Zofia

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a month to one day

Today our baby was to be one day old, instead we are celebrating Zofia's one month birthday with a bath, cupcakes and of course - MILK.

After feeling like our plans were evaporating and trying to come to terms with a birth opposite to our vision. Our last bit of faith was answered. Weeks of trying to "buy" one more week from the doctors in hopes of a healthy baby and natural birth suddenly came to fruition. My only prayer was for Anne and baby's health. My unspoken, almost unthought, belief was that we would have a girl of her own arrival.

We truly have been blessed.

it's Official: Anne's a speedster...

...she delivers like she drives

"Speedsters skip the beginning emotional signpost along with the accompanying easy contractions. Quick birthers frequently get right down to work - no fooling around."
Susan McCutcheon: Natural Childbirth the Bradley Way

We crossed week 36. The doctor gave us to week 37 and the challenge will be keeping bored insanity at bay and the anxiety of "is everything okay?" from wearing any further. We were between tests and there was a satisfaction in going 4 weeks past what the doctors expected. Let's relax for the weekend. A Smoothie run!
After pushing all week to try to have the house(okay, I had reached the point where I was just hoping to have the nursery ready) ready just in case, I relax with the thought of 1 more week(maybe I can stretch to cleaning the house too, even laundry). So I set off to see Anne a little early, expecting to be there well before her 5:00 dinner tray. Friday DC traffic says otherwise and I make it to her at 6:30 Smoothies in hand. We catch up on our same old story days.
Instead of another night of TV or games, I hop into bed with Anne and we watch "O Brother, Where Art Thou" on the laptop. Our favorite movie and impossible not to feel lighter and nourished after watching. Suzie is back on for the night shift. It is nice to see her again and we chat for a bit. It's a slow night and I offer the movie if the nurses are getting bored. I stay until around 12:00 and get ready to head home. We are feeling good - numbers are good, baby is good - we aren't hanging on the next test results. All the nurses are at the nurses' station as I leave, and I stop when I see Charlie. I comment about the slow night and Charlie says "It's still early." I tell them to enjoy the break while they can and they buzz me out of Labor and Delivery.
Home and settling into bed by 1:00. I'll scrub the nursery floor and set up the furniture tomorrow. Asleep by 1:30. 3:30 the phone rings -

"My water broke."
"Oh no..." with an unexpected quaver(this means they will induce, no options)
"Are the contractions starting?"
"Yes."
"Do you want me to come in now?" (did this question come out of my mouth? I am thinking of the birthing stories where the woman cleans house and bakes cookies during her early labor, I am tired. I am a lout)
"Yes."
"Okay, I will be there soon."
And it hits me. Why the hesitation? I haven't thought about this part, I am unprepared. Anne and I never talked about going to the hospital, going into labor. We didn't want to jinx what hope we had for a natural birth. And now, suddenly, miraculously, our vision is about to happen. IT HITS ME. I am preparing to go to the birth of our child!
What do I need to take? What was all the stuff they went over in class? What am I going to wear? My brain is trying to think way too much.

Luckily, most of what Anne needed was already at the hospital. The one thing I knew I had to take were our two books from the Bradley Classes. With 10-14 hours of labor coming I might be able to stay a page ahead. After a month of reading up and becoming an expert on pre-eclampsia, the natural birth pieces fell out of my head. I spun around and around the house and in my head. I was going to the birth of our baby, I need to get out of here. I throw the camera, books and power bars into the computer bag and head out. Fly down the highway, in through Emergency for after hours admission and the happiest, briskest walk I have made through the halls I just got to know so well.

I am buzzed back into Labor and Delivery 4 hours after leaving. Anne is okay, she is relaxed, Suzie has already given Anne an IV(the doctor had missed a test and they needed to give Anne antibiotics as a precaution) and is clearing the monitors to take Anne to a delivery room. Contractions are about 4 to 3:30 minutes apart, not too strong yet(but isn't that kinda close, I can't remember). I start packing the months accumulation to take with us(Anne wisely had been sending things home with me for the past week). Anne is packed and Suzie is back with a wheelchair to take her to delivery, goodbye cell.

