Facts & Figures & Dates and such

Since staying warm and growing are Will's two biggest tasks right now, we have close follow up with his pediatritian starting right away today, just 48 hrs after being discharged.  While all newborns get their first checkup early on, Will will have mainly 2 appointments a week for at least a while to make sure he continues to gain weight appropriately as we adjust his feeding schedule between nursing, fortifying his bottles and overall volume, along with his work of maintaining his temperature.

Reviewing where he's been so far:

• US all along estimated him large for age ~ at 32 weeks was estimated at 5 lb 1 oz - which was 95% for his gestational age, or average for a 35 weeker
• Born at 32 weeks 2 days weighing 5lb 5oz and 18 inches long - still 95%.  His head circumference was up there as well, albeit proportionately
• Initial weight loss (as expected) down to 4lb 13oz but after a week old & no significant gains for a couple days after that, added a fortifier to his breast milk
• Weight steadily went onward and upward from there ~ on the day of discharge up to 6lb 4oz and length up to 19 inches
• First outpatient visit after 48 hrs home weighs in at 6 lbs 8 oz

Perspective takes some reminding sometimes, because essentially now he is the size of a "normal" newborn.  But he is only just over 35 weeks gestational age, just over 3 weeks old, and technically was of low birth weight when born, even if big for his 'age.' Considering the usual guidelines of doubling weight by 6 months & tripling by a year he should, there is a big difference in these numbers had Will been born full term.  Estimating he would have been a 9-10lb term baby, the numbers at each of these milestones would go from 10lbs to 20lbs at six months; from 16lb to 30lb at one year!  And this is just his growth curve.  Technically his adjusted age is still talked about in terms of gestation - he is just shy of 36 weeks today.  As a preemie, he will be age adjusted for all developmental milestones for at least the first two years of life.  The ability to nurse, head control, having hands open, rolling over, smiling,  reaching, sitting up, babbling & speech, awareness of surroundings, crawling, cruising, walking, and the list goes on and on.  I'm not concerned about his development yet; I understand he will be on his own time frame.  However I do find myself already somewhat defensive for him, after all he is a preemie and from the beginning he's done well enough to fool people into having great expectations for him.  If we have to remind ourselves "he's just a preemie, let him be a preemie," then how often will we have to remind others?  I just want to let him be who he is going to become at whatever pace he gets there!

We're Home! Adventures of the first Night

Well, last night was the big day.  After his small setback, Will perked up again with good eating and good temps.  His team had re-planned for discharge Saturday, but until it actually got here I wasn't going to count on it.  This time I feel ready though.  Not that I'm any less terrified than I was when we talked discharge last time, but I feel ready.  Which I suppose is good since we are all home now!

We told Lydia that her baby was coming home, and while initially confused (after all, someone in this family has been living at the hospital for the last three months) she kept asking about him through out the day.  We had originally planned on dropping her off with friends to play while we went to pick up Will, but then she was so interested I thought she might feel better about coming along.  So we gave her the option, and while letting a two year old make her own decisions might not be frequently recommended, she was certain about this one: she was going to come along to the hospital!  And she was so excited when we got there.  Her expressions were great when he squeaked, she asked to hold him and feed him and help with his car seat.  When we eventually wrangled everyone into the car and back home, she wouldn't go to bed without giving him hugs and kisses.  So far today he was the first thing she wanted to see this morning; "I have to tell him good morning."  She didn't want to leave "her baby" to come shopping with mom, and she absolutely has to help with every diaper change - at least we have someone willing to run them to the garbage!

Charlie has been good at welcoming his new little friend as well.  He loves to sniff baby's heads, and this has been no different.  But mostly I think he is curious as to who caused all the ruckus that got him kicked out of the master bedroom (besides mommy).  He's been good though, even when Lydia tells him "no Charlie, that's my baby" when he comes in to see what is going on.

So now we have the first night down.  It was interesting coming home in the evening ~ not that I think we'd have slept more regardless ~ but the first few hours were just about getting settled, picking what routine we'd try first, and realizing there is no point in planning more than three hours in advance!  There are two big variables so far compared to when we brought Lydia home.  One - I seemed to have gotten some viral thing a few days ago that wish as I might isn't allergies, so I have to wear a mask when handling Will and really have to minimize that as much as possible for a few days (booooo, plus doesn't help help the little sleep I would otherwise get).  Two is that Will isn't mature enough to exclusively breast feed (as expected) so we have the potential triple threat of nurse/bottle/pump for each feeding.  Since Lydia was only nursing, that was pretty much a one (wo-)man job; not this go around. 

