Friday, April 21, 2017

The Birth of Penelope

This pregnancy can only be described as horrible. From high AFP results to a nephrostomy tube to sepsis I have been through more than I ever cared to experience. The silver lining to all of this though is my beautiful baby girl in my arms. She makes all of that pain, worry, fear and frustration worth it. So come with me as I tell the story of how she arrived...

My birthday on Monday came and went and while I was hoping for a birthday baby I wasn't too surprised she did not arrive that day. I had been having some telltale signs she would probably be here soon, although I never say anything is for certain until the baby's head is out. I had been scheduled to be induced at 39 weeks on April 10th but was hoping to avoid that mess.

It was Thursday morning and I dragged myself out of bed and got the kids up and ready for daycare. At this point I had an incident of what I figured was just pregnancy related bladder leakage (pregnancy is awesome) and put a pad in my underpants just in case. The thought of my water leaking vaguely occurred to me but I wrote it off quickly. I dropped the kids off and then went off to my chiropractor appointment to hopefully get baby nice and aligned for birth. Walking up the stairs to the office I felt it. The rupture of membranes, the very distinct flooding feeling that I've felt three other times in my life. You would think a normal person might just pop in and say "sorry, can't stay." and leave. Nope. Not me. I was actually still in denial. No way I thought. No way was that my water. Nah. I continue to go in and get checked in. All through the appointment I was feeling the little gushes. Still in denial by the way. I managed to get adjusted and make it down the steps before that poor pad reached it's maximum and my shorts started getting soaked. I got to the car and took a second to be thankful for leather seats. I called Kenny first and told him what happened and what my plan was. Then I placed a series of calls to my mom and my mother in law to let them know. Then I drove my butt home to load up the car with all of our stuff, managing to forget one bag entirely by the way. Truth be told I was STILL not 100% convinced my water had gone. The denial is strong with me.

I arrived to the ER triage, wet shorts and all. I got checked in and they asked if I wanted to walk or take a wheelchair. I chose to walk. So I waltzed my way up to L&D. I ran into a previous co-worker in the elevator, that was a fun and sort of awkward moment. Oh hey...yeah...don't mind my wet shorts or the tiny puddle that might be forming under me, so how are you? I got to the L&D unit and they put me in the triage room. I was only at 2cm and still not contracting much. They did a test to check if it was amniotic fluid which of course was positive, I finally accepted that I was not going to be leaving the hospital without my baby in my arms. The put me into my room and got my IV in. I know most of the nurses there really well and they are all just amazing. I can't say how much I loved having them by my side for all of the kids.

They started pitocin right away to get contractions going. A little after noon or so the doctor came in and broke a forebag of water but I was still pretty much the same as when I arrived progress wise. They continued to up the pitocin throughout the day. The doctor came by and checked me out again in the evening. She had me get up and bounce on a big exercise ball to help push things along. That must have helped because sitting on that ball the contractions began getting worse. I felt her moving down further and knew the hard part was coming soon. I got back in bed and the contractions increased even more. I had already told the nurses what was going to happen: I would be chatty and happy until about 5cm when I'll get quiet and start focusing really hard through contractions. The journey to 5cm would take forever but once I hit that things would go faster. By 9 ish at night I was starting to get to that point. I had to focus a little more and my contractions began causing me to internally scream curse words in one continuous string. On the outside though I'm very quiet. I'd focus on something in the room, and for a long time it was the wheel of the baby bassinet. It looked like a scary duck. Don't ask. Many contractions were endured by staring at that wheel and thinking "scary duck, scary duck. scary duck." Hey, whatever works.

