Monday, 06 July 2009

• Derek's Birth Story and Pictures!

  Thanks to everyone for all the kind words and congratulations yesterday, not just here, but also through texts, phone calls, emails, Facebook and my online mommy forums. Johnny and I truly appreciate all the comments, and we feel so loved. I know you all understand that this is one of those rare times when I can't answer everyone right away, but I am reading every word of every comment and email, and I promise I will reply eventually! (Those of you who were around for Jack's birth can vouch for this. :))

  Well, as promised, I'm here to share Derek's birth story, some pictures and updates on both kids. Many of you have read about the story and seen the pics in other places already, so feel free to skip! Besides filling in the people who primarily keep up with my through my blog, I'm also just recording this for my own pleasure for the future.

  Labor/Birth Experience

  On Friday, July 3, I had my first real contractions. Sure enough, just like last time, the telltale sign was that they began in my lower back and radiated all through my entire abdomen, not just random spots like with Braxton-Hicks. The first contractions were around 8 p.m. or 9 p.m. They were about 10 minutes apart, though not always, and lasting only 30 to 45 seconds long. At this point, they were very mild. Johnny, my mom and I were all very excited, and Johnny and I checked through our hospital bag one more time to make sure we had everything we needed. I couldn't really sleep because every 10 to 15 minutes, a contraction would hit, and while it wasn't painful, it was uncomfortable. Plus, I was excited! So, I passed the time by posting on my mommy forums, reading blogs and watching TV. Finally I was able to lay down and catch a bit of rest in between the contractions.

  The midwives and the labor & delivery unit at the hospital had instructed me to come in when my contractions were intense (as in, I couldn't talk through them) and spaced consistently between three to five minutes apart. On Friday night, I naively expected that Johnny and I would be heading to the hospital sometime Saturday morning. Well, Saturday morning comes and goes, and not only have the contractions not increased in frequency or intensity, but they space out even more! I was discouraged. No Fourth of July baby, it looked like. My mom, Jack, Johnny and I all headed to the mall. I wanted to walk around somewhere besides the house. While at the mall, I began getting very intense contractions that made my face turn red. I couldn't talk through them. When we got home, those contractions began hitting consistently, every 10 minutes. A couple of hours later, around 6 p.m., they were coming every seven minutes. I got into the shower, rechecked my hospital bag, and told Johnny to get a little rest. By 10 p.m., they were coming every five or six minutes. Sometimes they would go back to seven minutes, but always very intense pain and for at least a minute each. I didn't want to go in too early, but at the same time, I was cognizant of the fact that as a VBAC candidate, I shouldn't labor too long at home because the hospital would need to monitor me for a uterine rupture. Finally, at 11:30 p.m., I told Johnny we should go. The contractions were every four to five minutes at that point.

  Since it was so late on a holiday, we figured traffic wouldn't be too bad. There is a major hospital (actually, two of them) in Torrance, where we live, but since I was delivering at UCLA Ronald Reagan Medical Center (which is equipped to do VBACs), we had farther to drive. Well, who knows what was going on, but the freeway was packed at 11:30 p.m., and what was supposed to be a half-hour trip took one whole hour, during which my contractions were three minutes apart. Yikes! When we finally got up to L&D, they examined me and told me I was already five centimeters dilated, 80% effaced and that Derek was at -2 station. We were elated! We had come in at a perfect time, they said, and they predicted the rest of the labor would go well. Johnny and I settled into the huge labor and delivery room shortly after 12:30 a.m., and I anticipated continuing on my medication-free labor. I did meet with the anesthesiologist, per hospital protocol, and I made it clear that I didn't want an epidural.

