Wednesday, January 15, 2014

Adam's birth story and my recovery (part 1)

Adam's birth story really begins at the start of my pregnancy. When I found out I was pregnant, my first feeling was, "It's a boy," and my next thought was, "Am I going to have another c-section?" Natalie's birth story was actually, in retrospect, fairly traumatic, and I was very emotionally upset by it for a long time. A lot of my emotion was tied up in the fact that I knew that a first c-section has a high probability of turning into a repeat c-section for a second birth.

For a long time I was leaning toward attempting a VBAC (vaginal birth after c-section). I tried to find reputable information about the pros and cons of attempting a VBAC versus choosing a repeat c-section, but I found a depressing lack of information in both print and electronic form. The best information came from my midwife friend who sent me a 48-page document from National Institutes of Health titled, "NIH Consensus Development Conference Statement on Vaginal Birth After Cesarean: New Insights" published in March 2010. The abstract of the paper really spoke to me when it said:
The data reviewed in this report show that both trial of labor and elective repeat cesarean delivery for a pregnant woman with one prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus. This poses a profound ethical dilemma for the woman, as well as her caregivers, because benefit for the woman may come at the price
of increased risk for the fetus and vice versa. 

This is exactly how I have felt when trying to make this decision. I can see the benefits and drawbacks of each choice, and I didn't want to make either choice lightly.

Finally, after being honest with myself about my emotional state after trying and failing to have a vaginal delivery with Natalie, and the unpleasant aspects of (what still amounted to, in the grand scheme of things, a relatively easy) recovery, I opted for a repeat, scheduled c-section. It took me the majority of my pregnancy to reach this decision, but once I did, I found great peace with my choice. The conclusion of my entire delivery story this time around is that this experience was almost therapeutic -- it really helped me come to terms with my previous labor and delivery.

This peace was only amplified on delivery day. Yes, I cried as I left home, saying goodbye to my mom who was there to take care of Natalie during our two-night hospital stay. I cried as I realized this was the last time I'd see Natalie as an only child. But I also cried because I was a little scared. Sure, I'd had a c-section two years prior, but last time I didn't have time to really think about what was happening to me because it all occurred so fast. This time I had plenty of time to psyche myself out. Despite my fragile emotions on the way to the hospital, once we were there and I was getting prepped for surgery, I went back to a peaceful feeling, knowing that in a matter of moments we'd have our son out in the world.

With a scheduled c-section, my doctor gave me two important instructions:

1) Do not eat anything after midnight (which was 12 hours before my scheduled c-section the next day).

2) Take a shower the night before the surgery and the morning of the surgery using Hibiclens, this weird, super strong pink liquid that can be purchased at pharmacies (or apparently online). According to my doctor, using Hibiclens this way has been clinically proven to significantly reduce the risk of catching a hospital-borne infection. She also advised me to wear clean PJs the night before surgery and to sleep on clean sheets and use clean towels and washcloths. 

So, I did the following:

1) I ate an Italian sub at midnight, and I drank three big bottles of water, knowing that I might not eat again for a really long time. The fact that I went without food or drink for so long during Natalie's labor and delivery is just one of the many reasons that experience was particularly trying, and I didn't want to repeat that.

2) I went into a final cleaning frenzy the two days before my scheduled c-section, cleaning all sheets and towels. Fortunately, in a particularly not-organized move, I also waited until the last possible second to pack my hospital bag, so I was also washing everything I'd need for the hospital in the final two days before my surgery. We slept on insanely clean sheets the night before going to the hospital.

Here's the timeline from there:

Monday, January 6, 2014 -- Adam's birthday
10 a.m.
We arrived at the hospital. We realized we didn't know exactly where to check in (somehow that tiny detail had been overlooked by us and my doctors) so we had a 15-minute walking tour of the hospital, during which Matt joked, "You should walk up to someone and ask, 'Where can I go to get this baby taken out of me?'" 

10:15 a.m. 
We sauntered up late to the nurse's station in labor and delivery where we were greeted with, "Oh, we thought maybe you'd changed your mind." Good news: the hospital was running a little behind, so our being 15 minutes late didn't change anything. I filled out two super simple forms and got taken with Matt to a pre-op room.

Final pregnancy picture...ever

Here's something I didn't know how to answer before the day before my surgery, so I thought I'd share it here: If you're having a planned c-section, take as little as possible with you into the hospital before your surgery. For us, that meant me bringing a purse containing a consolidated version of my wallet with my ID, my insurance card, a little cash and a credit card, just in case, as well as my phone. Matt brought our DSLR camera and our car keys and his phone. Otherwise, we had nothing on us. My nurse, Mindi, took my clothes and put them in one of those patient's belongings hospital-issue plastic bags and stored them in a locker in the PACU (post-anesthesia care unit) where I'd be recovering for a couple hours after the surgery.

10:20 a.m.-12:20 p.m.
We spent these two hours in the pre-op room, where I changed into a gown, was hooked up to a fetal heart monitor, had my blood drawn, had an IV inserted in my arm and was given my first round of fluids, and had the surgeon, anesthesiologist, nurse, and a medical student ask me a series of (relatively redundant) questions. Everyone was super nice, and the only time I was unhappy was when the nurse put in my IV. I do not do well with that last step, so when I started to feel faint after she'd put in the IV, I asked for an ice pack on my head and all was well again.

