Friday, February 28, 2014

Pregnancy: the last 7 weeks

 The last pregnancy update I wrote was at 26 weeks, at the beginning of the third trimester. It was early December and we had birthdays and friends visiting over almost every weekend. I kept feeling mostly well. I had days when I was tired (but not all of the time, as in the first 14 weeks, when I was like a cat, napping in the sun all day); days when I was full of energy and days where I really wanted salmon, a steak or orange juice, always orange juice. As much as I craved it I never got the salmon* because I never manage to find out if it comes from a sustainable, toxic-free environment.

As I started to get heavier (at my last midwife appointment, I had already gained 10 kg), I was having more and more trouble finding a comfortable position to sleep. The other main symptom I had was a constant, dull pain in the pelvic area. Basically, it was a soreness that felt as if I had been kicked down there. I think it was pubic symphisis dysfunction, but the midwives always said it was normal, due to the increased weight I was carrying. Yu had been lying very low, with her head ready to engage for at least a month. She was in that position at every time they listened to her heart and felt my belly.

1 day before 27 weeks, on December the 1st

It was a period full of medical check ups. On December 23, at 30 weeks exactly, we had an ultrasound to check for growth and my blood was screened for iron levels; on December 24 I had an appointment with the gynaecologist** so that she could redirect me to the anesthesiologist to make sure I could get an epidural.*** Then on January 8 I had another midwife appointment and on January 10 I had the appointment with the anesthesiologist. He kind of laughed at us... telling us that if I could go up and down the stairs of course I was fit for anesthesia. He did not even listen to my heart with his fancy stethoscope.

December 14, almost 29 weeks

That last weekend before my waters surprisingly broke we went to a friends' house for a 'Rosca de Reyes'. The last pictures of me before my stay at the hospital were actually taken that day, while I was making Mexican-style hot chocolate. Then, on Sunday we went to visit another friend who is also expecting a baby. Funny thing is, as we bought presents for both these friends we saw some really cute-size 45 cm. baby clothes on sale and we both said,: "too bad she will never fit them". (Mark measured 49 cm. at birth and I was 52 cm. so we expected her to be at least 51 cm. at birth).

On January 13, as I looked at the fridge trying to decide what I'd cook that day and seeing how it was full of vegetables I called Mark to tell him I was *really* craving a steak. We went out looking for an Italian trattoria, a simple place where we could have some meat and pasta. I ended up eating only pasta because the steak we ordered was very rare. I had no idea when we went to sleep that she would decide to come to us a lot earlier than we ever thought, as there was no indication for it. I had pretty much a textbook pregnancy until her arrival: my blood pressure, weight, glucose and iron levels were  always good and except for tiredness and discomfort I never really felt sick. I was mostly thrilled to finally be showing a bump and have her grow and live and play inside me. And we couldn't wait to meet her.

That night I saw the full moon and I remember thinking: "The moon synchronises women and horses... but we'd better wait for next month's moon". I guess we don't control that kind of thing.

"Había una luna a medias la noche que desquició para siempre los ordenados sentimientos de la tía Inés Aguirre. Una luna intrigosa y ardiente que se reía de ella. Y era más negro el cielo que la rodeaba que adivinar por qué no pensó Inés en escaparse de aquel embrujo.
Quizás aunque la luna no hubiera estado ahí, aunque el cielo hubiera fingido transparencia, todo habría sido igual." -(
Angeles Mastretta)

"There had been a half-moon the night that Aunt Inés Aguirre's orderly feelings became unhinged forever. A scheming, burning moon laughed at her. And the sky surrounding it was so black that it was anyone's guess why Ines did not think of escaping that bewitched thing. Perhaps even if the moon hadn't been there, even if the sky had pretended to be transparent, everything would have turned out the same way".