It was about 11:30 when I was getting to the point of making these weird little noises during contractions and having to really fight to breathe through them. I wanted to time out the IV pain medication as best as I could. I know I get one dose and that's pretty much it. Second doses do nothing for me. I put it off but lasted a whole 15 minutes before I asked for the drugs. There was some delay in getting them but once I had them the pain wasn't as sharp and I could relax in between the contractions. I remember actually falling asleep between some of them. The experience of those contractions though. I forgot how awful they are. As I felt one coming on I would instinctively look for Kenny. Locking on to his eyes and squeezing the hell out of his poor hand was the only way I could get through them. It feels like something is ripping you open from the inside out...every minute...for a minute long. I'm pretty proud of myself for not screaming at anybody though. At a certain point I had begun getting super sleepy in between contractions. To the point where I was not breathing. My oxygen levels were dropping to the high 60s at times. I remember Kenny and my mom telling me to breathe and then remembering oh yeah...I have to breathe that's right. It was an odd experience.

I had also let the nurses know when I hit transition, right around 7 ish centimeters then things would move very, very, very fast. I found myself in that transition and as per my usual I was saying I wanted the epidural. As with every kid, Kenny and I worked out an agreement about the epidural. I knew at some point the pain was probably going to be so bad I'd ask for one but when I'm not in unbearable pain I know I didn't really want one. I'm scared of them, have you seen that needle?! It's huge and I'm a big ol' baby with needles. Therefore when I asked for the epidural Kenny knew to tell me no and keep encouraging me that I could do this. The one exception being if I used the "safe word" which signaled to him that I was really needing it. I knew I was getting close, The nurse checked me and sure enough I was right around that 6-7cm range. I got another round of pain meds but of course they did pretty much nothing. Not much longer I knew I was getting close to the "pushy" feeling. I wasn't there yet but I know my body pretty dang well. I told them to call Dr. Weise. I was at 8cm but knew it wouldn't be long. I don't know how much longer it was really but it seems like mere minutes I felt the "pushy" feeling. The nurses were dismantling the bed, rolling in the delivery table and getting things set up. They checked me again and yup, I was complete and ready to have a baby! Dr. Weise got there and as soon as she said "Ok" I was on it. I knew the faster, better and harder I pushed the faster that pain was going to be gone. It's quite the motivator. There is also this weird paradoxical type of pain relief with pushing. It hurts like hell but it's also a relief from the contraction at the same time. It's weird. I had to be told a few times to breath and take a second in between pushes because I was just that determined. It didn't take but a few minutes and Penny was out. I was looking at this itty bitty baby plopped on my tummy and I couldn't believe it. The baby nurse was once again my OB clinical instructor from nursing school who also helped deliver Ellie. It was awesome getting to have her as a nurse again.

 Delivering the placenta was awful but once it was out we saw what was probably the reason for that high AFP result. It was covered in tons of cysts, including one hard lump on the umbilical cord. The cord itself was also very short which was abnormal. Due to those abnormalities I wasn't able to take it home and encapsulate it, but it's good we sent it off to make sure there wasn't anything nefarious with it. I don't yet know what the results of the patho are yet but hopefully it's all good. It's a good possibility that placenta wouldn't have kept up very well for a lot longer and it was also most likely a contributing factor to Penny's small size.

Ms. Penelope Estelle Stutler was born at 3:18am on March 31st, 2017 at 6lbs and 17.5 inches
She was perfect in every way. I loved her instantly and my heart has grown yet again to make room for another amazing little person. She had some difficulty keeping her body temperature up even while skin to skin with me and her blood sugar dropped really low. Unfortunately she did not latch or nurse very well at all and we had to give her some formula. The rest of the night was tough and I wanted so very much to be exclusively breastfeeding her but it just didn't work out that way. I wish I hadn't been so groggy and tired so I could have maybe tried to offer up more ideas besides formula in a bottle. She still didn't nurse the next day and I had to start pumping for her. I am still pumping for her and it's killing me inside not being able to nurse her like the other kids. We are still trying and working on it though.

Overall the birth of Penny was probably the best I've had all things considered. The nephrostomy tube didn't cause a single issue and I never even knew it was there. There was some bittersweetness to the whole ordeal. Penny will be our last baby and I'm having a hard time coming to terms with that. It's insane I know but closing this chapter of our lives is huge for me. For the past decade all I've known is having's over. We are on to bigger adventures now but I'd be lying if I said I wasn't sad about it.