12:20 p.m.-12:30 p.m.
The operating room was ready and my blood work was back (this is apparently the step that can hold up the surgery) so the nurse draped a sheet over my back and had me walk in my hospital-issued non-skid socks to the OR. Walking to the OR was a surreal experience. It's also the time during which I was separated from Matt. He was taken to a "weird tiny room with nothing but a chair," he says, while I was in the OR getting my spinal block. Here's another scheduled c-section fun fact I learned in this process: Most doctors and anethesiologists prefer a spinal block to an epidural, the reason being a spinal block takes effect much more quickly than an epidural, and the effects of the spinal block wear off more quickly than an epidural. Having experienced both an epidural with Natalie's birth and a spinal block with Adam's, I can say that my spinal block definitely took effect fast. In fact, as a nurse was holding me up while my spinal block was inserted, I started laughing because I couldn't feel my feet basically the second the anesthesiologist put it in. All this time, I kept noticing how peaceful the OR felt this time. Last time, during Natalie's birth, it felt like there were about 20 people in the OR. Whether that's true or not, I don't know, but I was so traumatized and out of my mind that I felt like my body was being taken over by hordes of people in scrubs. This time, though, there were a couple nurses, my surgeon, my anesthesiologist, and two ladies (a nurse and a pediatrician?) there to take care of Adam when he emerged. Everyone was happy and calm, and that really set me up for such a better experience than last time. To make sure that my spinal block had taken full effect, the anesthesiologist took an alcohol swab and asked me to tell her if I felt hot or cold or nothing as she swiped the swab across different parts of my body. She's swipe my forehead, where the swab felt cold, and then my chest or my legs or my stomach, where I either felt a slight warmth or nothing at all. This felt like a test, and I couldn't tell if I was failing or not. Good news: You should feel cold on your forehead, but you shouldn't feel cold anywhere else. I passed! Whew.

12:30 p.m.-12:53 p.m.
Matt arrived in the OR. The blue sheet went up, separating my head from the rest of my body in what is perhaps one of the most bizarre aspects of a c-section. The anesthesiologist kept telling me that as soon as I felt nauseous I needed to tell her and she'd "give me something" in my IV to make me feel better. I asked Matt to tell her about five times during these 25 minutes that I was beginning to feel nauseous, a common reaction to the spinal block.

I reminded the anesthesiologist that during Natalie's birth I felt pain, not just pressure, when they took her out of me. She reminded me that the spinal block doesn't block out pressure, but she would give me fair warning when I should start feeling pressure. She was super great about walking me through everything I should be feeling and when. I think thanks to her narration, and the fact that Adam was nearly 2 pounds lighter than Natalie and therefore not as tightly lodged underneath my rib cage, this time I truly did feel pressure and not pain, and for that I am so thankful.

12:54 p.m.
Matt and I heard a cry, and we both broke out in tears before they even brought Adam around to the other side of the blue sheet. I didn't know if I'd have as emotional of a reaction this time as I did last time, given the fact that this was such an insanely orchestrated procedure, but in some ways I was perhaps even more emotional the first time I heard Adam cry. I think I not only felt happy to know we had a healthy baby, but also to know that we are so lucky that this is the second time in our lives that we get to experience this. It's like lightning has struck twice in the best possible way, and I don't want to take it for granted. 

12:55-1:40 p.m.
During this time, Adam was getting cleaned off and measured and having his two rounds of Apgar tests (8 and 9, respectively -- good job on your first assessments!). I was being sown up and given my first round of Pictocin to help my uterus shrink back down. My world's-most-amazing anesthesiologist was chatting us up and taking some pretty awesome operating room photos. This time I delivered at a different hospital (not by choice, but by insurance policy necessity) and I am so glad I was in a different hospital because during this 45-minute post-delivery period in the OR this hospital keeps the entire family together, unlike my previous hospital for Natalie's birth where they almost immediately whisk the father and baby away, leaving the mother awkwardly alone and pretty scared (or maybe that's just me). We got to just admire our son and talk to the medical staff and it was glorious and so happy.

Adam's first photo
 Our first photo of the three of us
The photographic evidence from Adam's birth says what words really cannot express. Last time, I did not want any pictures of me, and we didn't even bring our nice camera into the OR. If we'd gotten photos that involved me in the OR (besides the top of my head, not my face), I definitely would not be sharing them here. This time, though, I love the fact that we have these early pictures.

Now, on to recovery...
I'll begin my recovery story, which is an ongoing story, seeing as Adam is now only 9 days old, with the PACU.

1:40-3:45 p.m.
We spent these two hours in the PACU, where my nurse for my c-section continued to be nearby monitoring the baby and me. At 2:30, the nurse brought me ice and a little water to see how I could handle it (basically, without throwing up). I took down the first cup slowly but with no problems, so she brought me another round soon after, this time with more water and less ice, and I drank it faster.  Somewhere in this time I breastfed Adam for the first time, and he did really well.