Into the delivery room and we are greeted by Charlie, "This is so great." She is absolutely thrilled to see us coming in for a natural birth. We are happy to have a familiar face to start our journey into parenthood. Charlie hooks up the monitors, contractions are running 3:30 minutes apart and up in strength. Baby is looking good. Charlie gets us settled in and regrets she will miss the delivery. She is happy with the baby's heart rate and gives us the okay to plug and unplug Anne(a useful skill we picked up from the nurses) if she needs to go the bathroom or just get up and walk. She leaves us to labor away.

I have pulled out the Bradley workbook and opened to the chart on the stages of labor. Things are still calm enough to pull out a grapefruit for breakfast. Anne has a slice or two, I manage about half between reading and massaging Anne to help her relax. The contractions are picking up in pace and strength. It is becoming clear Anne is having back labor. I apply pressure and Charlie brings hot packs. I look at the book and figure Anne is well into the First Stage. The back pain is intensifying. Charlie suggests the rocker and we help Anne into it. Contractions are picking up, Anne has to pee. I disconnect the monitors and off to the toilet. The contractions are under 2 minutes apart now and strong. Anne must be getting lots of work done. The toilet is comfortable and we stay in the bathroom for a bit. Shift change, Charlie comes in to check on us and pass us to Tiffany(a slight disappointment in going into the last stretch with a stranger). We say hello from the bathroom and Anne is ready to lay down again for a bit. Anne is struggling, the contractions are mounting, a little doubt is entering her mind. I don't know if i can take another 10 hours of this. I tell her to focus on each contraction and don't think about the contractions to come(she is having productive contractions, I can't see 10 hours at this rate). Anne asks Tiffany to check her dilation. Tiffany is reluctant since Anne's water has broken and infection is a concern. Please check, okay, 5cm, halfway there. It's 7:30 and the contractions ease slightly, it is nice to have the monitor so I know what is happening inside Anne and can predict when she'll need pressure(monitor reading was another skill learned over the past month). I call my dad to let him know. A big contraction and a little more doubt(could we be in transition already?). Tiffany experienced back labor herself, she suggests for Anne to stand for a while and lean on the bed while I keep pressure on her back. A huge improvement - Thank You Tiffany. Happy with the babies heart rates, Tiffany removes the monitors from Anne. Ahhh, a little more natural. To ease the pain, Tiffany plans to start a warm shower as soon as the antibiotics are through the IV. Anne is able to roll with the contractions, but they are still really strong. And now a strong sensation to poop and push. Tiffany assures that it is natural and you will know when the real push signal comes. Time for another pee - off to the toilet. The contractions are coming fast, she doesn't even have time to stand much less make it back to the bed.

Anne wants Tiffany to check her again before we start the shower, she really feels like she needs to push. Tiffany is reluctant, it is still early. Anne is certain she wants to be checked and Tiffany agrees. We get her into bed. "I can feel the baby's head, 10cm, you're ready." Second Stage. Tiffany shows how Anne needs to be positioned and has me hold Anne's right leg as she holds the left and counts for Anne to push. Tiffany goes to call for doctor Fracasso and call for the nursing team. I pick up holding Anne's legs and counting off. Tiffany returns and gives me a "good job dad." Another check and the baby's head is right there(that's my baby, her head looks like a collapsed oragami balloon, is that okay?, OUR BABY IS HERE!) Tiffany calls for the OB on call.

Tiffany and I keep coaching Anne and try to slow her up. I have to step aside to make room for another stranger, the OB on call. Her comes the head, looking more round now. Here comes a little bit of an ear. Try not to push. Here comes the other ear. Try not to push. Here comes the nose, face, chin, baby - DONE. It's a girl and she has just leapt into the world.

