Tuesday, March 23, 2010

Crazy

2 lbs 7 oz
14.5 in.
27 weeks 1 day gestation

Here is an account of the crazy circumstances that brought The Kid into the world. It's not poetic; I wrote it just a few days after his birth, so I could remember all of the gory details. Gore isn't pretty. But The Kid sure is. Or, handsome, rather.

Wednesday, November 11th:
I had gone to work that day like normal. I had been having braxton hicks contractions for the past month (which actually were probably real ones, I just had no way of knowing) but none this day. The only difference in today is that I hadn't felt Caleb kick or move all day, which was odd. He always kicked more when I was quiet and still, so I was quite and still and he still didn't kick. Not a single time. So, I called my doctor's office just a few minutes before it closed, but it turns out that it was closed all day for Veteran's Day. So I just went home at 5 like normal. Nate called at about 6:15 to tell me he was on his way home from work, and I told him about the absence of kicks and asked if he thought I should go to the hospital. He thought I should, so we planned to meet at the hospital in American Fork. As I was pulling in to the hospital, Mom called and told me that my cousin Cheri had died. I cried for the next ten minutes and when Nate got there we sat on the curb and cried some more. Then we went in.
They decided to monitor Caleb's heartbeat and my uterine contractions. I didn't have a single contraction, but my uterus appeared to be under some stress, slightly tensing every few seconds. Caleb's heart was at about 150-160 for a long time, and then for a few seconds it plummeted to about 60. The doctor said that as far as anyone can tell, that's not abnormal for a 27 week baby. Then, about ten minutes later, it happened again. They decided to do an in-depth ultrasound, called a bio-physical profile. Before they started, the doctor said that he was probably just shy of 2 lbs. The first thing that they checked was my cervix. It was supposed to be tight and thick. The doctor and the ultrasound tech got really worried looks on their faces right away, and they said that I was dilated to 4 cm and effaced to 80 percent (meaning my cervix had lost 80 percent of its thickness). For a baby as small as Caleb, that was half of the way there. The most concerning part was that, although my water sack was still intact, it was bulging through my cervix and was about to break at any second. Then the mayhem started. They told me I was on strict bed rest, that I couldn't even sit upright because my water might break if I did. They put an IV in me (on the fifth try), a catheter, a steroid shot to help develop Caleb's lungs, ordered an ambulance to take me to Utah Valley (where they have a great neonatal unit), measured Caleb and told me that he was estimated at 2 lbs 11ozs (a great size for only being 27 weeks), told me that Caleb's heart was great but that he was oddly not moving very much at all, and that they would be lucky to keep me pregnant for 48 hours. I thought they were crazy. I felt fine; I was not going into labor. They gave me penicillin through the IV and it made my whole arm ache so badly that I was about to cry. So, they gave me some different IV antibiotics. They also started me on magnesium sulfate, which helps the baby's brain develop faster so that they are less at risk of getting cerebral palsy and other brain disorders. Supposedly is is also supposed to stave off contractions. The ambulance guys came and wheeled me away on a stretcher. Nate had to follow us to the hospital in the car. He looked terrified. I was still in denial.
The ambulance guys were really nice. They made me feel very calm. I told them that we had tried for 14 months for this baby, and I wasn't ready to lose him now. That was the only time that I cried, but it was only for a second.
I got to the hospital and they had a whole team of people waiting there for me. I was told that I would be in the hospital until I delivered, which may be one day, and maybe a month, but every day that Caleb stayed in me meant three days that he wouldn't have to be in the NICU. They seemed optimistic, although they told me that when delivery time did come, it would most likely be under emergency circumstances, at the very last minute, and that it would most likely be a c-section.
They set me up in a room and asked if they had manually checked my cervix at the other hospital. I told them that they hadn't because they were worried about breaking my water. So, Doctor Warner checked me and he immediately became less optimistic. I was indeed dilated to 4 and my water really was bulging out. He said that the most important thing was to hold off labor for 24 hours so that they could get me a second steroid shot for Caleb's lungs. I thought they were crazy. I felt fine.
The mayhem was over and it became a waiting game. The bed was really uncomfortable, and I was starting to have some minor contractions. Every time I had a contraction Caleb's heart rate would go down slightly, which worried me, but they said that as long as it doesn't go below 100 it's nothing to worry about. I didn't sleep well that night because I was so uncomfortable, but I was oddly calm.

