The Hospital Stay
The Week at the Hospital--this section is different because it's a combination of entries Dan made at our hospital web site, entries from my journal at the time, and comments I added months after-the-fact. I'll try to keep it all clear.
Monday, March 8th:
Dan:
Peter was born this morning at home at 6:35 am after a LONG labor…
The fluid was terminally meconium-stained (baby pooped inside during the last bit of labor), probably due to the cord over his shoulder that was pulled tight before final escape. This was remedied as his head came out, he was thoroughly suctioned, and the rest of him slid out. It took some more coughing (him) and suctioning (the midwives) to get him crying, but he did and perked up well. The lungs sounded wet, so he was "cried" to get the gunk out and watched, and given some blow-by oxygen (a tube blowing into his face). After a bunch of checking, he was deemed to be healthy and we began the cleanup.
The midwives did a full newborn exam which looked good. We were told to watch him closely for about 24 hours to make sure his color remained pink. My sister Kara stayed with us to watch the baby while Amy and Dan (now Mom and Dad) slept. However, we were woken at 10:30 to be told that his grunting wasn't going away (a sign of labored breathing) and that we'd need to take him to the NICU for monitoring. One midwife led the way to Children's Hospital in her car, while the other followed with Peter and Dan. It was a bit scary, since a snowstorm had quickly erupted outside making travel difficult. I kept stimulating the baby to keep him moving and making sounds in the back as the midwife drove. We made a wrong turn in the snow, and had difficulty parking, but were led right into the NICU (our backup doctor had set it up).
The crew here is really great. They were all very kind and informative to me (Dad), as well as respectful of the fact that we had the baby at home. Peter wasn't in immediate, emergency danger, but his breathing was grunty and very labored. An x-ray identified pneumonia in both lungs (the wet fluid we had heard) as well as 2 - 3 small pockets of air that had poked through his lung walls. Both are caused by meconium, blood, or amniotic fluid that enters and irritates the lungs during labor. Also, blood tests found that his blood was a bit too acidic from his labored breathing. The oxygen mask wasn't getting his blood O2 up high enough so they tried a little dome over his head with 100% oxygen. That still didn't have the desired effect, so they intubated him. This is how he is tonight, and his blood O2 is now very good and his lungs sound much better (still a bit of raspiness, but filling well). He is also being given two kinds of antibiotics to prevent any potential infections from the pneumonia. The air bubbles are too small to take out with a needle, so the will be left alone and will hopefully reabsorb on their own.
Amy is doing very well after the birth, and Peter is expected to make a full recovery. He will only be left on the ventilator until he can breathe on his own without much difficulty. He will remain here for at least 5 - 7 days to watch for infection and to check on his pneumonia. There were no emergency procedures done, but Peter is now getting the help he needs to breathe after an unlucky birth. We will keep this journal updated (hopefully daily) with how he is doing.
Your prayers for patience, courage and health are welcomed. Amy and I are so glad to see our wonderful baby boy, despite the unexpected circumstances! :)
Me, now:
Three hours post-partum, it looked as though Peter’s lungs were clearing and we’d just need to keep an eye on him, so Dan and I both got some much-needed rest while Kara and the midwives watched Peter. I am so grateful they didn’t leave him with us because we probably would have been too tired to see that his breathing was getting worse instead of better. Kim (one of the midwives) tried to wake Dan up but couldn’t rouse him until she woke me and I told him he needed to get up.
At first, the midwives thought Peter just needed to be seen by the back-up doctor in her clinic, but the doctor told them to go to the hospital instead. She (Dr. B, the one I’d seen at 37 weeks) called St. Joe’s, her preferred hospital, but they told her to bring Peter somewhere with a higher-level NICU. So she called Regions, but they were full and told her to call Children’s. Dr. B didn’t have privileges there, but was able to arrange for Peter’s arrival anyway.
We hadn’t paid much attention, but shortly after Peter was born, it began snowing. By 10:30 when Dan and the midwives left the house, there were white-out conditions. Kim drove her car and Jeanne drove my car, with Dan watching Peter in the back seat. The drive is usually just under 15 minutes, but in the snow it took them over 45, even in mid-day. The freeway barely moved and later we learned that a 20-car pileup had occurred in that stretch of road going the other direction right at that time. Everywhere they looked, cars were sliding off the road.
After a few minutes without extra oxygen, Peter’s grunting got so labored that Jeanne counseled Dan to take him out of his car seat in order to rub and stimulate him more. Those few minutes holding Peter in the midst of the sudden blizzard were the most contact Dan was to have with Peter for many days and he later said that he was happy he was able to help him in some way in the midst of a very scary time.
Dr. B had cleared Peter’s arrival with the NICU staff and at the front desk, Dan was told to bring the baby straight up. I am so grateful they did not need to sit in the ER or fill out any paperwork-they were given a NICU room immediately and seen by the perinatologists who’d already been briefed on the situation. Throughout the day, Kim and Jeanne stayed with Dan, answering questions if Dan asked them, but generally staying in the background. The NICU staff was aware that we’d had a homebirth and must have realized that they were the midwives, but just directed everything to Dan and let them stay to support him. Occasionally they were asked information such as APGAR scores. Not once was our decision to homebirth blamed for Peter’s health.
As Dan’s journal states, Peter was x-rayed-right there in the room while Dan stood by. Only the eventual MRI required leaving the room. The hospital contained nearly 50 NICU beds, with separate rooms for each family (multiples had bigger rooms). The rooms had a pull-out couch, a storage locker, and privacy curtains in addition to all necessary medical equipment. The department was just renovated a year ago. For the families of preemies, the additional privacy must make the long stays so much more bearable. In addition to the babies’ rooms, there was a family room with comfy chairs and a TV, plus two computers and a kitchen where we could keep food. The only computer time I had that week was while I ate meals in that kitchen.
A variety of techniques were attempted to get Peter’s oxygen level up to normal. When they put an oxygen helmet on him, he rolled onto his side and grabbed at his face, trying to get it off. The nurses were amazed by how powerful our newborn was. Granted, they’re used to 3 lb babies, but still. Eventually, he had to be intubated when the less invasive procedures weren’t helping him enough.
A number of routine procedures occurred upon Peter’s admittance-they took his height and weight (22.4” and 9 lbs 7 oz) and gave him the PKU test, the eye ointment, and the Vitamin K shot. Although I’d hoped to avoid the eye goop and shot, even the midwives said that if he was going to spend his fragile first days in the NICU environment, it was probably best to have them.
Meanwhile at home, Kara was staying with me. She woke me up to eat around lunchtime and again in the late afternoon. She then drove me to the hospital that evening. Just as we left, Kim dropped Jeanne off since her car was still at our house. Getting into the car was no easy feat and I began a habit of using a wheelchair in the hospital to avoid aggravating my tearing any more than necessary and avoid any extra work. The woman at the NICU front desk asked if I was Peter’s mom and led us to his room.
After eight hours being away from my baby, it was very strange to see this little guy wrapped up in an incubator, under a heat lamp, with a tube down his throat and taped to his face, covered with wires. All sorts of machines were blinking and buzzing and the baby looked so small and strange surrounded by all of that. I didn’t know if I could touch him. He looked so different than he had in the morning, wires and gadgets notwithstanding, due to the IV fluids and lack of clothes or birth goo. It was hard to believe that I’d actually given birth to this child and he was mine. I had a BABY? A son?
Peter was either sleeping or sedated, it was hard to tell which, but the nurse said it was okay for me to touch him. I began to stroke his head and arm until she said that stroking was too much stimulation and I should just hold onto him. We stayed for an hour, maybe two. The resident came by to talk to us, and I talked to someone about pumping my milk. I had originally hoped to begin pumping that night, but I realized how much I needed a full night’s sleep and decided to wait until the morning when a lactation consultant would be available. After staring at Peter for awhile and praying over him, we went home around 10.
It felt very odd to be back at home, the two of us, with all these reminders of my labor, but no baby. Dan was stressed out to be back in the house where every corner reminded him of somewhere he rubbed and rubbed and rubbed my back some more. I didn’t realize until then how hard it had been for him to watch me labor. He didn’t complain once as I woke him up or motioned for him to come RIGHT AWAY. Even though he was exhausted that night, he sat in front of the TV for awhile to escape everything that had happened. I tried to use the computer and quickly realized that it would be a long time before I comfortably sat on that chair.
We slept our first and last full night’s sleep for a long time.