We never got to a birth plan. There were pieces, but we didn't know what to expect with induction and pre-maturity. I figured we'd put it together before induction. Too late. They clamped the cord and gave me the sicissors to cut the cord, but... And our baby is wisked off to the baby station and a team hovers over her and checks her out and does their thing. Comments of: she is long, she is active, she looks like a little ballerina, she looks good. Dr. Fracasso arrives. He missed the birth of the baby, but will deliver the placenta. The placenta isn't coming easily.

They bring the baby over toward the foot of the bed to weigh her. "Do you have a camera?"(Oh yeah, pictures). I take a couple of her on the scale and am too stunned to take anymore. 6lbs 2oz, a girl, Zofia.

I remind Dr. Fracasso there are two lobes. He sort of gives me a so what and patiently eases out the placenta. He then picks it up to check for the two lobes and discovers a tenuous connection between the umbilical cord and the vessel connecting the two lobes. The source of the pre-eclampsia. Anne has a little tear from the speedy delivery. I look to see, is it bad? I can't tell. Will she be okay, is this bad? Seems to be minor, the doctor says he will call it a second degree. Is this minor? He calmly starts stitching, it doesn't seem so bad. I am watching. I haven't had sleep and have only managed half a grapefruit and a Balance Bar all morning. I better sit down. The nurses commend me on sitting, apparently many dad's end up dropping.

Zofia is fully healthy, they wrap her up and leave her with us. We have at least an hour with her alone in our room. We are finally parents and it is amazingly peaceful.

Smoothie King Saved My Baby

Yes, Smoothie King! Okay, not just Smoothie King, thanks also go to Five Guys and Burger King. Thank you Dr. Brewer for the Brewer's Diet and Wendy for a well timed reminder of the importance to keep up the Protein however we needed to do it. After Anne lost 4 pounds (on bed rest!) and all the testing started to show more things touching the "danger" line, it became clear: diet was at the center of things and we needed to get more proactive. Whopper Jr. took the first response. I brought Anne one in contraband. Then Joel and Jess visited from Vermont and smuggled in a burger from Dairy Queen.

Reinforcement came with a phone call to our Bradley Method instructor, Wendy. I needed to let her know we would be missing the rest of the classes and wanted her insight on what we could expect from induction(was natural child birth still in our cards?) She had experience with natural child birth after induction, but all with later term pregnancies. Hope was on the ropes, but we kept talking and she turned back to the more holistic and what were we doing to keep Anne and baby healthy. Focus on the condition of mother and baby, make decisions based on what is, not what might be. She iterated from class and brought up nutrition and especially protein - anyway possible. Ah, validation of our foray into diet enhancement. Now it was time to get serious. The doctor said induction next week and we needed to improve the next set of tests to push it back. A burger from Five Guys and then research on the Internet. Research confirmed the effect of protein on pre-eclampsia and Anne found a high-protein Smoothie King banana smoothie. My routine now involved a trip to the Pentagon Row Smoothie King on the way to see Anne every evening and, fortuitously, I even indulged in one the Friday of making week 36.

The net result was: an unhappy doctor having to concede to allowing us another week; happy nurses who supported us on waiting; a strong mother and baby going into week 37.

watching and waiting, waiting and counting

The waiting is the hardest part
Every day you see one more card
You take it on faith, you take it to the heart
The waiting is the hardest part

Tom Petty

Week 21 - the watching begins with the discovery of a low lying placenta and a second placental lobe. the lobes appear to be connected by an artery possibly lying across the cervix. any rupture and all the blood drains away from the baby. pelvic rest and wait. "make an appointment with a new doctor in a month."

Week 25 - the waiting ends a month later as we learn that the placentas have risen up in the uterus with one in the front and one in the back. the blood vessel attaching the lobes is tight to the uterine wall and risk of baby snagging it is negligible. everything looks good. "we'll have you come back in a month to be sure."

