sesame seeds- I am not looking forward to when they need a trim.