Tuesday:
Dan:
Peter's second day of life in the hospital was both encouraging and a cause for concern. The encouraging sign was that Peter came off his ventilator at about 3:45 pm. Monday night they began reducing the percent of oxygen in the air they were giving him, and that continued overnight until he was breathing regular air from the vent. When Peter was given the opportunity, he began to breathe faster than the ventilator and was successfully taken off of it. He now looks much more comfortable without the tube and calming drugs. They supplemented his breathing with oxygen through his nose until Tuesday night when even that came off. As of this morning, he is breathing all on his own! This is a very positive step.
The cause for concern is one that is unrelated to his pneumonia. Monday afternoon and night they noticed some seizure-like activity, occurring 4 - 5 times total (hiccup-like rhythmic gasps and some tight fist clenching). They gave him a loading dose of an anti-seizing drug (Phenobarbital) and they haven’t reoccurred. Seizures occurring within the first day or so after birth are consistent with a period of decreased blood oxygenation during delivery. A head ultrasound also showed some brain swelling that would also be a sign of that. Since Amy's pushing stage was indeed very long (~5 hrs), this is a possibility. After a preliminary talk with the neurologist, she was still not quite sure about the cause. An MRI scan to image the physical structure of the brain (done Wednesday morning) and an EEG to look at his brain patterns (done later Wednesday) will give more information, such as locking down the probable cause of the seizures and identifying the severity of any future problems that may or may not occur. There is a good chance that none will (the neurologist was optimistic after his exam and no other organs have been effected), but even if the tests all come back normal the seizures have warranted follow-up meetings and testing over the next year to track Peter's development.
So, his breathing is back to normal but we're waiting for more information about his brain. He looks very cute. Amy was able to pump for the first time Tuesday and has continued periodically through the night. Her supply is responding well and anything she stores will be given to Peter first when they start feedings. Amy is hoping that they won't be necessary and that she'll be able to stay with him for nursing instead of using a bottle when the time comes. We'll also get to hold him when we go into the hospital today (Wednesday). Yay! :)
Thanks to much help from both our families and midwives, and all of your kind words and prayers, Amy and I are doing well. The unusual has become our normal since we have no other situation with which to compare it.
Me, now:
I wanted to arrive as early as possible at the hospital on Tuesday, but I ended up not arriving until mid-afternoon. Dan left earlier and I stayed home and my mom helped me out. Jeanne came to check on me at 1:30. That was the first time anyone took a good look at me, since the baby had required more urgent attention. She said I had a couple first degree tears, which didn’t sound too bad, but that I needed to be incredibly diligent over the next few weeks as they healed since I didn’t have the luxury of lying in bed all day recuperating. She said that she usually tells new moms to avoid all stairs for a week and I should only go down once and up again each day. I also was instructed to take 3-4 baths a day and to “air dry” on chux pads as much as possible. I had no idea how to pull this off while at the hospital, but she said to do all I could, coming home to bathe if necessary. We quickly realized that so long as Peter was sedated, it made more sense for me to be home most of the time.
As soon as I got to the hospital, a lactation consultant came by with the NICU’s pump and a set of parts for me to keep. I didn’t expect to see results that first time pumping, but after less than a minute, colostrum began dripping out! It had been almost 36 hours since I’d given birth with no stimulation at all and bam, I’m producing milk. Amazing. I didn’t leak at all during pregnancy and all the women in my family had trouble breastfeeding due to low supply, so I was incredibly happy to succeed at pumping.
Soon after, a pump I could bring home arrived and I was told to pump 8-12 times a day-preferably every 2 hours while awake and every 3 at night. My second pumping attempt only produced a few drops, but by the end of the day, I produced 30 ml (1 oz) of yellow fluid each time I pumped.
The news that Peter had experienced seizures was confusing. By the time I arrived on Tuesday, he was no longer intubated and looked healthier. His oxygen levels were improving quickly and he appeared to be recovering. It seemed like the doctors weren’t completely sure he had seized at all-the signs are so slight in small babies. But they’d given him the Phenobarb that I came to despise later. They gave him a head ultrasound through his soft spot while we were there-after all those months avoiding them, he got one at two days old! This time, I’ll gladly admit there was a good reason for it.
We went home that evening and began setting an alarm to pump. We got into a routine that let me avoid getting out of bed. Dan would turn off the alarm and I’d pump while he dozed. When I was done, I’d wake him up and he’d go wash the pump parts. The next time I woke, I’d find clean parts waiting next to me.
Wednesday:
Dan:
Peter had his MRI and EEG in the morning before Amy and I came to the hospital in the early afternoon (we just can't seem to get here before 12:00!). We met with the neurologist at about 3:00 pm, a different woman than before but also very nice. The MRI was completely normal, showing no signs of injury from lack of oxygen. This was very good! The head ultrasound the day before had indicated possible slight brain swelling, but the MRI didn't confirm it. While the MRI can sometimes give false negatives, the doctor seemed to indicate that the normal result was very good.
The EEG scan revealed a few things out of the ordinary, causing the neurologists to classify Peter's brain activity as moderately abnormal. The scale goes from mild (95% of children have no future problems), moderate (50% have no future problems), to severe. After the examinations and the trend in Peter's progress, the doctors are optimistic that Peter is in the good 50% of moderate cases. Also done yesterday was a spinal tap that came back clear indicating no infection.
So, two out of three tests were completely normal and the Peter's trend suggests that the abnormal EEG will effect him minimally. At this time we're continuing to watch him to see if any further seizures occur and that he "perks up" as he clears the drugs out of his system (the anti-seizure dose from two days ago and the sedation from the MRI yesterday). Last night and today Peter did very well with no observed seizures. (The nurse on the phone Thursday morning mentioned a possible one overnight, but she was apparently mistaken and nothing was recorded in Peter's record. Boo her for scaring Mommy and Daddy!
Me, now:
When we arrived on Wednesday, Peter looked really good. He’d just finished the EEG and had tape marks on his face, but was free from breathing tubes. He wasn’t yet receiving nourishment from anything but IV’s, so that was the only day for awhile without any tubes connected to his face. Right away, the nurse encouraged us to hold him. She wrapped him up and found a way to swing all the wires to one side and I sat near his crib and held him. We tried to see if he would nurse, but he was too sleepy.
The news that Peter was classified as having “moderately abnormal” brain activity was scary, but it was so overwhelming that it was hard to think through all that might entail. The abnormal EEG was due to his not going into deep sleep during the hour-long scan and a few strange patterns. They also brought up the fact that his sodium had been incredibly low when he arrived. I hadn’t shown signs of low sodium levels and there was no way to test after-the-fact if he’d just carried over the low level from me. The neurologist’s hope was that the seizures had been caused by temporarily low sodium instead of decreased oxygen during his birth. I never quite figured out why one was better than the other, and the neurologists were never able to definitively tell us which caused the seizures. We just prayed that they wouldn’t return.
Jeanne came to visit us at the hospital that afternoon and it was suddenly obvious that they needed to check on Peter and I as much as I needed to hear from them. Both Kim and Jeanne called every day and one of them came to see us every day that week. I showed Jeanne the handicapped shower I’d found and begun using as a way to keep up my baths even at the hospital. She was relieved to see Peter looking better.
Thursday:
Dan:
Peter has indeed perked up today. They began giving him a bit of pumped breast milk through a gastro tube in his nose last night, and today upped that to a full feeding every three hours. Amy tried feeding him yesterday, but Peter was too sleepy and nuzzled contentedly at her breast. This afternoon we tried again but he was full from the tube feeding. Today he has found his cry when it's time to eat, and right now Mom is trying to get Baby to latch on. It's amazing, after all his drugs and sleepiness the novelty of his cry is wearing off already! ;) Truthfully, the sound is a joy to hear despite the stress of trying to satisfy him.
Amy stopped by to see her doctor today to check on her birth wounds. While our midwife was concerned of possible infection, the doctor thought Amy is healing well. She now has a prescription for antibiotics just in case.
While today was a bit tiring (coming here, trying to feed, pumping, eating, sending Amy to doctor's via her father, soothing Peter, trying to feed again), we are happy to hold our son - trailing wires et al.
Thanks you all for your prayers, visits, messages and kind thoughts. The Lord has allowed Amy to keep our heads enough to get done what needs doing. Keep 'em coming!