*Actually, the last meal I had at the hospital, just hours before baby Yu was born was grilled salmon with hollandaise sauce.
**The gynaecologist I saw that day, by coincidence was the gynaecologist that attended Yu's birth. I could not have been happier when I saw her at the labor ward. Not only because I recognized her, but because she was the most upbeat, happiest, kindest doctor I had pretty much every met. On that appointment where all she *had* to do was sign a paper she took her doppler and made us listen to her heart just because, even if we had had an ultrasound the day before that and we were due to have midwives appointments in the very near future.
*** (As a child I was diagnosed with a physiological heart arrythmia and I was always told this could potentially interfere with anesthesia)

Friday, February 21, 2014

To marvel

1. One that evokes strong surprise, admiration, astonishment or wonder.
2.  verb. mar·veled also mar·velled, mar·vel·ing also mar·vel·ling, mar·vels also mar·vels
v.intr. To become filled with wonder, admiration or astonishment as at something surprising or extraordinary. To feel amazement or bewilderment at or about. To  be curious about.

[Middle English marvail, from Old French merveille, from Vulgar Latin *miribilia, alteration of Latin mīrābilia, from neuter pl. of mīrābilis, wonderful, from mīrārī, to wonder, from mīrus, wonderful; see smei- in Indo-European roots.]
My word for the year came to me sometime during those days when I was still in shock trying to learn and understand what had happened to us, the huge surprise that shook our worlds, even-though we thought we were prepared for it, and had been preparing for a rather long while. 

Same as with our "unexplained" infertility diagnosis, where cases like ours account for about 1 % of all couples (10% of 10%), the causes for her mysterious arrival through a Preterm Premature Rupture of Membranes (PPROM) remain unknown to the medical science. We just received the final results from all the tests made*  and no abnormalities were found.  "PPROM occurs in about 1% of all pregnancies".

This girl is a miracle and a fighter since the very beginning and I am convinced that she just wanted to meet us earlier, after such a long wait. We are immensely grateful to every single person that was involved in her coming to life and in her care those early days. This includes prayers, thoughts, support (Yes, that's you). But most of all it leaves me in absolute awe. And that is what she is teaching us, and has been doing so since the very start. 

To savour every moment. To be present in the now. To focus in the instant. To always find the joy.

"Stay a while, you are so beautiful", "Permanece, eres tan bello", “Verweile doch, du bist so schön” (Goethe, in his play Faust, talking to the instant).
* Bacterial cultures in blood, vaginal swaps and urine, pathological study of my placenta.

Monday, February 17, 2014

Yulia's Birth Story

You will get these posts Hopscotch style, which means I willl go back and forth in time. I have yet to write a post on the last trimester of pregnancy and other random thoughts. So many random thoughts.

 On January 14, at 3:21 my waters broke spontaneously, without previously losing the mucous plug, and without any contractions. I was in bed, I hadn't been sleeping well, as had been the case for the last few weeks, because of the increased weight in my belly. I was having trouble sleeping,  both because little hummus was always very active at night, keeping me awake, and because of the back pain due to the fact that she had been laying so low for a few weeks already.

Suddenly, as I turned yet another time I felt a warm liquid trail out of me, all over my legs and pillow. At that moment I knew what had happened, and I knew it was a potential emergency. I was only 33 weeks that day. So I woke up Mark, who was sound asleep and I told him, "my waters just broke, we are going to the hospital right now" (the hospital bag was of course not packed, it was Mark's job and we were planning on getting to that around week 35 or 36). I am surprised at how calm and lucid I was at that moment. Also, at the fact that Mark did not doubt me for one second. We both knew, I guess. And yes, we checked my underwear which was soaked, as was the  Indonesian pillow (a goeling) that I had been using for support. The fluid was completely transparent. Mark could not find the telephone number of the midwifes at the hospital, where we were supposed to call , even though he is the most organized person I know. Again, I was surprised at how sharp and bright I was. I told him, the number is in the blue binder and also in the appointment card from the hospital, which is in my purse. He finally called and they confirmed that we should go to the hospital immediately, and that they would be waiting for us.