As we settled in to bed for 'the night' Chris says make sure to wake me up.  For those who don't know, a freight train could come through our room in the middle of the night and if it didn't physically contact Chris he may not wake up ~ so listening for/hearing baby sounds is all me.  At this point we are still on a bit of scheduled cares so involves minimally an alarm every 3 1/2 hrs if Will doesn't get us up sooner.  Two hours after Chris uttered those fateful words, I was standing over him with Will and a bottle trying all I could to bring him to consciousness.  The first understandable words I heard out of him (after a lot of grunting and mumbling) were "oh, you have him right there" and then a blank stare.  So this was our pattern every three hours for the rest of the night.  We could switch roles, but I don't think Chris would do as well pumping.  Plus I love seeing my two main guys just hanging in the middle of the night.

So far, so good.  Each set of cares still involves monitoring Will's temperature.  And it figures for the little guy that is temperature sensitive he'd come home on a July day that got as cold as into the 50's and raining overnight ~ so he's been bundled up.  I find it a little ironic that Lydia came almost a week late in October and went home on an abnormally warm day ~ sunny in the low 80's; Will arrives 2 months early and comes home in the rain on a 50 degree July evening.  But we are ALL home!

So Close, Small Setback

Week 3:  Will is growing, up to 6 lbs today.  He's had a lot going on this past week.  After a very brief but much needed respite to the north woods last weekend, we returned Sunday night to our strong boy doing exceptionally well.  He nursed great, almost an entire feeding and wowed the staff the entire 48 hrs we were away.  On Monday the team decided after some discussion that he was close enough on his oral feeds that he could trial having his NG tube (feeding tube) removed and see how he does.  So instead of getting a fixed amount on a scheduled basis, he would transition to ad lib feeds, with a goal amount to accomplish in a 12 and 24 hr window.  The first day he of course impressed everyone and exceeded his goals.  In fact he looked so good they started talking about discharging him at the end of the week, maybe as early as Thursday!

Now we have been anxious for him to come home of course.  But honestly hadn't done enough at home for him to be there yet.  Between months of bed rest, and then spending days in the NICU it all of a sudden felt like we had a LOT to do.  So we went into overdrive with laundry & cleaning (along with a lot of help).  I stayed the night here on Tuesday to get into the "real" rhythm of around the clock cares/pumping/naps etc.  We were excited, but I'd be lying if I said we weren't nervous...maybe even terrified a bit. 

Will had his own agenda, as usual.  The entire day he didn't feed as well, although seemed to perk up in the late afternoon.  But then overnight his body temperature was abnormally lower, he was exceptionally sleepy and again did not eat well.  He was having more episodes of low oxygen levels.  He didn't quite make his 12hr volume goal and that was with a lot of effort on every one's part.  I was exhausted from only 3 hrs of sleep - which was divided into separate 1 hour intervals, and especially concerned that he was not his usual self.  His night nurse agreed as she has taken care of him before, and we asked the doctors to take a look at him early Wed morning.  It all could be a simple point of Will reminding us he is only 35 weeks gestational age, and is tiring from the work of eating all on his own and just being premature.  However with the constellation of things happening at once his team was concerned he may have some kind of infection causing all these changes. 

At this point discharge was put on hold along with the "little things" he needed to do before leaving (car seat test, hearing screen, heart screen).  Labs were checked and while some were reassuring, not all were normal.  By now Chris had sent me home for some real sleep (defined as anything longer than 1 hour) which was needed, because all I could do was cry and worry.  Will was started on antibiotics, planned for at least 48 hrs or as the culture results dictate.  Unfortunately that meant restarting an IV, or in Will's case they tried.  And tried and tried.  He was a tricky one at delivery too I was told.   After more pokes than Chris likely told me about, they still weren't able to get his IV in so had to give him IM shots for the antibiotics.  Another ouch!  But necessary.  He got an additional two shots 12 hrs later, and then last night they were successful with another forehead IV to finish his antibiotics.