Me, Thursday morning:
My tears are looking sort of iffy and might get infected because I can't lie down all the time due to going back and forth to the hospital. If Peter gets the hang of feeding, I will likely start staying at the hospital 24/7 until he comes home. The earliest he'd come home would be Friday afternoon, but Saturday looks more likely, if not later.
I just want him to wake up and eat so we can bring him home and lie in bed with him all day.
Me, Thursday evening:
Peter is acting like a normal little boy! We got to the hospital and he was having his first full feeding (through a nose tube). He was sucking a pacifier while being fed, which was encouraging since he was associating sucking with feeding. He didn't seem all that active, but it was more than yesterday. I tried to feed him after 40ml, but he'd already eaten 4 times as much as he ever had before and didn't have much reason to do more than lick me :)
I left to go get checked by the backup doctor. There was a lot of waiting around involved, but most of that was lying on the examining table, which was rather restful :) The doctor (who has been amazing with getting Peter speed-admitted when he arrived) determined that I definitely had a second degree tear (no WONDER I'm so sore!), but the potential infection Kim had seen this morning was more likely just healing tissue. She also said I was keeping the area clean. Since I hadn't been home in hours, I didn't expect her to be too impressed. She gave me an antibiotic script, but advised I not fill it unless things look worse in the upcoming days. Even though I had thought it would be a relief to take the antibiotics and not worry so much, knowing that I was raising my chances at yeast infections and thrush--especially since Peter's on antibiotics, too--is actually less to worry about. Kim and Jeanne will be checking me every day in the near future, so they'll let me know if things look worse down there. The doc thinks the bad tear will heal fine--it's this goofy skin tag that might need to be repaired later.
When I got back to the hospital, Peter was WAILING and they had me try feeding him, but this time he was too pissed to suck. He'd suck on my finger, or anything else, but noooo, not my nipples. After awhile, they turned on the feeding tube again and had me try simultaneously. He was calmer, but still mostly just licked. They'd drop a few drops on my nipple and he'd root around to find them, lick them off, then just sit there. He's way too smart! Eventually, I just held him. He's such a sweetie. It was great to hear him being cranky and making all these sounds. They even disconnected all the wires so I could feed him on the couch.
I really wanted feeding to happen instantly so SOMETHING would go smoothly, but apparently that's too much to ask. I'm going to try once again tonight--hopefully before he's so hungry and upset--then go home and rest up for tomorrow. The lactation folks will all be here then and darn it, we WILL get this figured out! I pumped 75ml (still colostrum) after holding/feeding him a couple hours ago, which means I'm only one feeding ahead of him for the moment. So if he doesn't take the breast at 9 tonight, then he'll have my milk at 9 and 12, then formula at 3, 6, and 9 before I'm back with pumped stuff in the morning. Hopefully, he'll just feed from me tomorrow. I'll stay tomorrow night if we've got it figured out, and I think he'd be discharged Saturday.
It feels like we're normal parents with normal problems all of a sudden!
It seems that the nurse who told us about the seizure overnight was mistaken because none of today's nurses or the neurologist knew anything about it. Yay! We didn't get that straight until tonight.
So--his IV's are out, he's taking food well, he sucks (on everything but my nipples), and he's alert. I have worse tearing than we thought, but it's in better shape than expected. C'mon Peter, figure out how to latch on!!
Me, now:
Thursday was such an up and down day. We woke up and were told by one nurse that the previous nurse had observed a possible seizure. Then Kim came to check me and was worried enough that she arranged for me to go to the backup doc’s clinic. We were at the hospital for only a couple hours before my dad brought me to the clinic. I didn’t have an appointment and the front desk clerks weren’t quite sure what to do with me, but told me to take a seat. After maybe 20 minutes, they called me back. My dad was stuck in the waiting area for the next hour, but I was pretty comfortable on the reclining exam table. I would have turned the lights off and REALLY slept if I hadn’t been afraid that they’d forget I was there. A nurse came by to apologize every once in awhile, but so long as I could lie down, I was fine. Eventually, Dr B came to check me. I couldn’t thank her enough for her expediting Peter’s admittance. It was also a relief to hear that my tears were both worse than expected and not infected. I had thought that if the discomfort I felt was first degree tearing, that third and fourth degree tears must be truly horrific.
My attempts at breastfeeding are pretty well recorded above, so I won’t explain again. Peter didn’t nurse at 9pm either and it didn’t look like he’d be nursing full-time anytime soon. We left that night somewhat discouraged, but heartened that we were leaving the world of seizures and dealing with more standard issues.
Friday:
Dan:
The main task at hand is to get Peter eating from Mommy. Friday consisted mainly of Peter waking up, screaming as Amy tried to nurse him, then calming down as the nurse started his gastro tube feeding, then Amy pumped. This took about an hour from start to finish, and then we got a two hour break before trying again. As you can imagine, it was not soothing for Amy to have a baby screaming on her breast. The lactation consultant here was helpful, and gave us some options for over the weekend. We tried a supplemental nursing system where the pumped milk is held in a little cylinder clipped to Amy's shoulder and run through a tube that is taped on her nipple. As baby sucks, he gets milk a little easier. It didn't work, and since we didn't want one more thing to wash along with the pumping kit we haven't tried it again. Peter finally latched on at the 6:00 feeding for at least five minutes, which means he only needed half of his normal milk through the nose.
Me, now:
I had hoped that Friday I’d be able to consistently nurse and stay overnight for a possible Saturday release, but we soon realized it wouldn’t be that simple. The loading dose of phenobarb that Peter received three days earlier was clearly still affecting him. He had been so strong and feisty on Monday, then sleepy and calm ever since. The lactation consultant was helpful, but she didn’t give off a “any second now, this will work” vibe. Neither she nor anyone else in the NICU ever suggested we give him a bottle, and for that I am so grateful. I was bound and determined to do everything I could to avoid bottles and they were supportive of that. We also had one of the nurses attach a “No pacifiers for Peter” sign when it became clear that he could suck, but only wanted to suck on items bigger and easier to grasp than my nipples.
Friday afternoon, my favorite nurse introduced herself as Peter’s nurse for the evening. She had two kids of her own that she’d nursed and had taken extra training in lactation guidance. She happened to be the one in the room when Peter successfully latched on for the first time at 6pm Friday and I associated happy nursing with her ever after. When that success was deemed to be more of a fluke than the first of many consecutive nursing sessions, I decided to go home Friday night and rest.
Saturday
Dan:
Peter was very alert in the morning and had apparently been awake most of the night. We had a good visit with my aunt and Amy's mom in the morning, ending with a good 10 minute latch with intermittent swallowing. The neonatologist stopped by and said we could take out his IV (the antibiotics finished the previous night), gastro tube and all his monitoring. So we had a normal baby again! He was very fun, then got cranky. He got into the habit of being at the breast for a long time but not sucking very much. Finally after a cup feeding to top him off, he went to sleep... and kept sleeping for 4 hours! As you can tell, his schedule is not a normal one, probably due to the drugs still clearing from his little body. Amy stayed the night while I went home to sleep, which was hard for us. The night was especially hard for Amy as she tried to nurse an uncooperative child. The screaming was gone, and he appeared happy at the breast, but apparently doesn't get much food. He hasn't been peeing much, so we're working with cup feedings as well, which he downs no problem. We really need to get him eating before we can go home. Amy has been a bit down as Peter hasn't taken to nursing yet. I will stay with Amy here tonight (Sunday) to make things easier. Since Peter is now happy munching on mommy but doesn't seem to get the eating part, we're going to try the SNS again to see if getting the milk at her breast will give him the right idea.