At the elevator, going up to the labor ward

As soon as we arrived we were received by one of the midwives. We knew her because of the pregnancy checkups, so it was nice to see a familiar face. She confirmed that my waters were broken, and that although the fluid was completely clear (which is a good sign), this was a gynaecologic case and I was transferred to medical care. The gynaecologist on call came, and explained to us that my uterus was no longer sealed and there was a risk of infection. She checked me with  a speculum, said that my cervix was firm and that she saw a lot of fluid indeed, but that she would not check me for dilation. She told us I would have to stay in bed rest, at the hospital, until the end of the pregnancy. We were informed labor could start at any moment, or take days, or even weeks. I was given a drug (1) to stop contractions for 48 hrs in order to be able to receive two shots of another drug (2) that would help our baby's lungs mature and be able to expand and contract properly while breathing (3). I was also put on oral antibiotics (4) as a preventive measure, and they took a urine sample and a vaginal swap. They explained to us that the only known reason for premature rupture of membranes is a vaginal or urinary tract infection, so this had to be ruled out as the baby would be at risk (5). They said that if at any moment I developed a fever they would have to induce labor, as well as if there were signs of fetal distress. Depending on her position a c-section was also a last-resort possibility.

They strapped me to the monitors (6) to see both little hummus's heart rate (which was great) and my uterine activity. Time was passing fast. I called my parents, as it was still a decent time to call Mexico and we waited. It was suddenly morning and since the onset of labor had been pharmacologically stopped (1) we were moved from the labor ward to the maternity ward, where I would wait.  Hummus's heart rate was monitored at regular intervals, as well as every time I went to the toilet. The amniotic fluid is constantly being renovated, so as long as I did not lose any more fluid, she did not show signs of fetal distress and I did not get a fever, we could go on like this. But after that break of 48 hours (1), if labor started spontaneously, the doctors would not do anything to stop it. I remember feeling very calm, happy and accepting. Feeling her move following her normal patterns reassured me. I sent all my love to her and told her that whether she came early or decided to stay a bit longer in my womb, it would be fine. I kept telling her: "Do what you need to do little girl." I think my body knew I should not feel any stress, anxiety or fear, for the sake of her well being, connected as we were. I was zen personified, so unlike me.

 A day passed, and then a second one. Nothing. She was still doing perfectly fine. And I was not feeling anything.  I can never thank enough each and every person that prayed for us and sent us light and thoughts those days, you know who you are. My mother in law brought us pretty red flowers (alstroemerias to be precise) and all kinds of snacks. My brother in law and his girl brought me silly magazines, dried fruit, chocolate. That afternoon I saw a rainbow, and I remember, at the early stages of our infertility journey, asking for a sign that our little one would join us, and seeing one. That night Mark brought the laptop and as we listened to her song, the song that I would always play to her, while being strapped to the monitors, she started kicking hard, like she would at home. We watched a chapter of Big Bang Theory and she was laughing and kicking with us as well. It was so special to see her heart rate change in reaction to the things we always did together.

Earlier that day the gyneacologist checked her position and told us she was engaged, and as a result of her head acting like a lid, I was encouraged to walk around. She took one last ultrasound of her, and we actually saw her face. That morning at 8:25 I had had the last dose of the drug that was stopping me from starting labor (1), so from that moment on anything could happen. I think I started finally seeing bits of the mucous plug, light transparent blood mixed with a transparent gooey substance. We heard the results from the urine and vaginal swap cultures that were taken when we arrived, and they were both clear from Streptococcus B,. That was not the reason for the premature rupture of membranes. A relief of sorts.