4 p.m.
By now I'd been transported to my official post-partum hospital room. I scored a super-spacious accommodation thanks to the c-section. Although it wasn't the world's most comfortable sofa, Matt was happy to see a full-size sofa in addition to a rocking chair and several other chairs in the room. My new nurse, Chrissy, said I could order from the liquid-diet menu, so she brought me an Italian ice, some lemon Jello, and apple juice, all of which I took down super fast.

6 p.m.
At this point I was allowed to order off the regular-diet menu, so I put in my request for a turkey sandwich and some sides. I was thrilled to have only gone about 14 hours without liquids and 18 hours without solid food, compared to my experience with Natalie's birth when I didn't have liquids for over 24 hours and didn't have solid food for something like 48 hours.

Tuesday, January 7, 2014
2 a.m.
My night nurse told me that I'd be getting my catheter removed and getting out of bed to walk to the bathroom for the first time. I was really afraid of this moment, because last time with Natalie's birth it took three different women supporting me to get out of bed, and I experienced a decent amount of pain as I tried to sit down. This time, though, I only needed the nurse to hold my hand when I was getting out of bed. Once both of my feet were on the floor it was smooth sailing.

I won't bore you/gross you out (though it's probably too late for either of those) with every last detail, but let's just say that before I could get my IV taken out I had to prove that I could go to the bathroom unassisted. I passed those tests -- hooray! I most wanted my IV removed so I could take a shower. 

7 a.m.
An OB/GYN came by to check me out and took off my bandages over my incision. This is also when the doctors started really pressing down on my stomach to check the size and texture of my uterus. It is not the most pleasant experience, but I was on pain meds by then and didn't feel too much discomfort.

10 a.m.
My IV was out and I was showering, ready to turn back into a quasi-normal person. It's seriously so liberating to get that IV out and get out of the hospital gown and into my own clothes, PJs though they may be.

2 p.m.
I attended a breastfeeding class, something I never had the chance to do at the other hospital where I delivered Natalie. At first I thought going to a breastfeeding class as a second-time mom wasn't going to be particularly helpful, but as I soon realized I missed out on much of the first week of breastfeeding Natalie due to her week in the NICU. When the lactation consultant would say, "Well, you already know what it's like to nurse a one-day old baby," I would say, "Actually, I don't," so she refreshed me with some pointers on positioning and realistic expectations for a baby this age. It was a mostly positive experience.

Wednesday, January 8, 2014
1:30 p.m.
Our discharge papers were complete and we were ready to leave the hospital with our son who had just turned two days old. We took a few parting shots in the nice afternoon sun that was filtering through the hospital window (just after the Polar Vortex had come to a close). As we walked out the sliding glass doors toward our car, our son in his carseat carrier, we kept waiting for someone to stop us and tell us we had to come back. It was such a different experience to leave the hospital with our baby than to leave without him.

Here are a few other recovery-related details:

Swelling -- Before I left for the hospital on Monday, I took iPhone photos of my hands and feet to track what I expected would be out-of-control swelling like I had last time. This time, though, I hardly experienced any swelling. I even arrived prepared this time with flip flops and my husband's socks, and I didn't expect to wear my tennis shoes home. But I didn't need his socks, and I wore my tennis shoes home. Most importantly, I was so much more comfortable this time and not the Pillsbury Dough Boy like I was with Natalie's birth.

Walking and stairs -- Last time I had residual pain down the lefthand side of my body for about three weeks following Natalie's birth. It turns out that my pain was more a result of the 3.5 hours of pushing I did for Natalie rather than related to the epidural or the c-section, as I originally thought. I have experienced zero pain while walking, and I had no discomfort this time with the stairs in our house. In fact, just now I practically ran up the stairs.

Pain management -- By late Monday night or early Tuesday morning in the hospital, I was taking two pain meds: Percocet every 4 hours and Motrin every 6 hours. At first the nurses had me on two Percocets at a time, but after a few rounds of that I was practically feeling drunk, which I didn't think was particularly safe for me or the baby, so I went down to one Percocet every 4 hours and stuck with the Motrin regimen. By Thursday night I was taking no more Percocet (I just don't like the side effects and I didn't think I needed it anymore). I took one Motrin two days ago, which was exactly one week after Adam was born, and I haven't taken anything since then. With Natalie's birth I stayed on pain meds quite a few days longer, likely because I was more beaten up, having experienced essentially both types of deliveries, and I was having to go back and forth between home and the NICU, which wasn't conducive to recuperating.

Breastfeeding -- This warrants its own post, and hopefully one day I'll write it, but for now I'll just say that having my baby by my side for virtually his whole life has made breastfeeding a heck of a lot easier. Last time I was mostly pumping for the first eight days, and I think my supply suffered as a result. Fortunately, I didn't have too much breastfeeding difficulty with Natalie, but (knock on wood) this time is infinitely easier.

We have thoroughly enjoyed our week at home from the hospital as a family of four! (even if big sister Natalie doesn't look thrilled here, she's been shockingly sweet and well-adjusted so far...)

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