Me, Saturday:
I stayed overnight at the hospital for the first time Saturday (without Dan) and it was pretty rough. Peter had been disconnected from all wires around lunchtime (yaaay!!) after a successful cup feeding that morning and we were allowed to feed him on demand without threat of the dreaded nose tube being plugged in. He ate happily right away, and again every hour and a half or so until about 3pm. At that point, he became Mr. Crankypants and wouldn't stop screaming for anything (he'd been VERY alert since noon). We tried cup feeding him a little, but he wasn't too hungry. I couldn't take the crying and took a nap while Dan walked him and rocked him until he conked out. He didn't wake up until almost 8 pm! He fed enough from the breast that we didn't have to use the cup and he slept again until 11. Then Dan left and he munched at my breasts until 2:15. He didn't swallow much, but he didn't scream with the breast in his face, so I didn't want to mess with him. He hadn't peed since noon though, so the nurse gave him a cup feeding at that point and he ate 90cc's. I was so upset that he was that hungry after feeding so much that I could barely watch him eat. He slurps it down and it rips my heart into a million tiny pieces to see it. Meanwhile, I'm feeling engorged for the first time and my breasts are throbbing while he refuses to eat from them. I hadn't pumped all day (ahh, free from the tubes) so I could see whether Peter and I could regulate each other, but I pumped for 5 minutes at that point. He didn't fall asleep, even after eating the 90cc's, but didn't fuss until 3am. I picked him up and he nuzzled at my breast for 5 minutes before falling asleep. I love holding him--his little face is so cute and he makes such fun faces, but I just dread feeding him for fear of how he'll react. And knowing he's not peeing isn't helping. He did produce a number of poopy diapers (no more antibiotic diarhhea either), but never a wet one. At 4am, he woke up again, and he fed well for 5 minutes, then just snuggled for another 5 before falling asleep. I pumped for 10 minutes after that. The nurses were great about doing all they could for me--I wasn't sure if they'd wash pump parts and whatnot beforehand (since that's usually Dan's responsibility), but it wasn't a problem. Heck, he's probably one of the few kids without monitors to watch and all the extra paraphernalia--it's the least they can do to change his diapers and wash the pump.
Sunday
Me, Sunday:
Peter and I both slept until close to 8am. I was pretty zonked, if he wasn't. At that point, the nurse took his vitals and it looked like he was going to wake up. We brought him to my chest, and he'd take 3 swigs and fall asleep. She'd put him back in his bassinet and he'd wake up. We repeated that 3 times before I had her give him a cup feeding. I slept again until 10 when Dan returned. I pumped then (producing 130cc's) and on both Dan and the nurse's advice, left the room. Right before we left, the doctor came by and said that due to his lack of peeing (he did finally produce a wet diaper early this morning) and loss of weight (he's down to 8 lbs 12 oz), he won't be going home today. Even though I knew it wasn't a guarantee, I thought that if he could cup feed, they'd let us go. I can't deal with being in the hospital much longer. His long stretches of waking and sleeping are due to a combination of the drugs still leaving his system and the funkiness of living in a world where the lights are always slightly dimmed. I want him in bed next to me, with the curtains up when it's light out. Without a steady stream of nurses who change every 8 hours and doctors who nonchalantly tell us that he's not quite doing well enough yet. I feel like he's never going to have the chance to get the hang of breastfeeding until we get him OUT OF HERE.
A nurse yesterday asked if we were mourning the birth we'd hoped for. That's not it at all--it's the babymoon I'm missing. While I would have preferred a 12 hour labor that didn't leave me with tears I need to bathe 3 times a day, I'm happy with my birth experience. After I'd showered and they had him breathing, we tried nursing at home on Monday. He wouldn't latch on, but he would suck our fingers really vigorously. At the time, breathing and nursing seemed too much for him. But I can't help but think that if he had been able to spend the following days home with me, we would have figured it out during the colostrum time instead of him being fed through an IV then, and a nose tube later.
I never did figure out when exactly my milk came in. I didn't get hugely engorged or anything. Tuesday, I pumped about 15cc's each pumping, Wednesday it went up to 30, and by Thursday I was at 60 or 70. I didn't see the color change either. Apparently, it was just a subtle thing for me. I was worried that I wouldn't produce enough milk for him before the birth, and that's one of the few things I haven't had to worry about. How odd.
My bleeding has gone down a lot. I've become a fan of Depends--they're just easier than pads. I have an herb wash in a peri bottle that I use. The midwives are pretty concerned that I'm not able to rest enough for "my bottom" to heal. I don't think they usually deal with this much tearing. They knew he needed to come out when he did, and there wasn't any talk of slowing down to get his 14 1/2" head out gently. Once I get home with Peter, I'm just not going to wear underwear for a week =) I have been able to use a handicapped-accessible shower here at the hospital with a handheld nozzle--if that wasn't available, the midwives would have had me go home for baths multiple times a day.
I've been using a wheelchair around the hospital so I don't wear myself out any more than necessary. I feel a little lame, especially since a lot of the NICU moms are wearing robes and still have IV's attached. But I get worn out enough by the end of the day.
I've been sobbing a good portion of the morning, but life always looks better when Dan's around. He brought me up to the family resource room and has been checking out LLL's breastfeeding book for advice. I guess the plan is to try feeding him every 2 hours, whether he wants to or not, just to get in the extra practice. Hopefully that'll keep me from getting engorged and will let him trying feeding before he's starving. I think we're going to give the SNS another try, too. We tried it Friday afternoon, but he was too pissed to latch on at all then, so it didn't work. If we can convince him that mommy's nipples are for eating, we might be set. My right nipple is sore from some of his chomping overnight, but I hope that won't get worse.
I think I'm sane enough to go back to my boy now. He really is the most adorable precious little thing. I just can't stand him when the feeding doesn't work. He can pull his head from side to side and his eyes are amazing when he gazes at me. He'll turn to look at me when I talk to him. And he has my crooked toes =)
Monday, March 15th - Wednesday, March 17th
Dan:
Successful nursing continued the Monday morning and the doctors gave the ok for getting discharged. This involved some baby lessons from the nurse and an exam from our resident, which went well. We needed a cart to get all of our stuff to the car. I went out first, and then returned for my wife and son.
It was so nice to leave! When we got home I could feel 100 lbs lift off my shoulders. While the care we received at Children's was wonderful, the pressure of "get baby eating or else" was happily left behind. Our life has slowed to the normal new-baby pace of nurse, poop, change, sleep. The last two nights have gone well, and Peter is doing wonderful. We even are using and washing our cloth diapers successfully! :) Our midwife Kim came by Tuesday morning and said Amy was healing nicely, even giving her the cleanliness award for avoiding infection despite all the stress and hospital time. Amy's parents stopped by yesterday evening to look after her while I went to class at Hamline (I already had missed a class last week). My mom was here this afternoon comforting the baby while Amy checked email and I showered and shaved (hadn't shaved since labor began!). Peter had a good dose of his cousins during a brief visit this evening.
Both a homecare nurse and our midwife Jeanne will stop by at different times tomorrow for a checkup. Peter will see his primary physician for the first time on Friday. The NICU clinic will see him at 4, 12, 24 months, and 4.5 years old to track his development. We will also check back with the neurology center at 3 months. Basically, Peter's breathing cleared up fairly quickly after only a few days. The seizures did not reoccur, and the neurologist thinks that it was probably due to his low blood sodium since his brain scans were fairly normal. However, we don't know why his sodium was so low. The rule of thumb is that if a baby looks normal a week after birth, he probably is. Peter is indeed looking normal, and our family is settling into the new "normal" of life.
We are so thankful to our Heavenly Father for his strenth and healing grace throughout this ordeal. Thank you all for your prayers. Among other things, the Lord has taught us to trust him, for he is really the only one who has any idea where our lives are headed. And we are safe in his hands.
Come now, you who say, 'Today or tomorrow we will go into such and such a town and spend a year there and trade and get gain'; whereas you do not know about tomorrow. What is your life? For you are a mist that appears for a little time and then vanishes. Instead you ought to say, 'If the Lord wills, we shall live and we shall do this or that.'" Jas 4:13-15
May God bless each of you,
Dan, Amy and Peter "the Rock" Fisher
Me, Mon. March 15th:
We got through Sunday night pretty well--Peter was up feeding from 11 to 12 and 4 to 5, but otherwise slept from 12 to 7:30. My nipples are sore from his munching Saturday night, but for the most part, he seems to have figured out what to do. During one feeding yesterday, he slurped so much milk that we could hear it pouring down his throat! That was an awesome sound. He's peeing well enough that they aren't even weighing his diapers anymore. We met with the discharge nurse this morning; his nurse went over how to use the bulb-sucker, give him a bath, and wipe the goop out of his eyes. I've been concentrating so hard at getting from one feeding to the next that I'm at a bit of a loss when he's awake and not hungry, but I figure that will come with time. It's so fun to watch Dan interact with him! He's got a Peter-voice and he's been reading him The Hobbit, which we never did finish during the pregnancy. Dan's got the diaper-changing figured out, but we'll have to get used to cloth once we leave. This isn't the way I expected to skip the meconium stage!
They're expecting to discharge him around 3. I think I'm going to sob when we get to the house--it'll be amazing to have him there with us! I haven't been home myself since Saturday morning. I've started walking around the NICU a bit more instead of using the chair. My bleeding has really gone down. Kim will come over for our one week home visit later today.