Luckily he has perked up a little more in the last 12hrs, so is taking enough of his feeds yet that he so far doesn't need his feeding tube replaced.  His body temp and color are much better.  He is still sleepier than before, but appropriately mad when they poke his heal and likely needing a little extra time to recover from all the activity.  Cultures are negative so far.

We may not end up knowing for sure what caused his little set back, but I am happy he already looks better.  It could have been a start infection that we won't pick up on tests but the antibiotics are kicking in.  It could have been just too much work to eat & gain weight & maintain his temp & coordinate breathing only 24 hrs after asking him to do it all on his own for a guy who wasn't supposed to be born yet!  Or a combination of those things.  Today the team thinks his trying & failing to maintain his temperature at least was part of it, and he had a cold shock as it were.  The rooms were noticeably cooler that night (happens in every hospital I've been in with weather changes - building is too big to keep up) and he wasn't in a footed sleeper but a short-all with socks under his blankets.  This effort took so much out of him that the other points suffered.  At least now we know he may be more temperature sensitive and can plan accordingly for home.

So today things look back on track.  His other tests are being set up to finish in the next few days.  If he keeps improving again, we are so close to all going home.  But we are still terrified!

Myths and Reality

If there is one thing I feel the need to clear up, it is the commonly stated but vastly mythological concept of "at least you can get some rest while he's in the NICU."  Yes, in theory we could leave our miracle man here with his medical team, and know his cares are being handled.  In theory my only task could be to pump every three hours, and some might argue that I don't have to do that.  However we see things quite differently.  It is so important to us to be involved in Will's cares every day; both because we are his parents, and so that we are comfortable/familiar with his needs and ready (as we can be) to take him home when that time comes.  Even though he can't nurse regularly, I can at least provide expressed milk so he gets all the immunities and nutrition from that.  I realize that is a very personal choice for mom's ~ and for me it is extremely important.

So "resting up" while Will is in the NICU is not a reality.  It involves all the expected sleepless nights of a newborn, plus the logistics of being in a hospital and traveling back and forth.  His cares are every three hours and generally take 30-60 minutes to do.  Then I pump every 3 hours which also takes 30-40 min in total.  This leaves little time between each set of events to nap/eat/shower/etc.  And this is the routine that will continue when he comes home, probably even less organized since we won't have the nurses help, but we will have Lydia's! 

It is true that at least we aren't first time parents.  However, the details involved are so different this go around that sometimes I feel like I am a new parent.  Last time the "schedule" was much simpler; eat, poop, nap and repeat.  Now we have many more steps involved.  Granted there isn't too much extra to pooping, but napping involves the constant worry that his oxygen levels are going to drop.  Eating includes mixing fortifier to milk, giving bottle and/or nurse, pumping, and the dishes that involves each time so we are ready for the next one, and also the worry that his oxygen levels are dropping while he is eating.  We have been told several dozen times that all newborns do that to some degree as they learn to get their eating/breathing patterns organized, just usually aren't monitored so parents aren't as aware.  But after spending 3 weeks in the NICU, and hearing the dinging and alarming of the monitors in my head long after I've left, or in my sleep, or in the car, or filling any quiet space I might have...it goes without saying that concern is ever present.

So yes, we are overjoyed that Will is doing so well.  This is certainly not intended to be a complaint or a rant or anything negative at all.  Instead a brief writing about the daily experiences which are our reality.

One other item of clarification, is the confounding factor that I am still healing physically, emotionally and mentally.  We are healing from the entire process of not having anything straightforward or normal about our pregnancy, delivery, or newborn experience.  And admittedly there is some grief there ~ as wonderful as things are progressing, it was never pictured this way.  Just because I know how lucky and blessed we are, doesn't negate the dreams of a "normal" experience.  Most times I don't give it another thought, this is just the experience we are having.  But that doesn't change the fact that this isn't the route we had hoped for, and underneath it all the grief and sadness are still there.  They are both fading and being drowned out by the new realities of our days...we just need some time to allow those feeling their due and eventually be over.