  At 4 a.m., the doctor who works with the midwife came in and checked me again. She determined that I was now 7 cm centimeters dilated, 90% effaced, and Derek was still at -2 station (+2 station is push-ready). She said I was doing well, but that things would go faster (and Derek would descend more easily) if she broke my "huge, bulging" bag of waters. I told her I was cool with that if the midwife thought it was a good idea. The doctor consulted the midwife, who agreed that the bag should be broken, so we went ahead and did that (it was such a weird feeling, that warm water rushing down my legs!). The doctor warned me that things would get very intense from here on out and asked if I wanted that epidural. Cheerfully, I said no. She said she would be back at 6 a.m. to check on me. I figured, I've completed the active phase of labor all on my own ... surely I can make it in the final three centimeters of the transition stage au naturale, too! I braced for intense contractions, and sure enough, they came. I didn't time them because they were so painful when they did come, and seemed to come one on top of the other. Thank goodness Johnny was there -- he helped me get into different positions, reminded me to breathe deeply and refrained from corny jokes. ;) He also applied counterpressure to my back when I needed it. I was so tired at this point (having not slept since Friday night) that sometimes I fell asleep between contractions. Believe me, it is unpleasant to be woken up by a "Ooooh, I'm going to die!" sort of pain. But, I was really proud of myself for getting through the contractions when they happened. I took my midwife's advice and stood up or got on all fours for many of the contractions, which made them more intense but would supposedly also increase their power to dilate me and get Derek into prime birthing position.

  So, at 6:30 a.m., after two and a half hours of intense contractions, I thought for sure the doctor would tell me I was dilated to at least 9 centimeters. Well, she sticks what seems to be her entire right arm up there, and then pronounces that I have not changed at all since 4 a.m. No more dilation, after all that pain. I nearly died. I was almost at the end of my rope at that point, and I needed to hear that I had made progress. She explained that Derek was posterior, meaning that while he's head-down, he's facing out toward my belly, instead of facing toward my back (the ideal position for babies to be born is head-down, facing the mom's back -- in other words, when they come out, the back of their head is up toward the ceiling. It allows them to pass through the birth canal better). With posterior babies, the labor is very painful, because there's a lot of back pain (those of you who have been through this with posterior babies know that "a lot" of back pain is an understatement!), and apparently the contractions can be spaced farther apart, but come in twos when they do come. So while it feels really painful, they're not all that effective. That's what happened in this case -- once I hit 7 centimeters, the back labor contractions came only every five minutes, but two at a time, as opposed to one at a time but more frequently before 7 centimeters. The doctor and midwife consulted and recommended putting me on an extremely light dose of Pitocin, which brings on contractions. (It's usually not recommended for VBACs because of the increased risk of rupture, but apparently it's OK in very light doses.) The doctor then told me that the Pitocin would result in contractions even more painful than those I'd experienced already, and more frequently, and asked if I wanted the epidural. The midwife told me it was up to me (in other words, not to feel forced into a decision).

  I thought about it, and I said yes. Johnny asked if I was sure, because he didn't want me to regret anything afterward. All I had done throughout this pregnancy was talk about natural childbirth. But, I had made up my mind. If I hadn't gone through 35 or so hours of labor already, and if I wasn't sleep-deprived, I probably could have dealt with the extra-strong contractions that Pitocin would bring. However, I was tired from the previous 35 hours, and I knew I didn't have the strength to deal with the final 3 centimeters and then the pushing all by myself. I had a feeling that I needed to rest a bit. Once I consented to the epidural, the anesthesiologist was in the room almost immediately. Unfortunately, while he was setting up, my contractions (even before the Pitocin) began coming fast -- one every two minutes, and hard. At the same time, I had to curl up my back so the epidural catheter could be placed, and a nurse was trying to place external baby monitors on my belly (to listen to Derek's heart rate). There was a lot going on, not to mention the horrible pain. That was my lowest point in the labor. I was squeezing Johnny's hand and just whimpering. No tears were coming out; I didn't even have the energy to cry for real. I just whimpered, "Oh my God, stop touching me!" (By the way, some people asked if I screamed during labor, and the answer is, no, I didn't. Screaming takes a surprising amount of energy. Most of the time I just whispered, or just breathed. I did squeeze my eyes shut a lot, but had no extra reserves for screaming!) I was rather incoherent when people asked me questions at that point.