It's a happy, happy day :)
Monday, March 8th:
Dan:
Peter was born this morning at home at 6:35 am after a LONG labor…
The fluid was terminally meconium-stained (baby pooped inside during the last bit of labor), probably due to the cord over his shoulder that was pulled tight before final escape. This was remedied as his head came out, he was thoroughly suctioned, and the rest of him slid out. It took some more coughing (him) and suctioning (the midwives) to get him crying, but he did and perked up well. The lungs sounded wet, so he was "cried" to get the gunk out and watched, and given some blow-by oxygen (a tube blowing into his face). After a bunch of checking, he was deemed to be healthy and we began the cleanup.
The midwives did a full newborn exam which looked good. We were told to watch him closely for about 24 hours to make sure his color remained pink. My sister Kara stayed with us to watch the baby while Amy and Dan (now Mom and Dad) slept. However, we were woken at 10:30 to be told that his grunting wasn't going away (a sign of labored breathing) and that we'd need to take him to the NICU for monitoring. One midwife led the way to Children's Hospital in her car, while the other followed with Peter and Dan. It was a bit scary, since a snowstorm had quickly erupted outside making travel difficult. I kept stimulating the baby to keep him moving and making sounds in the back as the midwife drove. We made a wrong turn in the snow, and had difficulty parking, but were led right into the NICU (our backup doctor had set it up).
The crew here is really great. They were all very kind and informative to me (Dad), as well as respectful of the fact that we had the baby at home. Peter wasn't in immediate, emergency danger, but his breathing was grunty and very labored. An x-ray identified pneumonia in both lungs (the wet fluid we had heard) as well as 2 - 3 small pockets of air that had poked through his lung walls. Both are caused by meconium, blood, or amniotic fluid that enters and irritates the lungs during labor. Also, blood tests found that his blood was a bit too acidic from his labored breathing. The oxygen mask wasn't getting his blood O2 up high enough so they tried a little dome over his head with 100% oxygen. That still didn't have the desired effect, so they intubated him. This is how he is tonight, and his blood O2 is now very good and his lungs sound much better (still a bit of raspiness, but filling well). He is also being given two kinds of antibiotics to prevent any potential infections from the pneumonia. The air bubbles are too small to take out with a needle, so the will be left alone and will hopefully reabsorb on their own.
Amy is doing very well after the birth, and Peter is expected to make a full recovery. He will only be left on the ventilator until he can breathe on his own without much difficulty. He will remain here for at least 5 - 7 days to watch for infection and to check on his pneumonia. There were no emergency procedures done, but Peter is now getting the help he needs to breathe after an unlucky birth. We will keep this journal updated (hopefully daily) with how he is doing.
Your prayers for patience, courage and health are welcomed. Amy and I are so glad to see our wonderful baby boy, despite the unexpected circumstances! :)
Me, now:
Three hours post-partum, it looked as though Peter’s lungs were clearing and we’d just need to keep an eye on him, so Dan and I both got some much-needed rest while Kara and the midwives watched Peter. I am so grateful they didn’t leave him with us because we probably would have been too tired to see that his breathing was getting worse instead of better. Kim (one of the midwives) tried to wake Dan up but couldn’t rouse him until she woke me and I told him he needed to get up.
At first, the midwives thought Peter just needed to be seen by the back-up doctor in her clinic, but the doctor told them to go to the hospital instead. She (Dr. B, the one I’d seen at 37 weeks) called St. Joe’s, her preferred hospital, but they told her to bring Peter somewhere with a higher-level NICU. So she called Regions, but they were full and told her to call Children’s. Dr. B didn’t have privileges there, but was able to arrange for Peter’s arrival anyway.
We hadn’t paid much attention, but shortly after Peter was born, it began snowing. By 10:30 when Dan and the midwives left the house, there were white-out conditions. Kim drove her car and Jeanne drove my car, with Dan watching Peter in the back seat. The drive is usually just under 15 minutes, but in the snow it took them over 45, even in mid-day. The freeway barely moved and later we learned that a 20-car pileup had occurred in that stretch of road going the other direction right at that time. Everywhere they looked, cars were sliding off the road.
After a few minutes without extra oxygen, Peter’s grunting got so labored that Jeanne counseled Dan to take him out of his car seat in order to rub and stimulate him more. Those few minutes holding Peter in the midst of the sudden blizzard were the most contact Dan was to have with Peter for many days and he later said that he was happy he was able to help him in some way in the midst of a very scary time.
Dr. B had cleared Peter’s arrival with the NICU staff and at the front desk, Dan was told to bring the baby straight up. I am so grateful they did not need to sit in the ER or fill out any paperwork-they were given a NICU room immediately and seen by the perinatologists who’d already been briefed on the situation. Throughout the day, Kim and Jeanne stayed with Dan, answering questions if Dan asked them, but generally staying in the background. The NICU staff was aware that we’d had a homebirth and must have realized that they were the midwives, but just directed everything to Dan and let them stay to support him. Occasionally they were asked information such as APGAR scores. Not once was our decision to homebirth blamed for Peter’s health.
As Dan’s journal states, Peter was x-rayed-right there in the room while Dan stood by. Only the eventual MRI required leaving the room. The hospital contained nearly 50 NICU beds, with separate rooms for each family (multiples had bigger rooms). The rooms had a pull-out couch, a storage locker, and privacy curtains in addition to all necessary medical equipment. The department was just renovated a year ago. For the families of preemies, the additional privacy must make the long stays so much more bearable. In addition to the babies’ rooms, there was a family room with comfy chairs and a TV, plus two computers and a kitchen where we could keep food. The only computer time I had that week was while I ate meals in that kitchen.
A variety of techniques were attempted to get Peter’s oxygen level up to normal. When they put an oxygen helmet on him, he rolled onto his side and grabbed at his face, trying to get it off. The nurses were amazed by how powerful our newborn was. Granted, they’re used to 3 lb babies, but still. Eventually, he had to be intubated when the less invasive procedures weren’t helping him enough.
A number of routine procedures occurred upon Peter’s admittance-they took his height and weight (22.4” and 9 lbs 7 oz) and gave him the PKU test, the eye ointment, and the Vitamin K shot. Although I’d hoped to avoid the eye goop and shot, even the midwives said that if he was going to spend his fragile first days in the NICU environment, it was probably best to have them.
Meanwhile at home, Kara was staying with me. She woke me up to eat around lunchtime and again in the late afternoon. She then drove me to the hospital that evening. Just as we left, Kim dropped Jeanne off since her car was still at our house. Getting into the car was no easy feat and I began a habit of using a wheelchair in the hospital to avoid aggravating my tearing any more than necessary and avoid any extra work. The woman at the NICU front desk asked if I was Peter’s mom and led us to his room.
After eight hours being away from my baby, it was very strange to see this little guy wrapped up in an incubator, under a heat lamp, with a tube down his throat and taped to his face, covered with wires. All sorts of machines were blinking and buzzing and the baby looked so small and strange surrounded by all of that. I didn’t know if I could touch him. He looked so different than he had in the morning, wires and gadgets notwithstanding, due to the IV fluids and lack of clothes or birth goo. It was hard to believe that I’d actually given birth to this child and he was mine. I had a BABY? A son?
Peter was either sleeping or sedated, it was hard to tell which, but the nurse said it was okay for me to touch him. I began to stroke his head and arm until she said that stroking was too much stimulation and I should just hold onto him. We stayed for an hour, maybe two. The resident came by to talk to us, and I talked to someone about pumping my milk. I had originally hoped to begin pumping that night, but I realized how much I needed a full night’s sleep and decided to wait until the morning when a lactation consultant would be available. After staring at Peter for awhile and praying over him, we went home around 10.
It felt very odd to be back at home, the two of us, with all these reminders of my labor, but no baby. Dan was stressed out to be back in the house where every corner reminded him of somewhere he rubbed and rubbed and rubbed my back some more. I didn’t realize until then how hard it had been for him to watch me labor. He didn’t complain once as I woke him up or motioned for him to come RIGHT AWAY. Even though he was exhausted that night, he sat in front of the TV for awhile to escape everything that had happened. I tried to use the computer and quickly realized that it would be a long time before I comfortably sat on that chair.
We slept our first and last full night’s sleep for a long time.
