Laia Isabela's birth story

Our beautiful daughter Laia was born on June 30 at 10:50, weighing  3900 gr. and measuring 52 cm. when I was exactly 41 weeks pregnant. We had been waiting for so long. Every week after week 34 (when her sister was born) felt like a relief... until the point where I started to worry she would never come by herself.  My mom arrived when I was almost 37 weeks. We really did not think I would make it past 38 weeks (my due date was June 23) and everybody joked that I would spend my birthday giving birth to this girl. But both dates came and went. We've had a lovely summer (for Dutch standards) and those last days were hard. I remember I could not sleep from the warmth, the back pain and the difficulty finding a comfortable position in bed, my feet were swollen and I felt enormous even when I kept walking and walking up until the very end. I did gain about 15 kg (I stopped weighing myself when I reached that point... I didn't want to know about any further weight, at around 38 weeks) eventhough I ate healthy food and kept active. I guess your body will do what it has to do.

On May 31st, timely coinciding with our 7th civil wedding anniversary, we went for what we expected to be a routine checkup only to realize that the baby was way up high touching my ribs (from being almost engaged in previous appointments) and since I was 36 weeks and 5 days and had tons of amniotic fluid (polyhydroamnios) the gynecologist recommended an External Cephalic Version (in other words, they turned the baby). It luckily went well and the girl stayed down for the rest of the pregnancy. At that point they started doing prenatal checkups very often. One week after that, just before I reached 38 weeks there was a day where I did not feel the baby move a lot and that raised all kinds of red flags. Since our girl seemed to be measuring "too big" and I had all that fluid they talked about starting an induction -right then and there- it was June 9. I was alone at the hospital, but I felt the baby was fine (I had been hearing her heartbeat all along) and still wanted a chance at labor starting spontaneously, when the time came. They had me checked for gestational diabetes, verified that the baby's blood and mine had not mixed during the EVC and monitored both of us. They ruled out all the known causes for polyhydroamnios, so that remained a mystery, but it was a relief as well.  I had to go for fetal monitoring everyday from then on but was told I would most probably be induced during the week that followed.  After 3 days of daily checkups a different gynecologist looked at us and decided to let us wait, since the measurements late in pregnancy are not that accurate and the 32 week scan (when measurements are more reliable) showed she was within the normal size range. I did not have diabetes, our blood hadn't mixed, my blood pressure was fine (regardless of my swollen ankles), I was feeling well and she was active, moving a lot, with a strong and steady heartbeat. So we waited, and waited and waited. I went on long walks with my mom, I ate eggplant parmigiana, I talked to the baby, I went to Monkey town and jumped around with the toddler. But she was way too comfy inside. There were some days where I had intense Braxton Hicks or a night where I had a couple of  regular contractions; but that lasted 1 hour or 2 and then... nothing.  When I reached 39 weeks and days I started asking how far they would let me go (I did not want to wait so long anymore) and they said by week 40 we could start discussing an induction. I was afraid she would be too big and I would tear myself badly or that the placenta would stop working.  Then week 40 came and I was told if there was no medical reason / fetal distress they would not induce labor until week 41. I was relieved by learning that latest research shows that inductions do not necessarily lead to more interventions or c-sections. And so we scheduled an induction for the day I was 40 weeks and 6 days. The baby was engaged, but I was only 1 cm. dilated and so they could not break the membranes.

Last belly picture at the hospital while waiting

On June 29, at 15:00  a Foley catheter (a little balloon) was introduced in my cervix. After this, they connected the CTG to monitor the fetal heartbeat and possible contractions. I was supposed to have the catheter on until 6:00 am of the next day, when they would check if I had dilated any further and if I was around 2-3 cm. by then they would proceed to break my membranes and start oxytocin (pitocin) if needed. The procedure did not hurt, it was only a bit uncomfortable, like getting a PAP smear, as they have to use a speculum to push the catheter in. After they introduced it I started feeling mild menstrual-like cramps, every now and then but I could handle them and I was told this was normal. The husband stayed with me until about 18:00 pm, when he went back home to have dinner and get rest, as we expected everything to start happening early in the morning the next day.  He left me with a Fanta and some chocolate chip cookies. I was mostly entertained, chatting to my family  and losing time on the internet. I video-called Yu and my mom who were home, showed them my hospital dinner and waited. At first I had the room at the maternity guard for myself, but later another woman (who presumably was also there for an induction) came, together with her husband. It was weird and sad because as soon as she came they closed the curtains in the middle of the room without saying hello or acknowledging me (though I tried) and she kept moaning and sobbing to herself. I would have liked to talk to her, offer comfort, but she mostly seemed annoyed that she had to share the room. It was so different from my first experience at that same maternity guard, when I stayed for a week on bed rest at the hospital before Yu's birth and other women would come and go but we'd  talk to each other and bond over why it was that we were there.