  

A Second Week of Progress

It is a little funny to think we are now in the window that we had last settled on scheduling my C section; and I say window because we had a lot of discussion about picking a date in the 34-36 week gestational time frame.  Way back when it was officially confirmed that I had a complete placenta previa, the plan was to schedule a C section at 37, maybe 38 weeks.  Then with my progression/admission/bleeds we were considering 36 weeks, and last were talking 34-35 weeks in the hopes of doing this delivery in a scheduled manner before being faced with an emergency situation.  I may have mentioned that during those most recent planning talks I felt less and less like I was going to make it to either of those dates as well; of course we didn't.

 Two weeks ago I was 32 wks and 2 days pregnant when we welcomed baby Will 8 weeks early.  Since that time he has impressed everyone who has met him, and melted our hearts.  His arrival has given Lydia yet another opportunity to melt our hearts as well.  Last night she was listing all the things she was going to teach him since she is the big sister: throw a ball, go on the potty, sing and dance, wear princess dresses, color, play with Charlie...and the list went on.  She came to visit him again, and now that he is out of his isolette and minimal "things" on his face I think she can really see him for the little baby he is.  She was talking to him and he was squeaking back which she thought was very exciting.  I'm pretty sure he was actually squeaking because his next feeding was due in the following 10 minutes, but I also thought that was exciting.

So what has Will accomplished in his second week of life?  He has moved to an open air crib and maintaining his body temp (with the assist of some layers of clothes/hat).  He has started to "nipple" meaning he takes at least part of most of his feeding either by bottle or nursing.  So far he is in the 50% range that way, and gets the rest still through his tube.  Once he is able to consistently due over 80% by bottle or nursing then he gets the tube out; if he keeps gaining weight after that, then they start talking about home.  So far he is back up to birth weight almost exactly at the two week mark.  He still has some episodes where his oxygen levels drop, but these are infrequent and short lived.  He corrects himself consistently, and the are as often a result of squirming, grunting, enjoying his bottle to fast or generally just working something out.  He is off the caffeine entirely as well.  And of course has a million girlfriends up here on the nursing staff. 

The most common phrase in the NICU is "each baby is so different, they call the shots."  This is the answer to any question you might think to ask.  How soon will he learn to nipple?  How long will it take to get up to 80% feeds by mouth?  How often does the tube have to go back in?  How long will the low oxygen events last?  How will he do transitioning between bottle and nursing?  Insert the same answer to each question. 

So now we wait for him to keep gaining weight and learning to eat.  His first few days he went from 10% to 30% to 60% of his feeds by mouth.  Apparently that was beyond impressive enough that we have been cautioned several times he isn't likely to keep that pace.  More likely these next few days will level off, or even go backward a little bit simply because it takes so much energy for these little ones to learn this skill.  Remember usually babies grow into it while mom's still pregnant; Will needs to learn it on the fly.  So we wait for him to decide his course.  And as long as he stays healthy, we've got time.

First week acheivements & new goals

Yesterday was Will's one week birthday, which is hard to believe.  I've adjusted to being home but really still being in the hospital for most the day.  Today I finally feel somewhat functional, generally more comfortable and increasingly independent which are all great things.  I am of course still weak and tired and generally have a LONG way to go given what the bed rest for so long did to my body, but at least the acute pain from surgery is significantly better.  I have had so much swelling from all the fluid they gave me during surgery that my legs themselves are so heavy I get tired just moving them, but I trust my joints/bones will reappear in the next few weeks.  My mind and emotions have been all over the place, plenty of days I still break into tears.  Some times there is a reason, most times there isn't ~ other than lack of sleep, hormones, worry, joy and all the other abstract things floating around in my head.  My personal goals for the immediate future are to walk more, nap more, start slowly working on getting my strength back, tackle a load of laundry or two and mostly just enjoy my family.