In the middle of the night, around 4:00 in the morning I started feeling painful Braxton Hicks, which was new. The Dutch name for a Braxton hick: "harde buik" is perhaps the best description of the sporadic practice uterine contractions, where you feel your whole belly tighten, then become really hard and later disappear. I had some every now and then during the pregnancy but they never hurt me and they were not regular. Now I felt the tightening together with a mild spasm or cramp, similar to premenstrual pain. They were happening every 10, 15, 20 minutes. At 7:00 in the morning I saw some diluted fresh blood, a light coral stain in the pad I was wearing. I told the nurses, but they all said this was normal, and as long as the blood stayed fluid, fresh, and light there was no reason to worry. I had the last spasm a 7:12, more or less at the time when they brought breakfast. The contractions started again around 10:00 and while they were not regular, they kept getting more frequent. Every 8, 10, 12 minutes. My mother-in-law visited me after lunch and stayed with me the whole day. I remember taking a walk with her around the maternity ward and pediatric department, looking at the pretty colorful cribs in the rooms where moms stay with their newborns.

My room at the maternity ward, the day she was born.

The contractions took another break while I walked and around lunch time, but they started again after our walk and they were beginning to get more and more painful. I was managing to get through them by breathing in and out of them and reading in  the pauses in between. I talked to the nurses and the gynaecologist, telling them I thought this was it. That labor was starting. But they kept telling me that this was pre-labor, not the real deal, and that I could stay like this for days. They said they would not check me for dilation because of the risk of infection, but that they had seen many women in labor and that judging by how calm and happy I seemed, the baby was not coming yet. "If these were real contractions you would be screaming", they kept telling me. (Endometriosis is a good way to learn how to deal with pain, I guess). I was talking on Skype with my mom, and she also told me that the pain would get a lot more intense, which I had trouble believing at the moment. My mother-in-law stayed with me until Mark came after work, around 18:20.

The last picture of my pregnant belly, that afternoon

And that's when sh*t got real. I suppose the little one was waiting for his daddy. As soon as he was with us the pain became more and more intense, and the spasms, which had been lasting around 1 minute started to last around 2 minutes and  became more regular, but they were still 5-7 minutes apart. I never reached that point where you are supposed to get 3 contractions every 10 minutes. I remember Lauren's birth story, and like her, I wanted to take long walks along the hospital corridors with Mark, but when we tried, as soon as I stood up I felt the weight go down and the pain became so unbearable that I had to go back to bed. He started massaging my back to relieve me and I think that's when I started to actually moan with pain. Then the nurses came for the regular afternoon checkup and when they took my temperature it was a bit high. Suddenly, I had a fever and they started preparing for a possible emergency delivery. They talked about starting intravenous antibiotics but there were 3 cesarean sections going on and there were no gynaecologists to decide.

 I am not convinced I had a fever... I remember feeling my face and ears get warm with every contraction (my mother in law says I kept getting red) and they were using an ear-thermometer, so I am not sure I believe the whole fever theory. From then on it all happened really fast. I remember the pain, I remember that we were still timing the contractions and writing them down. At that moment the contractions were still 5 minutes apart. By the time the gynaecologist finally came to check on me, around 21:56, I was 4 cm. dilated. He said my cervix was really soft and had stretched nicely, that labor would go fast. People came in, they took my blood in glass vials that looked out of an alchemy lab (for bacterial cultures) and they took vaginal and urine swaps again. They hooked me on antibiotics through the IV drip and they moved me on the rolling bed to the other side, from the maternity ward where I had been on bed rest for 4 days to the labor ward where I would deliver. When I heard I was 4 cm. dilated I remember feeling glad I had not missed my window, and I said: "Great, so I can get my epidural". They said yes, that the anesthesiologist was busy with it and it was on its way.

From then on it all happened in turbo mode. Mostly, I remember the pain. All there was, was pain and I thought it would never end. I was again strapped to the monitors and I saw the curves going crazy. I heard screams of other women giving birth. Their screams reminded me of horror films, the ones where they record the sounds of animals being slaughtered. At some point the gynaecologist gave a look to a nurse so that she would close the door. She knew those sounds were scaring me.