SO that is the story of how Ms. Penny arrived in the world. I can't wait to see her learn and grow and see how she interacts with her many siblings. I also don't want her to grow too fast, I will be savoring every second I can and trying to commit as much of this time to my long term memory as possible.

Tuesday, January 31, 2017

How My Life Got Flipped Turned Upside Down...

I thought we would get pregnant, have a normal ho-hum pregnancy like all the others and deliver our fourth and final child. All would be right with the world...until it wasn't.
This pregnancy has been plagued with problems and while baby girl is still happy and healthy I can't say it's been easy. Intense sickness that still shows up more often than I'd like. High AFP results which scared me beyond belief that something was wrong with her spine or neurological system. Even with the doctors assurance she was ok I still wonder and worry all the time. Finding placental abnormalities that can't be explained and need monitoring. The biggest most life changing thing thus far though is something I never even imagined could happen to me.

I woke up Friday morning with an ache in my right side, I suspected a UTI was again forming and chalked it up to that. I haven't had a UTI in almost a decade but this pregnancy I've already had one and figured this was just going to be a "thing" now. As the day went on the pain increased, leading to spasms which almost brought me to the floor. I finished up my shift at work and drove home [against the wishes of my husband who had been insisting I go to the ER at work all day]. I got home, we ate dinner and began watching a tv show before bed. Then it hit, the spasms came with incredible force and frequency. They got to the point where I was in tears, rolling around and unable to form a coherent sentence really. The pain was 10 times worse than the birth of any of the kids. Finally after I figured out this problem was not going away I finally agreed to go to the hospital. We arrived at the ER and were immediately sent to OB/L&D triage. They put the monitors on and I writhed around in agony trying not to let on how much pain I was really in. I apparently fooled nobody. They gave me he first dose of pain medication. This was a shot to my upper thigh, I hate needles and hate IM shots the most. It hurt like hell and didn't touch my pain. The doctor finally ordered an IV with fluids and some different pain medication. This finally eased things up, I was in pain (a lot of it) but less than before. They scanned my kidney with an ultrasound and saw there was a lot of urine built up in it and it was pretty angry. No stones though. Next was an IVP or Intravenous Pyelogram. Basically they injected some fancy dye in my IV and took three xrays of my belly. It showed my right kidney was swollen, irritated and there was a 100% blockage to my right ureter (the tube that drains urine into the bladder). They did not see a stone there either.

It was at this point the OB came to see me. She told me she would attempt to see if anybody local or in Kingman would agree to touch me. I needed this obstruction addressed sooner rather than later. If left alone and whatever that blockage is did not clear on it's own quickly... this could have potentially developed into sepsis and put my life as well as the baby's at serious risk. Of course no urologist near us wanted to mess with a 28 week pregnant lady. That's when I found out I was going to be flown to Banner Medical University Hospital in Phoenix. This all happened incredibly fast. I was then loaded into a helicopter (I have a fear of flying so this was just going splendid for me) and on my way to Phoenix. 45 minutes later I was in Banner getting checked in, more pain meds thank the Lord and being seen by a bunch of doctors. The urologist came in and explained that my ureter is blocked by one of two things: a congenital defect (his number one suspicion) or an unusual stone which is translucent on xray or ultrasound. Either way those need to be addressed with a CT scan (more radiation and we had already had enough of that) and surgery (general anesthesia is VERY risky for baby). The best option in light of this was to place a nephrostomy tube into my right kidney.