My achievements and goals are nothing though compared to Will's.  He has had such a week, and improved so much.  Every day the team cautions us that it wouldn't be uncommon for him to "not fully tolerate" whatever advancement they plan, but that he's doing well enough it is worth the challenge.  And while I know it wouldn't be a failure if he needed some supports back, I can proudly say that so far he hasn't!  His wean from the respiratory support went superbly, and for the last 36+ hours he has been breathing entirely on his own without even extra oxygen.  He hasn't had any more "spells" in over 48 hrs.  His caffeine treatments stopped yesterday, and that will remain in his system for about another 5 days, then we will really see what he does on his own.  They are increasing his feeds steadily & he is peeing and pooping like crazy so his GI tract is working great.  He still needs to start gaining a little more weight, and since he was a big guy to start with they feel he could use some extra calories so are going to fortify the breast milk for a few days.  Hopefully his weight will pick up more, because he is also starting to be alert enough and show feeding cues that we might be able to start formally nursing in the next few days.  They start with "nuzzles" to make sure he'll tolerate being at the breast, because at this age he could expend as many calories nursing as he gets while nursing.  But all are steps in the right direction.   He is getting better at regulating his own body temperature so they are turning down the isolette temps and getting him dressed/swaddled in more layers which is all progress toward being in an open crib.  His goals are similar to mine ~ eat, sleep, get stronger ~ but so much more important and impressive!

Hopefully he will continue to make strides in the upcoming weeks, and if all goes well we might be able to have him home by the end of the month.  It is a wish I entertain briefly, but have to wait and see.  His team said at this point he is basically calling the shots and making the plans, we are all just along for the ride.

The Big Sister

What does Lydia think of all this?  Honestly most times I have no idea what she is thinking in general, but so far she seems amazed by her baby brother.  I'm sure it is confusing that for so long we talked to her about mommy is in the hospital so the baby can grow bigger and stronger, and now he is "out" and mommy is home.  But baby still isn't, and mommy still can't do a lot.  She seems to expect things back to normal now that "baby is out" which is understandable.  At least daily she asks "mommy can you carry me now?" And although she looks said when we say not yet, she also seems to accept that answer.  We've told her mommy's new ouchie needs to get better first, and she either asks to see it several times a day, or asks if its getting better yet. 

As for her focus on Will, she has been up to visit him a few times, but one can imagine the threshold for a 2 1/2 year old for being still and quiet ~ so the visits are brief. I can't wait for her to see him again now that he has less lines/iv's etc attached to him as he really does look more like a little baby.  She asks to touch his hands whenever she is hear, and has been so good about a gentle little hold.  She got this toy dinosaur/lizard thing she wants to show him, and reads books to Will.  She shows genuine concern when he squeaks or cries, saying "its okay don't cry, you need a lovey.  I will get you a lovey" and hopped off the couch to walk out.  I asked what she was doing and she replies very matter of fact "well I'm going to the lovey store for my baby."  I just melted.

She does ask about him sometimes at home, but I think she is still in her routine enough that since he isn't there yet she isn't sure what to expect.  The first couple days we were sharing a twin room with another baby whose family was from farther away, so when we'd go visit Will there was another baby boy in the room.  Being the little lover that she is, Lydia has mentally adopted him as "her baby" too, and has asked about Alex almost as much.  When he was moved to another room she wanted to go find him.  Hopefully when we do bring Will home, she will be content enough with just one baby brother. 

The hospital has become so routine for her, she actually asked to go play there the other night.  She said she wants to play the games in mommy's room, and when we explained that mommy doesn't have a room there anymore, she suggested that daddy go away and he should stay at the hospital.  Apparently if we take turns being there and she can come play then it's all okay.  At least we know my being gone so long wasn't terribly traumatic for her!

In the next few weeks we will bring her up more to visit of course.  I'll ask her to help get his room ready, and she gets a big girl bed so "her baby" can have the crib.  So far she is on board for that transition.  She is such a loving and empathetic girl that I can't imagine she won't be happy when Will comes home, but like I said before sometimes I have no idea what is going on in that girls head.  She is amazing to me.

     

Preemie issues ~ "Spells" and other things

"He's a big guy"

" He's a good size"

"He seems long"

These are the most common variations of the theme surrounding our new man.  Every conversation with every staff member (nursing, aides, docs, RT) somehow includes a comment on William's over achieving dimensions.  At 5lb 5 oz and 18in at birth, that put him into the 95% for a 32 wk baby, and is more average for 34-35 wks.  Even with the expected weight loss that all babies have, he still is 5lb even today.  Will has been getting some protein and sugar through his IV, but the majority of his nutrition is through a feeding tube.  He is too young to have developed the suck/swallow/breathe coordination needed for breast/bottle feeding, but has tolerated his tube feeding well.  I have been pumping every three hours since about 6 hours after delivery; he started on a preemie formula but now is getting all breast milk which I consider a personal victory.  He feeds so well though that they have been increasing how much he gets every day ~ so good for him, but now I need to keep up!   The only minor downside to his, as his nurses have pointed out, is that when looking at him he appears older than he is, and therefore ends up creating higher expectations than we should have for him.  This is especially important since he hasn't had any other extra problems really, his is just doing what a 32 wk born preemie will do! 