Rationally I knew I had to breathe in a certain way to cope with the pain. But the pain was so intense that I could not remember how. Mark was on my back, massaging continuously, even during the breaks, that seemed shorter and shorter. I remember finally understanding those women who say they would just adopt, so as to avoid going through pregnancy and labor. I was the exact opposite. I yearned for a biological child, but I also actually viscerally wanted to experience pregnancy, to feel all the changes in my body, to have a physical connection to my child, to feel her grow, move, develop inside me. I remember internally laughing at Ina May and all those who advocate for eating pineapple and spicy food, moving around, squatting, taking showers, lighting scented candles or kissing to accelerate the process. I could not understand how anyone would want to make the process go any faster. I wanted to punch people who preach that what you feel is in your mind. Going through labor was like being possessed by the devil. All I could do was let it flow, feel the pain and hope it would end  soon. Everyone was saying I was doing great, to which I responded with quizzical looks. I was not doing anything at all. This was all my body and its pain party. If I had had any control, if my mind in fact controlled my body I would have instructed it to go easy on the prostaglandins and stronger on the endorphins so I would not feel any of it. For those who get Mexican slang going through the pain was like going through nonstop menstrual cramps in constant acceleration (cólicos de regla en chinga loca acelerada y sin parar). I thought of William Blake* and Goethe and their quotes on eternity took a whole new meaning. The pain felt eternal.

*To see a world in a grain of sand And a heaven in a wild flower, Hold infinity in the palm of your hand And eternity in an hour.

I understood then why you would get a doula, and to anyone who still has to go through this, I would get one right this instant. I thought that's what the midwives were there for. I thought my husband coaching me and reminding me how to breath would be enough. But the midwive or gynaecologist were at one end... Mark was on my back, massaging and talking to me from there, but I could barely pay any attention. I begged the medical intern (God bless that girl) who was assisting the obgyn to stay by my side. To help me breath through the pain.

Very fast I felt the urge to push. I never understood how it would feel "having the urge to push", how I would know I was at that stage. Well, to be very graphic, it felt like I was about to have a huge bowel movement.  As soon as I said it the gynaecologist had a look and said: "Oh, you will probably be able to push in the next contraction". She checked me and I was already 8.5 cm dilated. It was around 22 h 40. I went from 4 to 8.5 cm in less than an hour (this process, they tell you, is supposed to take at least 4 hours, 1 hour per centimeter). I asked for my epidural again. I knew it was too late for it, and so I was informed. At this point Mark got scared, he thought hearing the news was going to make me completely lose it. My birth plan was pretty much: "This is Holland, get me the drugs" and I had spent a lot of time researching how to not miss the window of time in which I could get my anesthesia. He knew his job was to advocate for me and made sure I got hooked on pharmacological pain relief as I had no intention of feeling the pain. (As if I could have planned for that). But I knew that if I reached that point I would have to continue, so I just took the news with stoicism and hoped the pushing phase would not last for hours.

I was very lucky, after that it all went kind of smoothly. It felt like I pushed during 4 contractions (it was probably more). It took all of my strength, and at moments I thought I could not do it anymore... me who hates exercise and pushing through my limits. But I knew that the longer I rested, the longer it would take, so I just kept going. Mark had to remind me the whole time to rest my chin against my neck, otherwise I would get hurt. At some point I heard they saw the head. They asked Mark if we wanted to take photos or video or if I wanted to look with a mirror. I had no interest in looking at any of that, and I think, neither did Mark. There was a point (the crowning) where her head was about to go out and the burning pain was awful. This was the point I was the most afraid of (not of the contracting part, which in hindsight was the hardest for me).  But that pain did not last long. Another one of my biggest fears was to get a total tear. In the Netherlands episiotomies are not common practice, reserved only to cases where intervention is needed for medical reasons, as the research here shows that a natural tear is easier to heal than a surgical cut. So I knew I had to be very obedient at the pushing stage. When they told me to stop. I did it, no matter how painful it was.