A nephrostomy tube is a catheter that is poked into the back and into the bottom of the kidney. This allows urine to drain out of the kidney and into a little bag, bypassing the blocked ureter. I then settled into my hospital room and thanked my lucky stars drugs existed because that was the only thing keeping me sane at the moment. The pain was out of this world. I can't even describe it. I was scheduled for the procedure the next morning. They did routine monitoring of baby girl and an ultrasound which was all great. They had to chase her a lot though, feisty booger. I was wheeled down to the Interventional Radiology Department about 10 that morning. I was utterly terrified. Completely scared out of my mind because I hate needles and I know what happens with a nephrostomy tube placement. Lots of needles. They had two nurses dedicated to monitoring the baby the whole time and that made me feel a lot better. The nurse in charge of my conscious sedation was awesome. She put oxygen on me and told me "I'm putting this on so I can get you gooooood and sleepy!" I could have kissed her. They gave me lots of medicine and I felt the local anesthetic in my back but only remember saying "ow, ow ow" a few times. The rest is a blur to me. Baby did wonderful the whole time, having to be chased around for her heartbeat. Apparently the sedation was not having any effect on her movement!

I came back hoping the pain would be relieved and it a point. I was still hurting. Not a 10 but still pretty bad. They gave me pain medication and I was kept reasonably comfortable. When the pain medication was in effect the pain was tolerable, I was sore and ached but could manage. I needed help getting up and moving but it wasn't unbearable. Then came Saturday night and I was to be sent home the next morning so we needed to wean off the IV meds and get onto some oral stuff. That is when things got tough. I was trying my hardest to be a good patient and not ask for the meds because well I wanted out of there. The pain came back, I had exchanged a 10 for a 7 or 8. I would reluctantly take my oral medication which dulled it enough to allow me some function back. I was examined by a perinatologist again who was great. He found not one but two cysts attached to my placenta. He was not worried about them and baby girl got a clean bill of health. We were sent home that morning with instructions to return in a month to change my tube out, only take the small amount of pain medication given if absolutely needed and stick to tylenol as best as possible. The ride home was awful. Every bump and blip in the road led to me shrieking and tears on more than one occasion.

At home I found myself needing help with simple tasks like getting up, dressing myself, going to the bathroom and showering. Kenny has been super helpful in this respect. Nothing says love like holding your spouse's bag of urine for them. Seriously he's been amazing even with me being "annoyingly independent". I am not used to being vulnerable and needing help like this. The pain is terrible no matter what I do. The only thing that helps is the pain medication and I'm trying to only take that when I'm really in a fit.

This whole ordeal has been difficult for me on a number of levels. I know I needed the procedure and that tube is what is currently keeping me from becoming septic and possibly dying or losing my baby girl. That tube has essentially saved my life. For that I am grateful. On the other hand I am in so much pain I can barely function as a normal human. Just day to day tasks are difficult, walking around is exhausting and sleeping is a nightmare. I feel useless and like a huge burden both in a physical and financial sense. Ideally I'd be able to take leave and recover at home but the reality is I don't have enough time off and what time I do have I will need after the baby. Not only for baby recovery but I will need surgery very soon after she is born. Without my income we could barely survive not to mention the HUGE medical bills soon to be arriving in our mailbox. I have no choice but to work, whether in pain or not. I must get back to work right away. This of course is against just about every member of my family's wishes. The stress I am feeling over all of this is enormous and makes me frustrated, emotional, depressed, scared and hopeless. I have no idea how I will survive at work with the pain and no pain medication (due to the nature of the job I absolutely cannot work under the influence of any pain medication prescribed or not). The doctor has given me the all clear to return to work so I have no medical reason not to go back.

I am full of fear and anxiety over what is to come these next few months. I am concerned what the tube replacements will be like. I am worried this pain will never go away. I fear labor and delivery with this dang tube sticking out of me. I agonize over the idea of having surgery right after having a baby. How will I recover from surgery with a new baby at home? How on Earth will I cope with the tube and a newborn? What will life be like for me these next few months? I don't know. I have appointments and follow ups galore, close monitoring for baby and me, back and forth to Phoenix all the time. What will we do for childcare during those trips? What will I do with a newborn, three other kids and handling my own problems?

All of these questions, fears and worries float around in my brain and my heart breaks knowing I am burdening our family. I have responsibilities as a wife, a mother and nurse which I am unable to do now or they come with great pain and difficulty. The only thing I can do is pray I will survive somehow and know that the tiny little baby pummeling my insides is safe and that is all that matters. Somehow, someway we will make it but I have no idea how.