In general since being born Will's biggest issue has been needing respiratory support, which is one of those things expected for being born at this gestational age.  Initially he was on only CPAP and they increased the settings once on that.  However his first full night he had a number of "spells."  These spells are events where his heart rate and then oxygen levels drop below specific criteria, and we are told are not uncommon when born at 32 wks.  Some babies come out of these spells on their own, others need external stimulation to do so.  Will was needing enough extra help to break the spells that they changed him to additional ventilator support.   He didn't need an invasive breathing tube put into his lungs, but was able to get the extra support and breaths delivered through his cannula.  They also started giving him caffeine thru the IV ~ yes, the same ingredient in the much needed coffee that gets me going in the morning.  As a stimulant, it helps preemies "remember" to breathe, making the spells less frequent and less severe.  I guess I don't need to worry about having my coffee while pumping/nursing with this one!  Fortunately in all this he didn't require much if any extra oxygen delivery, and has not yet needed surfactant, which are both good signs.  The spells have gotten less frequent and he has been able to pull himself out of them more often than not over the past day.  Today they plan to cut back the ventilator support and get back to standard CPAP; if this goes well they will continue to cut back the breathing supports over the next few days.

Another common preemie issue is jaundice.  Initially his bilirubin wasn't too high, but it kept trending up so he was put on a bili-blanket.  It seemed to make him uncomfortable, mainly because in order to work has to have access to the skin, so all his little blankets and supports and cushioning had to be moved/repositioned.  He is also such a squirmy guy that he kept knocking his eye protection off.  Fortunately his labs improved in 24 hours and we were able to remove that again today.  Almost right after the bili-blanket was removed he settled down into a quiet, calm, very relaxed state which was comforting to see.   

At this point we have pretty much traded one hospital room for another.  Everyone in the NICU is very welcoming, the rooms are private and have sleeper couches/rockers etc, and parents are encouraged to participate in as many of the cares as we are able.  So I still get to check temperatures, change diapers, and help with dressing.  I was able to hold him in "K care" (kangaroo care) twice, but we had to put this on hold when his vent settings and bili light were active; we hope to resume K care again tomorrow.  So far I am spending nights at home, but will likely spend some with Will especially as he gets closer to coming home and I get to take over more of his needs.  His care team has been wonderful, involving us where they can, answering questions, and speaking directly with us on rounds and in making plans so we are always updated and clear on what is happening and what is expected. 

The neonatologist today said it well in that "he is a preemie, and we have to remember to allow him to act like one."  Today we would have completed 33 weeks pregnant; instead Will 5 days old.  And I have been grateful for every one of them!

Best of the alternatives

The 24hrs of July 4th-5th are hazy.  What started as a laid back holiday and mini picnic in the room obviously ended with quite a bang!  And the main thing is that Will is here, and doing well for being born at just 32 weeks.

I am also so thankful that all the planning for "worst case scenario" was in place but ultimately not needed.  It made for a crowded OR ~ Chris counted 23 people in the room at one point ~ but fortunately we could say "thanks but no thanks" to a number of them.  So of all the ways this delivery could have gone, other than early it really went the best way possible.  I was able to have just the spinal anesthesia instead of needing general and being completely out; it was important to me that I be emotionally and mentally present for everything going on.  They did do a larger vertical incision (instead of the common low horizontal one) at the request of the Gyn-Onc team; this was part of the "just in case" process that if I would have needed an emergency hysterectomy as well would have given the best/fastest access.

My blood pressure was low at baseline, so didn't have a lot of room to move but was being monitored closely.  I got terribly nauseous several times from the low pressures, medications and all the "sensations" of the procedure itself.  For not being able to feel pain, it was the most uncomfortable yet indescribable feeling.  They warn that you'll feel "pressure" or "tugging."  I'm not sure what I felt but it was something!  I was tempted to watch a few times since I could see everything reflected in one of the lights if I wanted to, but decided against that for the most part.  Although I may have watched more than Chris did ~ we haven't clarified that yet!