Suddenly she was with us. And everything changed in one second. A switched flipped and all the pain was gone, there was only happiness. There are no words to describe what I felt when I saw Mark's face while he cut the umbilical cord and then her, so small and beautiful. She was taken to a small room by a team of paediatricians to have her tested. Mark went with them while I stayed. And that's when it dawned on me... I still had to deliver the placenta. I had a pitocin shot and it all went out. The obgyn and the medical intern just pushed on my belly and pulled it from me. I did not feel any of that. They told me I had a minor tear and that I would need two stitches. I asked for anesthesia, but they said injecting it would be more painful than the actual stitches so I went on with it, I had already gone through the whole thing without any form of pain relief, so I couldn't care less.

Then everybody left, leaving Mark and us alone in the room to wonder at the miracle that had just happened. They brought us vanilla vla and beschuit met muisjes. That meal tasted like glory. Mark's mom and my brother-in-law were already there, so we went to meet them. And then our tiny one. So much love and so much joy, it's like it all suddenly made sense, like the pieces of a puzzle were finally all put together.

Right after giving birth, don't mind the messy hair.

(1) Tractocile / Atosiban (an inhibitor of  oxytocin and vasopressin. It is used intravenously as a labour repressant (tocolytic) to halt premature labor.
(2) Celestone / Betamethasone (Betamethasone and dexamethasone are corticosteroids, also called glucocorticoids, that are given before birth (antenatally) to speed up a preterm fetus's lung development. Either is used when a mother is in preterm labor and birth may occur in 24 to 48 hours. This helps prevent respiratory distress syndrome (RDS) and related complications following premature birth.)
(3) If you imagine the lungs as a bag full of soap bubbles, the surfactant would be the soap, a substance capable to mantain surface tension and allow the air ballons to expand and contract as they fill with air. Betamethasone and dexamethasone cause an immature fetus's lungs to produce a compound called surfactant. A full-term baby's lungs naturally produce surfactant, which lubricates the lining of the air sacs within the lungs. This allows the inner surfaces of the air sacs to slide against one another without sticking during breathing. Premature infants whose lungs have begun producing surfactant are more able to breathe on their own, or with less respiratory treatment, after birth.
(4)  Erythromicin
(5)  Streptococcus b / Bacterial meningitis (a fear that was like Voldemort, I did not dare say it out loud, not even to Mark).
(6) the Cardiotocograph (CTG)

Monday, February 3, 2014

Seeking advice: Breast milk pumping (# Medela Pump in Style)

I am calling out all mom's who have experience with electrical breast pumps. In order to have my milk production synchronized with our beautiful baby girl, I pump at her feeding times, every 3 hours (6 am, 9 am, 12 pm, 15 pm, 18 pm, 21 pm and 24 pm). (Yup, I totally understand my best friends the cows to a whole other level and I have all but respect to moms who manage to pump while at work and then succeed at being efficient at their job afterwards, but more thoughts on all of this coming later).

For the last two weeks I had been using the hospital-grade pump Symphony from Medela, with its strong vacuum force, and I got used to it. It is very comfortable to pump with it. However, I have now being using Medela's Pump in Style Advanced (since last Saturday) and even if it is the strongest of pumps for home/work use available to the public it is not the same thing. And here is where you come in. I try to sit straight while I pump, but ever since using the Medela Pump In Style Advanced I have a neck pain that keeps getting worse and I do not even know what I am doing differently. For those of you who have maybe used this (or other) electrical-double-breast-pump, how did you sit? What kind of chair did you use? (I am sitting in this chair with an extra pillow in the back). All your tips and advice are welcome... I feel that if I continue like this  I will messup my neck, and we don't want that. Help!!!

PS: All three of us us are doing well. I promise the birth story and more updates will be coming soon, I know I keep saying that, but I really just have to figure out a way to schedule the time to write amongst the million things we have to do. 

*Second image source.
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