At around 22:00 pm I tried to get some sleep but as I was dozing off, around 23:00 regular cramps, that were starting to get more painful in intensity woke me up. I walked to the nurses in the guard, but they told me to take a couple of paracetamol and ride it out. However, 10 or 20  minutes after I asked to be connected to the CTG for monitoring because it was becoming too painful and I really felt something was happening.

Finally, at 24:10 they connected me to the monitor and at 24:29 I had contractions every 4-5 minutes with the maximum intensity (100-120 on whatever scale they use to determine uterine activity). At 24:43 the doctor finally came to check me and it turned out I was already 4 cm. dilated. This was the official (spontaneous) start of labor, they took the Foley catheter out and told me I could call my husband in. Mark arrived soon after and we moved to the labor and delivery section.

By 1:22 we were in the room I would deliver, I was still 4 cm, but I could barely stand the pain and most of all I felt it was starting to progress very fast.  I requested an epidural, as this time I was determined to get pain relief. Funnily enough, the nurse in charge suggested I take a warm shower instead as "hot water is the best analgesic" and "we didn't know if labor was going to go so  fast that maybe the anesthesiologist would not have time to come from home".  I already knew the risks of an epidural (I might get a fever and antibiotics as a consequence, contractions could get slower, I had to get an IV drip in case my blood pressure dropped and I would not be able to stand up until after delivery) and had thought long and hard about it. My previous birth had been extremely fast (I went from 4 cm to 10 cm. in less than 3 hrs) and intense, with a tiny baby, and I did not want to try that level of painful intensity with a larger baby.



 I think they sensed my determination and called the gynecologist, who have me the talk about the risks (again). She was confident I would do well with it, as I had been through birth before and was going to be able to feel the sensations / contractions / urge to push and finally got the anesthesiologist. I really do not know why they try so strong to dissuade you from pain relief, as if there was value or medals for going through it.

The blessed epidural came at 1:59. I was a bit scared of that part where they tell you to sit very still while they put it in, but it did not hurt at all. I still felt the contractions, and they were still very mildly painful, but they were manageable, like menstrual cramps. At some point I started to feel very numb and the pain totally disappeared, though I did still feel my uterus contract.

At 3:08 they came to check me again, I was 6 cm. dilated, which was a good progress, right out from textbooks,  and contractions were regular and efficient. Two hours passed and by 5:00 am I was still 6 cm. and my contractions had become irregular, so they broke the membranes to generate efficient contractions and we were told to wait.

Around 6:30 we started playing music to call Laia, we listened to some of the music we always played her and her sister while in the womb: 
 Origin of Love, ( Mika),
Cuando Llegaré (Natalia Lafourcade and Emmanuel del Real),
Amor de mis Amores ( Natalia Lafourcade),
Around the World  (Daft Punk),
Gypsy (Suzanne Vega).

I think it kind of worked because I started feeling contractions. But at 7:08 the obgyn came again and I had not progressed from 6 cm. So they started me on oxytocin. They told me to rest because the active part of labor was yet to start and we had been awake all night (I have an obsession with the CTG and loved to see how often the contractions came and how high they'd go on the scale). I was able to sleep a bit. The contractions became strong almost right away. I felt weak, tired, dizzy, thirsty. The breakfast trolley came and I had some milk, orange juice and bread with raisins. I was so happy to eat. And then I started shaking and vomiting, but I felt no pain. I thought it was an effect of the anaesthesia, but they told me it was my bodies' reaction to the intense contractions, that the pain would be unbearable without the pain relief. I felt like that girl in the Exorcist.

Finally, at 9:29 I was 10 cm. dilated. But Laia was a bit "high" still, so they told us to wait to start pushing, so that she would go down by herself and my cervix could become softer. At 10:00 am they checked my vitals and I had a fever, so I had to get antibiotics and wait until they were all in to start pushing. (They said this was a consequence of the epidural, but I think it is just what my body does with labor, as with Yu I did not have an epidural but I also got a fever just before starting active labor).

At 10:40 I was finally able to start pushing. I think I pushed through 4 contractions. The gynaecologist in training that was assisting the obgyn was the best... he kept encouraging me and made me feel so confident and powerful. Him  and Mark . At those moments, being told you are "doing great" and that they see the baby coming is what keeps you through it. Only 10 minutes after, at 10:50, Laia was born. They put her in my arms right away (after totally failing at getting a photo of Mark cutting the umbilical cord, pro tip: hand the nurses a phone or some other simple device that they will be able to use). It was the happiest moment, having her in my arms after so long, talking to her, holding, feeling, smelling her.

Then at 11:00 I was told I had to go to the operating room... my placenta had detached from the umbilical cord when they were trying to pull it out and they had to extract it manually. I think this was the hardest part for Mark, as he stayed alone with our girl and was told I had to get general anesthesia. It turned out, since I had an epidural, they just had to up the dose and I was conscious during the whole procedure. It was very entertaining and I did not feel anything. They were finished quite fast, but I had to wait about an hour in observation at the intensive care unit to make sure I was not losing blood and everything was fine. I was so thirsty. They must have known because the nurse came with an ice-pop that tasted like heaven. I could not wait to go back up to our family. It seemed like such a long time, but around 13:00 they finally pushed me up to our room. It was pure joy to find Mark,  Yulia, my mom, my mother in law, and Laia sleeping peacefully in her cot.