Week 29 - we meet with a new doctor for the follow up. "it has been explained to you why we are watching you, i hope." well, we know there are two lobes and you're keeping an eye on them and we need to make sure both come out at delivery. we get the rest of the story. depending on whether the umbilical cord is attached to the healthy lobe or not(in order to have two the first had to not be attached to a fertile area and so growth moved to a healthy area) the growth of the baby may be compromised as the growth accelerates in the later months. he checks the baby and looks for the umbilical cord attachment. the baby looks great, lips puckered out(a raspberry for all this fuss). he cannot find where the umbilical cord attaches to the placenta, just a really long cord. "baby looks good, see you in a month."

Week 30 - the watch steps up. anne fails a test and is diagnosed with gestational diabetes. we are working with anne's regular OB's partner and her nurse. so now Anne is basically being seen by four doctor's - a male/female(fracasso/selgado) OB and a female/male(poggi/ghidini) perinatal radiologist. the nurse tells anne to make an appointment immediately with INOVA diabetes center and also with an endocrinologist. another doctor? why? anne and baby are fine. anne is only home on fridays at this point, so she gets into the diabetes center. a class and a device to self monitor her blood sugar. "keep a log of your levels(four times a day) and see you in a week."

Week 31 - the numbers have been fine. why the endocrinologist? anne does not make an appointment. a consultation at the diabetes center and confirmation that everything is fine. the "diabetes" is easily controlled by diet and exercise(pretty much anne's normal diet and exercise). the nurse has no explanation for why the need to see an endocrinologist. "just keep monitoring your blood sugar."

Week 32 - anne only has one week of travel left and then we start our final preparations for the baby. the blood sugar has been fine. anne always has elevated blood pressure at the doctor's office(white coat syndrome) so she checks it at home with her own blood pressure cuff to be sure it isn't elevated. it has been creeping up this week. probably the stress of her project and traveling. one week and then relax. and then the mucous plug makes its appearance. a call to dr. selgado and she tells us to come into the hospital for monitoring and more tests. our hospital tour is scheduled for today. we get a more up close tour than expected. anne checks into labor and delivery and we are placed in a delivery room. microphones are placed on anne's belly(ah, this is fetal monitoring) and they start tracking the baby's heart rate and anne's contractions. contractions? she could be in pre-term labor. ohh! blood is drawn. and drawn. and drawn. and drawn. and drawn. and drawn. apparently the doctor thought of something else to test for with each draw. and now, wait for the results - 4 hours. the tour time comes and goes, we thought this would be quick. the results come back. no labor, but possible pre-eclampsia, you will not be going to New York this week. after 6 hours in the hospital we are able to leave. "go home and come see me in the morning to follow up."

monday morning in the doctor's office. the test showed no labor, but there is another test - cervical length. doctor checks - "hmm, seems short. better have an ultrasound to be sure." and there is another test for the pre-eclampsia. 24 hour urine collection to measure protein levels. the doctor gives a string of numbers. this level is normal, this level is a concern, this level and we induce immediately. something hundred is okay, but 2 is bad. what? it just crashes like a wave, but anne feels fine, none of this matters. the doctor goes into a whole scenario of pre-term delivery and mentions a shot to help the baby be prepared for early arrival. it all blurs, anne is fine, she will not be delivering a baby anytime soon. off to the ultrasound.

the baby looks great. the cervical length is 2.2cm, the doctor wanted 2.5cm. close enough, the cervix starts to shorten the last couple months, some women even dilate. the radiologist(just regular, not one of the perinatal) sees something to follow up on before we leave. another ultrasound, we mention that the umbilical connection hasn't been confirmed. she sees the umbilical cord is attached to the larger placental lobe and her concern about the baby's kidney was actually just a cyst on anne. part of the pregnancy and nothing to worry about. we go to check out. standing at the front desk we are called by the OB's office. "go see the perinatal radiologist, get the shot, get to the hospital." what? anne is fine, the baby is fine. i take the phone and explain the baby was just checked and is right on track for size and development. the doctor agrees we can just go home and start the urine collection. and we wait as anne fills the jug.