Tuesday:
Dan:
Peter's second day of life in the hospital was both encouraging and a cause for concern. The encouraging sign was that Peter came off his ventilator at about 3:45 pm. Monday night they began reducing the percent of oxygen in the air they were giving him, and that continued overnight until he was breathing regular air from the vent. When Peter was given the opportunity, he began to breathe faster than the ventilator and was successfully taken off of it. He now looks much more comfortable without the tube and calming drugs. They supplemented his breathing with oxygen through his nose until Tuesday night when even that came off. As of this morning, he is breathing all on his own! This is a very positive step.
The cause for concern is one that is unrelated to his pneumonia. Monday afternoon and night they noticed some seizure-like activity, occurring 4 - 5 times total (hiccup-like rhythmic gasps and some tight fist clenching). They gave him a loading dose of an anti-seizing drug (Phenobarbital) and they haven’t reoccurred. Seizures occurring within the first day or so after birth are consistent with a period of decreased blood oxygenation during delivery. A head ultrasound also showed some brain swelling that would also be a sign of that. Since Amy's pushing stage was indeed very long (~5 hrs), this is a possibility. After a preliminary talk with the neurologist, she was still not quite sure about the cause. An MRI scan to image the physical structure of the brain (done Wednesday morning) and an EEG to look at his brain patterns (done later Wednesday) will give more information, such as locking down the probable cause of the seizures and identifying the severity of any future problems that may or may not occur. There is a good chance that none will (the neurologist was optimistic after his exam and no other organs have been effected), but even if the tests all come back normal the seizures have warranted follow-up meetings and testing over the next year to track Peter's development.
So, his breathing is back to normal but we're waiting for more information about his brain. He looks very cute. Amy was able to pump for the first time Tuesday and has continued periodically through the night. Her supply is responding well and anything she stores will be given to Peter first when they start feedings. Amy is hoping that they won't be necessary and that she'll be able to stay with him for nursing instead of using a bottle when the time comes. We'll also get to hold him when we go into the hospital today (Wednesday). Yay! :)
Thanks to much help from both our families and midwives, and all of your kind words and prayers, Amy and I are doing well. The unusual has become our normal since we have no other situation with which to compare it.
Me, now:
I wanted to arrive as early as possible at the hospital on Tuesday, but I ended up not arriving until mid-afternoon. Dan left earlier and I stayed home and my mom helped me out. Jeanne came to check on me at 1:30. That was the first time anyone took a good look at me, since the baby had required more urgent attention. She said I had a couple first degree tears, which didn’t sound too bad, but that I needed to be incredibly diligent over the next few weeks as they healed since I didn’t have the luxury of lying in bed all day recuperating. She said that she usually tells new moms to avoid all stairs for a week and I should only go down once and up again each day. I also was instructed to take 3-4 baths a day and to “air dry” on chux pads as much as possible. I had no idea how to pull this off while at the hospital, but she said to do all I could, coming home to bathe if necessary. We quickly realized that so long as Peter was sedated, it made more sense for me to be home most of the time.
As soon as I got to the hospital, a lactation consultant came by with the NICU’s pump and a set of parts for me to keep. I didn’t expect to see results that first time pumping, but after less than a minute, colostrum began dripping out! It had been almost 36 hours since I’d given birth with no stimulation at all and bam, I’m producing milk. Amazing. I didn’t leak at all during pregnancy and all the women in my family had trouble breastfeeding due to low supply, so I was incredibly happy to succeed at pumping.
Soon after, a pump I could bring home arrived and I was told to pump 8-12 times a day-preferably every 2 hours while awake and every 3 at night. My second pumping attempt only produced a few drops, but by the end of the day, I produced 30 ml (1 oz) of yellow fluid each time I pumped.
The news that Peter had experienced seizures was confusing. By the time I arrived on Tuesday, he was no longer intubated and looked healthier. His oxygen levels were improving quickly and he appeared to be recovering. It seemed like the doctors weren’t completely sure he had seized at all-the signs are so slight in small babies. But they’d given him the Phenobarb that I came to despise later. They gave him a head ultrasound through his soft spot while we were there-after all those months avoiding them, he got one at two days old! This time, I’ll gladly admit there was a good reason for it.
We went home that evening and began setting an alarm to pump. We got into a routine that let me avoid getting out of bed. Dan would turn off the alarm and I’d pump while he dozed. When I was done, I’d wake him up and he’d go wash the pump parts. The next time I woke, I’d find clean parts waiting next to me.
Wednesday:
Dan:
Peter had his MRI and EEG in the morning before Amy and I came to the hospital in the early afternoon (we just can't seem to get here before 12:00!). We met with the neurologist at about 3:00 pm, a different woman than before but also very nice. The MRI was completely normal, showing no signs of injury from lack of oxygen. This was very good! The head ultrasound the day before had indicated possible slight brain swelling, but the MRI didn't confirm it. While the MRI can sometimes give false negatives, the doctor seemed to indicate that the normal result was very good.
The EEG scan revealed a few things out of the ordinary, causing the neurologists to classify Peter's brain activity as moderately abnormal. The scale goes from mild (95% of children have no future problems), moderate (50% have no future problems), to severe. After the examinations and the trend in Peter's progress, the doctors are optimistic that Peter is in the good 50% of moderate cases. Also done yesterday was a spinal tap that came back clear indicating no infection.
So, two out of three tests were completely normal and the Peter's trend suggests that the abnormal EEG will effect him minimally. At this time we're continuing to watch him to see if any further seizures occur and that he "perks up" as he clears the drugs out of his system (the anti-seizure dose from two days ago and the sedation from the MRI yesterday). Last night and today Peter did very well with no observed seizures. (The nurse on the phone Thursday morning mentioned a possible one overnight, but she was apparently mistaken and nothing was recorded in Peter's record. Boo her for scaring Mommy and Daddy!
Me, now:
When we arrived on Wednesday, Peter looked really good. He’d just finished the EEG and had tape marks on his face, but was free from breathing tubes. He wasn’t yet receiving nourishment from anything but IV’s, so that was the only day for awhile without any tubes connected to his face. Right away, the nurse encouraged us to hold him. She wrapped him up and found a way to swing all the wires to one side and I sat near his crib and held him. We tried to see if he would nurse, but he was too sleepy.
The news that Peter was classified as having “moderately abnormal” brain activity was scary, but it was so overwhelming that it was hard to think through all that might entail. The abnormal EEG was due to his not going into deep sleep during the hour-long scan and a few strange patterns. They also brought up the fact that his sodium had been incredibly low when he arrived. I hadn’t shown signs of low sodium levels and there was no way to test after-the-fact if he’d just carried over the low level from me. The neurologist’s hope was that the seizures had been caused by temporarily low sodium instead of decreased oxygen during his birth. I never quite figured out why one was better than the other, and the neurologists were never able to definitively tell us which caused the seizures. We just prayed that they wouldn’t return.
Jeanne came to visit us at the hospital that afternoon and it was suddenly obvious that they needed to check on Peter and I as much as I needed to hear from them. Both Kim and Jeanne called every day and one of them came to see us every day that week. I showed Jeanne the handicapped shower I’d found and begun using as a way to keep up my baths even at the hospital. She was relieved to see Peter looking better.
Thursday:
Dan:
Peter has indeed perked up today. They began giving him a bit of pumped breast milk through a gastro tube in his nose last night, and today upped that to a full feeding every three hours. Amy tried feeding him yesterday, but Peter was too sleepy and nuzzled contentedly at her breast. This afternoon we tried again but he was full from the tube feeding. Today he has found his cry when it's time to eat, and right now Mom is trying to get Baby to latch on. It's amazing, after all his drugs and sleepiness the novelty of his cry is wearing off already! ;) Truthfully, the sound is a joy to hear despite the stress of trying to satisfy him.
Amy stopped by to see her doctor today to check on her birth wounds. While our midwife was concerned of possible infection, the doctor thought Amy is healing well. She now has a prescription for antibiotics just in case.
While today was a bit tiring (coming here, trying to feed, pumping, eating, sending Amy to doctor's via her father, soothing Peter, trying to feed again), we are happy to hold our son - trailing wires et al.
Thanks you all for your prayers, visits, messages and kind thoughts. The Lord has allowed Amy to keep our heads enough to get done what needs doing. Keep 'em coming!
Me, Thursday morning:
My tears are looking sort of iffy and might get infected because I can't lie down all the time due to going back and forth to the hospital. If Peter gets the hang of feeding, I will likely start staying at the hospital 24/7 until he comes home. The earliest he'd come home would be Friday afternoon, but Saturday looks more likely, if not later.