More importantly the placenta delivered as normally as could be expected.  The entire surgery of course had some urgency besides the bleeding from the previa, the rest of my placenta lay anterior so had to be cut through to get to Will.  This puts a time crunch on getting him out since his lifeline is cut just to get to him.  Although I have gotten pretty anemic no transfusions needed, just some good makeup tricks to put some color back in my complexion.  I'm still waiting for pathology results on the placenta but my OB said everything looked normal.  They were great about updating me over the curtain as things were happening.  I know that when things get too quiet it means there might be trouble, so the updates were reassuring.

Now it is on to recovery, which I am actively learning required more than I anticipated!

Recovery

I don't know what I expected, but this wasn't quite it.  The last few days have made it obvious that I hadn't given much thought to recovering from surgery. 

Certainly I thought a lot about Will's arrival ~ when would it be? would it be controlled or emergency?  would Chris make it on time if he wasn't here?  would I need transfusions or a hysterectomy?  And of course I thought plenty about how Will would do related to all these same questions.  What will the NICU experience be like?  Will he be stable?  What can I do to make his chances for success better?

But I apparently never thought much about recovering from the C section itself.  I knew I would have less strength and stamina after being on bed rest for so long, and that is no surprise.  Perhaps I was unprepared because of stories related from friends who have had C sections and preferred that option.  Or the cliché of "to posh to push" suggesting a C section would be easier?  Either way my body has been loud and clear the past few nights ~ hello lady, you had surgery, sit down and rest and take some meds!  I'm not complaining, just adjusting.  And things are definitely getting better as I am scaling back on types and amounts of meds.

I'm trying to let the positive reinforcement do some good.  I'm not sure if the nurses and staff are just trying to convince me, or if I really look like I feel better than I do, but either way I'll take it. 

Fireworks (part 2) - He's Here!

There was something different about this one.  I had almost gotten used to the little bleeds - random episodes (which for me were always overnight) that required some extra monitoring, sometimes extra medications, consideration for transfusion or other interventions that proved time and again why I was living in the hospital.  But this past week has felt different ~ more unsettled, more episodes of contractions or bleeding.  Generally these didn't even happen together, and this is the time for Braxton Hicks to show up; baby looked great on every monitoring event we did.  And the doctors were technically more surprised on the nights I had no events than the nights I had small ones, which in a weird way was reassuring.  But still it felt different. 

At 10:15 on the 4th of July I was dozing off, waiting for my nurse to do night assessments and listening to the neighborhood fireworks.  Oh, and I started bleeding again; but this started different.  Usually when these happened I would only wake Chris (always happened at night!) if they escalated the plan for monitoring or moved me to the L&D floor "just to be safe."  My nurse happened to come in just as I was going to call for her, so instead I let Chris know.  Just felt like this wouldn't turn out to be one of those wait and see nights.  I could tell right away the bleeding was more significant and steady; the fact that the number of nurses in my room kept steadily increasing was a sign as well.  Oh, and that the doctors showed up at my bedside 10 min later rather than the usual phone consult for my usual behavior.  The conversation with Chris went from "hey something is happening" to "give a heads up to our dear friends re: staying with Lydia if needed" to "come ASAP" in the same amount of time it took to type that. 

Fortunately this wasn't technically a "crash C section" nor was I really hemorrhaging ~ but it was obvious this wasn't going to stop soon.  I was on the monitors by 10:20 and down to the L&D floor by 10:30.  Contractions started then and continuously became stronger and real, and with each contraction the bleeding picked up.  It looked like this was as controlled a situation as we were going to get, and the decision was made by 10:40 that we were delivering this baby in short order.  Quick paperwork, lab draws, baby blue scrubs for Chris, re-consulting with the NICU and GYN-ONC surgical team, meeting with anesthesia, and in-bed scrub down while wheeling to the OR quickly followed.  They had Chris wait on a very lonely looking chair just outside the OR while they finished getting me prepped.  I just kept hoping he wasn't having PTSD from our first semi-traumatic delivery while sitting out there alone in the hall (except for everyone rushing past to get into my OR room).  Luckily things were "stable enough" I could start with a spinal so I didn't have to be put to sleep unless "things progressed."  These terms are all nebulous enough to be reassuring...at least for those who don't already speak medical.