i quickly set up for anne's bedrest sunday night, so now i will get her settled in. the office is converted to anne's personal nest with everything at hand. i start trying to build meals that meet the calorie, carbohydrate(we are not going to risk agitating the diabetes), and especially protein requirements for anne. the jug fills and i find another container for the rest of the pee, no problem with water consumption. off to the lab to drop off the jug and get a blood draw. home to wait for the results.

a call on my cell phone while i am at my dad's. elevated protein, 800mg. "head to the hospital for the steroid shot and monitoring." steroid shot? do we need it? the steroid shot is used to develop the lungs of a baby born before 34 weeks. delivery doesn't seem imminent, we are almost to 33. 800 sounds high, is it bad. i have to go home and tell anne. what does it all mean? anne is on the phone, i start to research on the internet. "what's up?" "we're going to the hospital."

back to labor and delivery. are you ready for your shot? what? we haven't decided to get the steroid shot. the doctor has ordered the shot. we'll wait. more monitoring in a delivery room. everything looks good, but anne's blood pressure is walking the line for pre-eclampsia. anne is admitted to the ante partum hall and another 24 hour urine collection is started. i can stay with anne until 11pm. the next test will be fine, this too will pass. i head home and spend the night learning about pre-eclampsia, no more birthing study.

thursday and anne spends the day filling the jug, i spend the morning with her waiting for dr. poggi. in my research i discover 300mg is the acceptable protein level and 5g(5000mg) is the redline. we are way closer to the 300. anne is still okay, we are not in danger. dr poggi comes by and the ultrasound looks good. she flips out when anne says we haven't had the steroid shot. she calls it irresponsible as a mother. she goes on about how pre-eclampsia can turn in an instant and if you have a headache that is cause for us to deliver you. wait lady, we don't know the ramifications of this shot and don't want to set a chain of events in motion that compromises the amount of time the baby stays in anne and the potential for a natural child birth. anne mentions going back home for bedrest and the doctor implies she would keep her there until she delivers. anne says she can't stay there a month, the doctor says you can and we have kept women here longer. but, anne is fine. i head home for lunch and to get the house ready for the possibility of an early arrival. instead i research the steroid shot. anne has a follow-up with dr. poggi and it is more relaxed and the doctor gives her an NIH statement to read. in my research i learn that it is a cortisone shot and one course is pretty well confirmed to be safe and is standard practice. i call anne before i head back in and we agree to go with the shot. now just wait on the jug.

Week 33 - the jug and blood are off to the lab. and.... 810mg. the doctor is okay with this. the first cortisone shot doesn't send anne's blood sugar off the charts as the doctor predicted. the second shot has little impact on the blood sugar and anne is allowed to go home. anne's nurse, diane, says we'll be back, pre-eclampsia only gets worse. we didn't even know her name at that point and thought no way we'll be back. i am a little familiar with pre-eclampsia through my brother and sister-in-law's experience. anne has none of the symptoms my sister-in-law had to endure, anne is fine. home for more bedrest and continued watch of the pee. we have an appointment with dr. fracasso. he explains the outlook. watch. watch. watch. pre-eclampsia doesn't reverse and we will watch the levels and make sure things aren't critical. he mentions that at 37 weeks the baby is baked and after that anne is just a warming oven, so he will induce at 37 weeks. i shift my sights from 40 weeks to 38 weeks, he can wait another week. and bargaining begins in my head. we ask about the endocrinologist. "oh, based on your tests we thought you would need insulin and felt it would be best to have an appointment ready if you needed it rather than having to wait a week if your sugar levels were high." hmmm, flawed test maybe? home for more bedrest, sugar watch and another pee watch. i start getting a handle on the nutrition and plan a menu for anne. off to the grocery store to prepare for the long haul. the jug goes in the end of the week. hmm, no call from the doctor, no news is good news.