Thursday, November 12th:
I woke up that morning feeling fine. I was convinced that I wasn't going into labor for three more months. They told me that today I would meet with the perinatologist to talk about the baby's condition and how to keep him inside longer, and also with the neonatologist to talk about what would happen when the baby did come, because he was sure to come early. I thought they were crazy.
Then, around 11:30 AM, I started getting what I thought were cramps and they were kind of painful. I told the nurse about them at around noon, but she dismissed it because they were wheeling me on my bed to see the perinatologist. In her room, they did an ultrasound that estimated Caleb to weigh 2 lbs 9 ozs. They also said that I was dilated to 5.5. They brought me back to my room and the nurse asked me if they checked how dilated I was. I told her 5.5, and she flipped. 1.5 cm was a lot of progress in a short time. So, she checked me manually, and my sack of water was bulging so much that she couldn't even reach my cervix. Doctor Warner was out, so his partner came in and checked me, and it was the same with him. He said that my water was about an inch away from being out of my body all together. I had progressed so fast that they had no choice but to break my water so they could try to control labor as much as possible, and hopefully avoid a c-section. By this point I had figured out that the cramps were actually real contractions that were getting very painful and were only about 4 minutes apart. I was in active labor.
They brought in the anesthesiologist who gave me an epidural while the neonatologist came in to talk to me. The epidural didn't hurt very much, but I hated how it made my legs numb. Then it made me sick. I threw up. I didn't hear much that the neonatologist said because my head was spinning just trying to take it all in. I do remember him saying that Caleb had over a 90 percent chance of living and about an 80 percent chance of not having any lasting problems. Those sounded like good odds to me.
They had Nate dress in a white jumpsuit with a mask, hat, and shoe covers. Then they wheeled me on my bed into the operation room and moved me onto the table. They had told me that one of five things could happen when they broke my water: 1) the baby could slide right out and be born in a matter of seconds, 2) I could “un-dilate” and they'd have to wait for the contractions to reopen my cervix, 3) the umbilical cord could come out with the rush of water, making an emergency c-section necessary, 4) some other body part (like an arm) could come out first, also calling for an emergency c-section, or 5) his head would be right there and the delivery could progress like that of a normal woman. Because of these chances, they prepped me for a c-section. Just before he broke my water, they did an ultrasound to make absolutely sure that the baby's head was indeed the closest thing to my cervix and the most likely thing to come out first. It was, and the doctor said that my odds of needing a c-section were very slim now, as long as the baby didn't show signs of stress.
The nurse asked Nate if he wanted to watch, and without hesitation he said no. It made me laugh.
So, the doctor broke my water with what looked like a blue knitting needle. The baby's head stayed in the cervix, and I dilated just a little bit more. They gave me pitocin through my IV to bring on stronger contractions. The doctor said that I only needed to be dilated to 8 to deliver a baby as small as Caleb. Literally about sixty seconds later the contractions started coming on strong. On about the second contraction I was told to push. They had me sit up and push to the count of ten, rest for a second, and to do that two more times before the contraction ended. Then I did it over and over for each contraction. Nate's job was to hold the pillow behind my head and help me lean forward while pushing. He also was the one to count to ten, but he counted too slow for my taste.
After just a few contractions I was dilated to 8. After a few more contractions they said that the baby had lots of dark hair. Between each contraction I listened to the baby's heartbeat, making sure that it was staying strong. Also between each contraction the doctor and I made small talk. I told him that at least I wouldn't have to spend the next three months not being able to ride horses. He talked about how he grew up on a sheep farm and saw horses as tools. I told him that I thought of them as tools and companions.
After a few more contractions they were really starting to hurt. The doctor said that they could give me more epidural, but that if I could go without more it would be better, because he really liked that I could feel my contractions coming on so well. I toughed it out for one more contraction, and then decided that I needed more. They gave me more medicine. Two contractions later, and only twenty minutes after they broke my water, the nurse told Nate to look. He looked and saw Caleb. It was 2:53PM and he was out. Nate said, “He's so beautiful!” with tears in his voice. They told me to look, but I couldn't sit up and they weren't holding him high enough for me to see. All I could see was the top of his head, until they started moving him away. My first thought was that he looked completely normal, not even very small. The nurses said that his bright red color was a very good sign. Before I knew it he was gone, and Nate had followed him into the other room, where they put him on a ventilator and brought him up to the NICU.
They brought me back to my room where Nate met me about 15 minutes later. I was told that he weighed two pounds, seven ounces, and measured 14.5 inches long. They wheeled me on my bed down to the recovery room and on the way we stopped in the NICU to see Caleb. It was about 45 minutes after he was born. They were putting an IV in his right hand and he was very feisty. They had me help by holding his hand still so that they could tape the IV. It was so good to see him moving. The only place on his body that I felt comfortable touching was his foot, because that was the only part that didn't have a monitor or tube on it.
They brought me to my new room and said that once I was able to walk to the bathroom they would wheel me in a wheelchair back to the NICU where I could see Caleb again. If I had known that, I wouldn't have taken the second dose of epidural. But it wasn't long until I could feel my legs again. By then I felt as though I had never been pregnant and had never given birth. I walked up to the NICU.

They can't definitively pinpoint what caused me to go into labor so early and without symptoms, but they did find two infections on my placenta (group B strep and staph aureus). The nurses said that if Caleb had been born one day later, he would have been incredibly sick. As it was, he showed very minimal signs of infection. They also said that if he had been inside of me for one more week, he would have died. 13 weeks early was right on time for Caleb. We can deal with brain bleeds and an uncertain future. We have our little miracle and he is worth everything that it took to get him here.

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