  Finally, the epidural catheter was placed, but it was another hour before I felt relief, because for whatever reason, my feet went numb, but my belly retained all feeling! I told the nurse, "Listen, I'm not having the baby in my feet! Fix it!" At last, they got the dosage correct, and when the relief hit, it was wonderful. Even though the contractions were frequent (especially once the Pitocin drip began), I only felt pressure alerting me to the fact that contractions were occurring, but no pain associated with them. I was able to fall asleep. As great as that felt, I was convinced that with all the interventions going on -- the Pitocin, the epidural and the fact that I was bed-bound -- I was probably headed for a repeat c-section, since these interventions were all known to cause labor to stall, and make it harder for a baby (especially a posterior baby) to descend. But, my midwife and Johnny were wonderfully optimistic, and my midwife said, "Well, Derek would not be the first posterior baby to be born to a mom who was bed-bound from an epidural, so don't give up hope."

  After only 1.5 hours (at 10 a.m.), when my midwife came in to check on me, I told her I felt like I really needed to poop. She got really excited and checked me for progress. She'd thought it was too early to check, but lo and behold, I was already fully dilated to 10 centimeters, and Derek's head was at +2 station: In other words, time to push! That was why I felt like I needed to go #2. The epidural apparently relaxed me enough to cause all that to happen. Derek was no longer fully posterior -- he had rotated some as he descended. The midwife asked if I would be willing to wait one hour to push, though, so that I could "labor down" -- that is, let the contractions do some more work to get Derek as low as possible. In that hour, she would also have me repeatedly flip from my right side to my left side, and back again, so that he could maybe become fully anterior. I said yes, but by the time that hour was up, boy, I was ready to push. I swear I thought I was going to poop out a baby. Ha. My midwife said it was time and that Derek had indeed become anterior! She went and gathered a doctor and a nurse, and the delivery implements. Then she came back and gave me a lesson on pushing.

  We began pushing shortly after 11 a.m. I was really excited, and had some strength from resting. I could not believe that I would get to have my VBAC after all. That got me through the next 2.5 hours of pushing. Toward the end, it became really painful -- they're not kidding when they say that the baby crowning feels like a "ring of fire." Plus, my arms, legs and abs became really sore from the effort. Anyway, the midwife and nurse said I was an excellent pusher, but that since it was essentially my first birth (since I never pushed with Jack), it would take a bit longer. It really was fine until the crowning happened, and then it was the worst stinging sensation I've ever felt. The midwife used a lot of massage oil to help prevent tearing, but she also had to stick her hand up in there to help guide Derek out. OUCH!

  At one point, right before Derek was born, the midwife stopped what she was doing and said, "Get the chief resident. There's more blood than usual." I could tell by her face that she was nervous, and that made me nervous. To my face, she said everything was fine, and was very calm. Johnny could also see what was going on, since he had been supporting one of my legs as I pushed. He turned a bit pale but also reassured me. I was thinking maybe my uterus had ruptured and I would need to get an emergency c-section. The resident came over in about 0.1 second -- lightning fast -- and thankfully declared it must just be an internal tear of some sort. Turns out, Derek had his hand up by his chin, and on his way down, he had scratched a second-degree tear along the inside of my vagina, which resulted in all the blood. I asked Johnny later, "How much blood?" and he said, "Well, let's say that it was probably a whole baby's worth of blood." He said he thought I might die, and that's why they'd all turned so pale. I'm so glad I couldn't see what was going on down there! Everyone kept their cool, though, and after the chief resident came, the delivery kept going as though nothing had gone on. (By the way, I kept expecting Dr. Bailey to walk in when they said "chief resident." Yes, I'm a dork even while losing tons of blood, apparently.)