I just want him to wake up and eat so we can bring him home and lie in bed with him all day.
Me, Thursday evening:
Peter is acting like a normal little boy! We got to the hospital and he was having his first full feeding (through a nose tube). He was sucking a pacifier while being fed, which was encouraging since he was associating sucking with feeding. He didn't seem all that active, but it was more than yesterday. I tried to feed him after 40ml, but he'd already eaten 4 times as much as he ever had before and didn't have much reason to do more than lick me :)
I left to go get checked by the backup doctor. There was a lot of waiting around involved, but most of that was lying on the examining table, which was rather restful :) The doctor (who has been amazing with getting Peter speed-admitted when he arrived) determined that I definitely had a second degree tear (no WONDER I'm so sore!), but the potential infection Kim had seen this morning was more likely just healing tissue. She also said I was keeping the area clean. Since I hadn't been home in hours, I didn't expect her to be too impressed. She gave me an antibiotic script, but advised I not fill it unless things look worse in the upcoming days. Even though I had thought it would be a relief to take the antibiotics and not worry so much, knowing that I was raising my chances at yeast infections and thrush--especially since Peter's on antibiotics, too--is actually less to worry about. Kim and Jeanne will be checking me every day in the near future, so they'll let me know if things look worse down there. The doc thinks the bad tear will heal fine--it's this goofy skin tag that might need to be repaired later.
When I got back to the hospital, Peter was WAILING and they had me try feeding him, but this time he was too pissed to suck. He'd suck on my finger, or anything else, but noooo, not my nipples. After awhile, they turned on the feeding tube again and had me try simultaneously. He was calmer, but still mostly just licked. They'd drop a few drops on my nipple and he'd root around to find them, lick them off, then just sit there. He's way too smart! Eventually, I just held him. He's such a sweetie. It was great to hear him being cranky and making all these sounds. They even disconnected all the wires so I could feed him on the couch.
I really wanted feeding to happen instantly so SOMETHING would go smoothly, but apparently that's too much to ask. I'm going to try once again tonight--hopefully before he's so hungry and upset--then go home and rest up for tomorrow. The lactation folks will all be here then and darn it, we WILL get this figured out! I pumped 75ml (still colostrum) after holding/feeding him a couple hours ago, which means I'm only one feeding ahead of him for the moment. So if he doesn't take the breast at 9 tonight, then he'll have my milk at 9 and 12, then formula at 3, 6, and 9 before I'm back with pumped stuff in the morning. Hopefully, he'll just feed from me tomorrow. I'll stay tomorrow night if we've got it figured out, and I think he'd be discharged Saturday.
It feels like we're normal parents with normal problems all of a sudden!
It seems that the nurse who told us about the seizure overnight was mistaken because none of today's nurses or the neurologist knew anything about it. Yay! We didn't get that straight until tonight.
So--his IV's are out, he's taking food well, he sucks (on everything but my nipples), and he's alert. I have worse tearing than we thought, but it's in better shape than expected. C'mon Peter, figure out how to latch on!!
Me, now:
Thursday was such an up and down day. We woke up and were told by one nurse that the previous nurse had observed a possible seizure. Then Kim came to check me and was worried enough that she arranged for me to go to the backup doc’s clinic. We were at the hospital for only a couple hours before my dad brought me to the clinic. I didn’t have an appointment and the front desk clerks weren’t quite sure what to do with me, but told me to take a seat. After maybe 20 minutes, they called me back. My dad was stuck in the waiting area for the next hour, but I was pretty comfortable on the reclining exam table. I would have turned the lights off and REALLY slept if I hadn’t been afraid that they’d forget I was there. A nurse came by to apologize every once in awhile, but so long as I could lie down, I was fine. Eventually, Dr B came to check me. I couldn’t thank her enough for her expediting Peter’s admittance. It was also a relief to hear that my tears were both worse than expected and not infected. I had thought that if the discomfort I felt was first degree tearing, that third and fourth degree tears must be truly horrific.
My attempts at breastfeeding are pretty well recorded above, so I won’t explain again. Peter didn’t nurse at 9pm either and it didn’t look like he’d be nursing full-time anytime soon. We left that night somewhat discouraged, but heartened that we were leaving the world of seizures and dealing with more standard issues.
Friday:
Dan:
The main task at hand is to get Peter eating from Mommy. Friday consisted mainly of Peter waking up, screaming as Amy tried to nurse him, then calming down as the nurse started his gastro tube feeding, then Amy pumped. This took about an hour from start to finish, and then we got a two hour break before trying again. As you can imagine, it was not soothing for Amy to have a baby screaming on her breast. The lactation consultant here was helpful, and gave us some options for over the weekend. We tried a supplemental nursing system where the pumped milk is held in a little cylinder clipped to Amy's shoulder and run through a tube that is taped on her nipple. As baby sucks, he gets milk a little easier. It didn't work, and since we didn't want one more thing to wash along with the pumping kit we haven't tried it again. Peter finally latched on at the 6:00 feeding for at least five minutes, which means he only needed half of his normal milk through the nose.
Me, now:
I had hoped that Friday I’d be able to consistently nurse and stay overnight for a possible Saturday release, but we soon realized it wouldn’t be that simple. The loading dose of phenobarb that Peter received three days earlier was clearly still affecting him. He had been so strong and feisty on Monday, then sleepy and calm ever since. The lactation consultant was helpful, but she didn’t give off a “any second now, this will work” vibe. Neither she nor anyone else in the NICU ever suggested we give him a bottle, and for that I am so grateful. I was bound and determined to do everything I could to avoid bottles and they were supportive of that. We also had one of the nurses attach a “No pacifiers for Peter” sign when it became clear that he could suck, but only wanted to suck on items bigger and easier to grasp than my nipples.
Friday afternoon, my favorite nurse introduced herself as Peter’s nurse for the evening. She had two kids of her own that she’d nursed and had taken extra training in lactation guidance. She happened to be the one in the room when Peter successfully latched on for the first time at 6pm Friday and I associated happy nursing with her ever after. When that success was deemed to be more of a fluke than the first of many consecutive nursing sessions, I decided to go home Friday night and rest.
Saturday
Dan:
Peter was very alert in the morning and had apparently been awake most of the night. We had a good visit with my aunt and Amy's mom in the morning, ending with a good 10 minute latch with intermittent swallowing. The neonatologist stopped by and said we could take out his IV (the antibiotics finished the previous night), gastro tube and all his monitoring. So we had a normal baby again! He was very fun, then got cranky. He got into the habit of being at the breast for a long time but not sucking very much. Finally after a cup feeding to top him off, he went to sleep... and kept sleeping for 4 hours! As you can tell, his schedule is not a normal one, probably due to the drugs still clearing from his little body. Amy stayed the night while I went home to sleep, which was hard for us. The night was especially hard for Amy as she tried to nurse an uncooperative child. The screaming was gone, and he appeared happy at the breast, but apparently doesn't get much food. He hasn't been peeing much, so we're working with cup feedings as well, which he downs no problem. We really need to get him eating before we can go home. Amy has been a bit down as Peter hasn't taken to nursing yet. I will stay with Amy here tonight (Sunday) to make things easier. Since Peter is now happy munching on mommy but doesn't seem to get the eating part, we're going to try the SNS again to see if getting the milk at her breast will give him the right idea.