Spinal in and working (thank goodness too because contractions at this point were true labor pain intensity); Chris invited into the room & sitting by my head (reminds me what great eyes he has when that's all I can see of his face); the NICU team arrived and ready and GYN/ONC on standby & we are ready to begin.  One of the highlights is that even my regular OB was out of the call schedule for the week, she came in to assist her partner for my surgery anyway.  Her dedication to getting us through this with our sanity and health has been awesome.

I'm not sure exactly when surgery started, but I know that at 11:25 on July 4th our big little man entered the world!  William Oliver let out a squeaky cry to announce his own arrival, all 5lb 5oz and 18 in of him.  It was the best sound, and I cried to celebrate it ~ we both kept this going for a bit.  He went straight over to the NICU team, and once assessed and well enough, took a pit stop in his isolette at the head of my bed for a glimpse before heading up to the NICU with his proud daddy in tow. 

Of course they aren't done with me yet, but that is for another post.  What is important now is that Will is here, so far doing relatively well considering he was only 32 wks + 2 d, and we love him terribly.  Each day since his birth has been another adventure, one we expect to continue for a lifetime.  But now we take it day by day, and pray he continues to be the strong little miracle we know. 

32 weeks and Fireworks (part 1)

Well this post has needed some revisions, and additions since it was started (see Fireworks part 2 to follow).  A couple days ago I was planning to update with our newest information and associated updated timeline ~

Our growth scan/US for 32 wks was done 7/1, and keeping up with previous measurements this little one was no longer so little ~ at least for gestational age.  Major bone lengths, head and abdominal girth were all closer to an average for 34 wks.  We were guessing what the weight would be; 4 1/4 lbs?  4 1/2?  Either of those are well ahead of average.  You can imagine my reaction when she told us an estimated 5 lbs 1 oz!  Good thing we're planning a C section - a full term baby would be at least 10 lbs at this rate! 

Next, we finally had a C section date set, following some discussion in deciding the best timing in the 34-36 week window.  The dilemma being both to give baby longer to mature and in trying to not push our luck with my bleeding events; all with a lot of professional opinions out there but no solid data to guide the choice one way or another.  Ultimately we settled on a date and I knew no matter what, I was looking at 3 more weeks at the most.  It felt good to have that "one last goal" in place, although with all the back and forth I wondered if it would matter.

The past week somehow I had been feeling different.  I can't say how, just know I had this feeling I wasn't going to get much farther.  I was certainly getting much bigger though!  And with this last growth spurt came more frequent "minor" bleeds, expected really for this phase of baby and uterus growth.  No matter how expected though, it still makes for sleepless nights and drowsy days.  My pattern has been nighttime events all along, and each time is harder to fall back asleep as I can't help but wonder if it is done or if this is going to turn into "the big one." 

On July 4th my always entertaining husband suggests the middle name "Pendence" ~ which I was more confused by than anything.  We had already narrowed a list of middle names, and I had no idea where this was coming from...until he also says we'd have to change the first name to "Indy" if it was going to work.  Ha ha, always the joker!  Of course I was clear that was not going to happen, besides the only way that would work would be to have this baby on that same day.  So instead we had our hospital provided "picnic" lunch (another long stay patient perk) complete with table cloth and picnic basket & all took naps at various points in the day.  We said our good nights as usual, and Chris headed out to tuck Lydia in at home after she gave baby hugs.  (This has been the cutest thing, as she hugs my belly, gives kisses and talks directly to my belly button as if it is a direct portal to communicate with "her baby"). 

Another evening, ready to tuck in and just waiting for my nurse to do her nighttime assessment.  We always plan for that between 10-10:30 so that I can have the "do not disturb" status then until 6:30 am unless I need something ~ just another perk!  And then promptly at 10:15 my nurse arrived, as did more bleeding.  Which became more bleeding...and more nurses, and the start to our very own fireworks extravaganza!  This July 4th birthday suddenly felt not just possible, but likely.