Week 34 - the waiting ends with a call from dr. fracasso. 2400mg. well sure anne's protein is high, that is all she can eat on this diabetes diet. it doesn't work that way. the doctor plans a follow up test to confirm the result and figure out the pattern. we can stay home, but if things really are moving this fast time could be evaporating rapidly. we decide to err on being in the hospital unnecessarily. anne packs up and we are off to the hospital until she delivers.

dr. ghidini(parinatal radiologist) is the first to see anne. the amniotic fluid is down to half what it was, the platelets are down. the protein has tripled. he begins to talk about inducing, now. "you have had the steroid shot, you are at 34 weeks so the baby will survive and your placenta could detach at any moment leaving only 20 minutes to deliver the baby." what? anne is fine, no symptoms, well away from the 5000mg. "it is your decision, we can't tell you what to do." we have heard this several times. go to the hospital, don't go. receive the steroid shot or don't. induce your child now, or don't. we keep being told things are going bad, act immediately, the sky is falling, save your life, save the baby's life, things are going to get worse we just can't say when. in the end it is always our decision, anne's body could blow up any minute. but anne is fine, the baby is fine. we'll wait to see the results of the next 24 hour urine collection. "okay, but i am ordering an IV just in case we have to perform an emergency c-section." great, treat anne like a sick person. even dr. selgado is confused by the IV.

the number drops by nearly half to 1400mg. now it is watch the amniotic fluid level and the platelets. the next tests will be the end of the week. we spend the week watching the fetal heart rate monitoring that they do each morning and evening. always a strong healthy baby, it eases the wait. anne is fine, the baby is fine. the IV is removed.

Week 35 - the amniotic fluid level has dropped and is skirting the danger limit. another flag goes up. the platelets have increased though. keep watching. start another 24 hour urine. on sunday dr. fracasso comes in early and tells anne he will induce this week and plan to deliver the baby at 36 weeks. anne calls to tell me. i am very bothered, she is somewhat resolved to it. it has been a long haul and the amniotic fluid is shaky. we talk when i get in. it was easter weekend and anne was feeling down. i plan to be there early on monday to talk to dr. fracasso and spend the day with anne waiting for results.

monday and i make it in to see the doctor. i ask why we would deliver at 36 weeks when everything was still in the acceptable limits and he had said 37 weeks was term relative to baby's development. he agreed to hold the decision pending the test results. Diane(an old friend by this time) came in just after the doctor left and chatted with us. we mentioned dr. fracasso was ready to induce and she asked, "what was your response?" we told her we did not want to induce and were going to wait for the test results. she smiled and we felt reassured. she said she would let us know the results as soon as they came in. we wouldn't have to wait for the doctor. it was nice to have such support.

lo and behold the numbers came back improved, except for the protein which held steady. improved? but pre-eclampsia doesn't improve. hmmmm. i leave for a bit in the afternoon, feeling confident we have just bought another week. the bargaining has become overt. dr. poggi comes by to check the amniotic fluid level and, you bet, the level has gone up. dr. fracasso is forced to concede to week 37. Diane is thrilled, we later learned that she was being encouraged to encourage us to give in. she never flinched, she knew anne's condition better than anyone. and then anne gets a headache. "did it go away?" "no, take all the flowers home." "did it go away?" "no, i am going to ask for a tylenol." should we say anything, will telling someone raise a flag, headache is a symptom. anne's blood pressure has been fine, even good at times. we can't blow it now, we are winning. "did it go away?" "feeling better, probably just allergies."

Week 36- everything is looking good. no tests hanging over our heads. just watch the numbers and those ever encouraging baby heart rate strips. anne is fine, baby is fine. and then...

after nearly 4 months of inching along a tightrope with people calling out (from below, behind and before us) a wind blows from above and we are whisked to the other side.


...counting week by week. it is almost incomprehensible to be watching a life so young that a week becomes a milestone that can make a lifetime