  A few minutes after that blip on the radar, Derek's head had popped through, and the midwife tugged the rest of him free. It was an amazing feeling to feel him coming out, and to see him being born. I felt so powerful and so ... complete as they immediately put him on my chest while they clamped the cord. Johnny got to cut the cord, and we were able to hold him right away. They cleaned him up a bit on my belly (his first action was to poop tarry meconium all over me ... thanks, Derek!), then took him to another area right there in the room to clean him up some more. He cried almost right away, and both Johnny and I were near tears with joy. He looked exactly like newborn Jack!

  I just could not believe I'd had my VBAC, and I kept thanking the midwife and the staff. I really believe that at any number of points, they could have said, "OK, into the OR we go," but instead they really tried everything to make it happen. I told them it was a dream come true for me, and I meant it. Finally, I had the experience I'd always pictured. I was also proud of myself for not being stubborn and recognizing that my body needed help by accepting the epidural. As you all know, I had wanted to do it all natural, but I think in this case, the epidural was really what enabled me to have the VBAC in the end, by relaxing me and enabling me to regather some strength.

  The other wonderful thing was that I could sit up right away! But, the not wonderful thing was spending the next hour with my legs in stirrups while they fixed up the tear Derek had left. Ouch! It was a small price to pay, though. I do have to reiterate again that both a c-section and a vaginal birth are huge battles for a mom to fight, so no matter which way a birth goes, a mom deserves lots of credit for going through the experience.

  Pictures

  OK, what you've all been waiting for!

  The first picture we have of the three of us, shortly after Derek was born

  

  Derek looked like a clone of his brother

  

  Tired but happy!

  

  We do have a picture almost exactly like this of Jack

  

  And this was me immediately after pushing. WHEW! A total of 42.5 hours ... I won't let Derek forget that ("clean your room! I was in labor with you for almost 43 hours!" Just kidding)

  

  Jack meets Derek for the first time!

  

  Post-Birth Updates

  So I'm doing fine. Very tired, still, and sore down below, but walking around and recuperating well. Jack met Derek yesterday afternoon and was delighted by him. He kept saying "Dee-dee," which is the Chinese word for "little brother." Apparently, when he woke up this morning, he asked my mom for "Mama, Baba, Dee-Dee," and when he saw Johnny this afternoon (Johnny stopped at home to get some things), he wanted Johnny to read him the "Your New Baby" picture book we got him, and also asked for his brother (and for me ... aww!).

  Derek is doing well also, although he had to go to the NICU. At some point shortly after birth, Derek breathed some fluid into his lungs -- we suspect it was excess fluid that wasn't suctioned out of his mouth, although no one really knows about these things. It's fairly common, but newborns can't cough out liquid as quickly as we adults can. It's only a small amount, and it will evaporate or be resorbed by his body on its own, but the hospital likes to be extra certain that there's no infection, because sometimes liquid in the lungs can lead to an infection. So, they took him to the NICU and started him on antibiotics, just in case. His stats look great -- he's 100% saturated with oxygen on his own, he's eating well, he's perfectly round and pink, so that's awesome. The NICU doctors agree that he's healthy, but once they've started antibiotics, they need to finish the round of treatment, so right now they're saying they'd like to keep Derek for the whole seven-day course. That would mean I would go home without him. :( It's very sad, but I'm mostly annoyed that I have to be separated from him rather than worried that something's really wrong. Please keep your fingers crosssed that they change their minds about the seven-day stay!

  The NICU nurses have been calling me every time Derek is awake, so I nurse him every chance I get. He's been doing great with that, and my milk should come in tomorrow. I've also been pumping during the two hours of the day that the NICU is closed to parents (otherwise we can go in anytime we want), and we've both been holding Derek and spending time with him every chance we get. It's sad to go into the NICU, though, and see the sick babies. It makes us really thankful to have Derek, and we hope he doesn't have to stay the whole week. If he does, though, I'll come see him every day, nurse him and drop off pumped milk. The lactation consultant came to see us today and said that Derek's latch was perfect, so she doesn't foresee any problems with a separation like this. Let's hope she's right!

  OK, this is ultra-long. I'll end this now and go to bed ... it's taken hours to write, between pumping and nursing Derek and getting my vitals checked. Thanks for reading!

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