Me, Saturday:
I stayed overnight at the hospital for the first time Saturday (without Dan) and it was pretty rough. Peter had been disconnected from all wires around lunchtime (yaaay!!) after a successful cup feeding that morning and we were allowed to feed him on demand without threat of the dreaded nose tube being plugged in. He ate happily right away, and again every hour and a half or so until about 3pm. At that point, he became Mr. Crankypants and wouldn't stop screaming for anything (he'd been VERY alert since noon). We tried cup feeding him a little, but he wasn't too hungry. I couldn't take the crying and took a nap while Dan walked him and rocked him until he conked out. He didn't wake up until almost 8 pm! He fed enough from the breast that we didn't have to use the cup and he slept again until 11. Then Dan left and he munched at my breasts until 2:15. He didn't swallow much, but he didn't scream with the breast in his face, so I didn't want to mess with him. He hadn't peed since noon though, so the nurse gave him a cup feeding at that point and he ate 90cc's. I was so upset that he was that hungry after feeding so much that I could barely watch him eat. He slurps it down and it rips my heart into a million tiny pieces to see it. Meanwhile, I'm feeling engorged for the first time and my breasts are throbbing while he refuses to eat from them. I hadn't pumped all day (ahh, free from the tubes) so I could see whether Peter and I could regulate each other, but I pumped for 5 minutes at that point. He didn't fall asleep, even after eating the 90cc's, but didn't fuss until 3am. I picked him up and he nuzzled at my breast for 5 minutes before falling asleep. I love holding him--his little face is so cute and he makes such fun faces, but I just dread feeding him for fear of how he'll react. And knowing he's not peeing isn't helping. He did produce a number of poopy diapers (no more antibiotic diarhhea either), but never a wet one. At 4am, he woke up again, and he fed well for 5 minutes, then just snuggled for another 5 before falling asleep. I pumped for 10 minutes after that. The nurses were great about doing all they could for me--I wasn't sure if they'd wash pump parts and whatnot beforehand (since that's usually Dan's responsibility), but it wasn't a problem. Heck, he's probably one of the few kids without monitors to watch and all the extra paraphernalia--it's the least they can do to change his diapers and wash the pump.
Sunday
Me, Sunday:
Peter and I both slept until close to 8am. I was pretty zonked, if he wasn't. At that point, the nurse took his vitals and it looked like he was going to wake up. We brought him to my chest, and he'd take 3 swigs and fall asleep. She'd put him back in his bassinet and he'd wake up. We repeated that 3 times before I had her give him a cup feeding. I slept again until 10 when Dan returned. I pumped then (producing 130cc's) and on both Dan and the nurse's advice, left the room. Right before we left, the doctor came by and said that due to his lack of peeing (he did finally produce a wet diaper early this morning) and loss of weight (he's down to 8 lbs 12 oz), he won't be going home today. Even though I knew it wasn't a guarantee, I thought that if he could cup feed, they'd let us go. I can't deal with being in the hospital much longer. His long stretches of waking and sleeping are due to a combination of the drugs still leaving his system and the funkiness of living in a world where the lights are always slightly dimmed. I want him in bed next to me, with the curtains up when it's light out. Without a steady stream of nurses who change every 8 hours and doctors who nonchalantly tell us that he's not quite doing well enough yet. I feel like he's never going to have the chance to get the hang of breastfeeding until we get him OUT OF HERE.
A nurse yesterday asked if we were mourning the birth we'd hoped for. That's not it at all--it's the babymoon I'm missing. While I would have preferred a 12 hour labor that didn't leave me with tears I need to bathe 3 times a day, I'm happy with my birth experience. After I'd showered and they had him breathing, we tried nursing at home on Monday. He wouldn't latch on, but he would suck our fingers really vigorously. At the time, breathing and nursing seemed too much for him. But I can't help but think that if he had been able to spend the following days home with me, we would have figured it out during the colostrum time instead of him being fed through an IV then, and a nose tube later.
I never did figure out when exactly my milk came in. I didn't get hugely engorged or anything. Tuesday, I pumped about 15cc's each pumping, Wednesday it went up to 30, and by Thursday I was at 60 or 70. I didn't see the color change either. Apparently, it was just a subtle thing for me. I was worried that I wouldn't produce enough milk for him before the birth, and that's one of the few things I haven't had to worry about. How odd.
My bleeding has gone down a lot. I've become a fan of Depends--they're just easier than pads. I have an herb wash in a peri bottle that I use. The midwives are pretty concerned that I'm not able to rest enough for "my bottom" to heal. I don't think they usually deal with this much tearing. They knew he needed to come out when he did, and there wasn't any talk of slowing down to get his 14 1/2" head out gently. Once I get home with Peter, I'm just not going to wear underwear for a week =) I have been able to use a handicapped-accessible shower here at the hospital with a handheld nozzle--if that wasn't available, the midwives would have had me go home for baths multiple times a day.
I've been using a wheelchair around the hospital so I don't wear myself out any more than necessary. I feel a little lame, especially since a lot of the NICU moms are wearing robes and still have IV's attached. But I get worn out enough by the end of the day.
I've been sobbing a good portion of the morning, but life always looks better when Dan's around. He brought me up to the family resource room and has been checking out LLL's breastfeeding book for advice. I guess the plan is to try feeding him every 2 hours, whether he wants to or not, just to get in the extra practice. Hopefully that'll keep me from getting engorged and will let him trying feeding before he's starving. I think we're going to give the SNS another try, too. We tried it Friday afternoon, but he was too pissed to latch on at all then, so it didn't work. If we can convince him that mommy's nipples are for eating, we might be set. My right nipple is sore from some of his chomping overnight, but I hope that won't get worse.
I think I'm sane enough to go back to my boy now. He really is the most adorable precious little thing. I just can't stand him when the feeding doesn't work. He can pull his head from side to side and his eyes are amazing when he gazes at me. He'll turn to look at me when I talk to him. And he has my crooked toes =)
Monday, March 15th - Wednesday, March 17th
Dan:
Successful nursing continued the Monday morning and the doctors gave the ok for getting discharged. This involved some baby lessons from the nurse and an exam from our resident, which went well. We needed a cart to get all of our stuff to the car. I went out first, and then returned for my wife and son.
It was so nice to leave! When we got home I could feel 100 lbs lift off my shoulders. While the care we received at Children's was wonderful, the pressure of "get baby eating or else" was happily left behind. Our life has slowed to the normal new-baby pace of nurse, poop, change, sleep. The last two nights have gone well, and Peter is doing wonderful. We even are using and washing our cloth diapers successfully! :) Our midwife Kim came by Tuesday morning and said Amy was healing nicely, even giving her the cleanliness award for avoiding infection despite all the stress and hospital time. Amy's parents stopped by yesterday evening to look after her while I went to class at Hamline (I already had missed a class last week). My mom was here this afternoon comforting the baby while Amy checked email and I showered and shaved (hadn't shaved since labor began!). Peter had a good dose of his cousins during a brief visit this evening.
Both a homecare nurse and our midwife Jeanne will stop by at different times tomorrow for a checkup. Peter will see his primary physician for the first time on Friday. The NICU clinic will see him at 4, 12, 24 months, and 4.5 years old to track his development. We will also check back with the neurology center at 3 months. Basically, Peter's breathing cleared up fairly quickly after only a few days. The seizures did not reoccur, and the neurologist thinks that it was probably due to his low blood sodium since his brain scans were fairly normal. However, we don't know why his sodium was so low. The rule of thumb is that if a baby looks normal a week after birth, he probably is. Peter is indeed looking normal, and our family is settling into the new "normal" of life.
We are so thankful to our Heavenly Father for his strenth and healing grace throughout this ordeal. Thank you all for your prayers. Among other things, the Lord has taught us to trust him, for he is really the only one who has any idea where our lives are headed. And we are safe in his hands.
Come now, you who say, 'Today or tomorrow we will go into such and such a town and spend a year there and trade and get gain'; whereas you do not know about tomorrow. What is your life? For you are a mist that appears for a little time and then vanishes. Instead you ought to say, 'If the Lord wills, we shall live and we shall do this or that.'" Jas 4:13-15
May God bless each of you,
Dan, Amy and Peter "the Rock" Fisher
Me, Mon. March 15th:
We got through Sunday night pretty well--Peter was up feeding from 11 to 12 and 4 to 5, but otherwise slept from 12 to 7:30. My nipples are sore from his munching Saturday night, but for the most part, he seems to have figured out what to do. During one feeding yesterday, he slurped so much milk that we could hear it pouring down his throat! That was an awesome sound. He's peeing well enough that they aren't even weighing his diapers anymore. We met with the discharge nurse this morning; his nurse went over how to use the bulb-sucker, give him a bath, and wipe the goop out of his eyes. I've been concentrating so hard at getting from one feeding to the next that I'm at a bit of a loss when he's awake and not hungry, but I figure that will come with time. It's so fun to watch Dan interact with him! He's got a Peter-voice and he's been reading him The Hobbit, which we never did finish during the pregnancy. Dan's got the diaper-changing figured out, but we'll have to get used to cloth once we leave. This isn't the way I expected to skip the meconium stage!
They're expecting to discharge him around 3. I think I'm going to sob when we get to the house--it'll be amazing to have him there with us! I haven't been home myself since Saturday morning. I've started walking around the NICU a bit more instead of using the chair. My bleeding has really gone down. Kim will come over for our one week home visit later today.
It's a happy, happy day :)