I have such complicated feelings about birth. Both my birth experiences were very positive,  I remember them fondly and happily and yet I also can't stop thinking of the process as violent, even when this time I was under anesthesia. People describe giving birth as a mystical experience. I think it is mystical, in ways: like going to the deepest pits of hell, of horror and pain and then coming back to the most undescribable joy and love. Like experiencing eternity. Having my body take the lead was like being possessed, without having any power against it. Fear is inevitable, being able to let it happen, to embrace it, to lose all control and flow were the hardest parts but also the what let me make it through to the other side.

Pregnancy: the 2nd time

 Being pregnant the second time was in many ways the same and in many others different. I still got lucky with almost no nausea during the first trimester, just a queasy feeling when I went without eating for a long time, for which healthy snacks (apples, bananas, yoghurt with granola) were the solution. I craved orange juice, salmon, enchiladas verdes, steak. I think I threw up only once. The constant tiredness was the same, maybe even more, with a toddler added to the mix. I remember coming home from work, having dinner, showering and going to bed at the same time as little Yu.

I started showing a lot earlier though. I think the body just "remembers" and everything gets pushed upwards and outwards almost immediately. I started wearing my maternity jeans sometime around week 10 or 11 because I just did not want to deal with tight waistbands. On my first pregnancy I was still wearing the loosest of my jeans up til week 28 or something.

I was a lot more achy this time though. I started having round ligament pain pretty much since the beginning. I also had a lot of trouble sleeping and felt some kind of weird pain in one side of my pelvis. I believe it was pelvic girdle pain (formerly known as pubic symphisis dysfunction), but the pain was not located in the center of the pubic bone, rather on one side, so maybe it was some weird muscular pain due to everything being stretched.

In terms of managing the pregnancy, since Yu was born quite early (at 34 weeks) I was considered high-risk and handled by the gynecology department of the hospital. My cervix was measured at different stages, to determine its length and possible weakness and to consider a cerclage. In the end it was not needed because my cervix was in the correct size range. I was also monitored closely: for diabetes, anemia, etc (not routine tests in every pregnancy within the Dutch healthcare system). Moreover, from weeks 10 to 36 I had weekly injections of progesterone, which seems to have an effect in preventing preterm birth. 

After Yu's unexpected early arrival we did not know what to expect in terms of when our second girl would come. Reaching 34 weeks was a relief. It coincided with the week I started maternity leave. From then on, we knew what to expect and we were glad for every week that passed. My mom arrived when I was 36 weeks and 5 days. At that point on one of the prenatal checks we saw the baby's head was way up high in my abdomen (from being down and close to engage in every other appointment) so they turned the baby (the procedure is called an External Cephalic Version) and luckily it went well. We also found out that our baby was measuring slightly above average and that I had a lot of amniotic fluid (polyhydroamnios) without any explained reason.

And then we waited, and we waited, and we waited. I reached full term (38 weeks), I reached 39 weeks, and then 40. I was feeling Braxton Hicks and every now and then a slight cramp, but then it would stop. I had swollen feet, but was otherwise feeling ok, still energetic, still walking a lot. In the end our girl was born at 41 weeks exactly. I never thought I would be overdue, at that point we were so eager to meet her already. I was also afraid she would be too big and that birth would become difficult. I will write the story down as soon as I get a moment.

This time I really wanted to document the pregnancy: knowing this might be our last, and haven't been able to do so last time, we did a pregnancy photoshoot. We hired Erika Bourne Photography, and we loved the results. She made us feel comfortable and the whole process was easy and enjoyable.

I was also very grateful that my closest friends organized me a baby shower, which I also wasn't able to have last time. I felt so blessed and overwhelmed by everyone's kindness. I am still in awe that our little girl is here, that we are a family of four.

Getting the pink lines

I am pregnant again. We are so happy this is happening and sometimes I still can not believe it.  After we had our miracle Yu I had totally drank the Kool-Aid that as soon as we "relaxed" we would get pregnant spontaneously. I know this is not a thing and yet I wanted it so much to be true. Everyone tells you those stories: "my friend did IVF, and for the second one, they got pregnant without expecting it" or "we were about to adopt, and in the middle of the process we did a test out of the blue, and boom, positive".

We basically never used protection since baby Y. was born. I breastfed her for almost 2 years so at some point I started taking ovulation tests to verify everything was "fine" and that I was ovulating again (my cycle was back and regular, it actually came back quite fast after birth, I think 3 or 4 months after).


 I read that CoEnzyme Q 10 might have a positive effect on sperm motility and function so Mark started taking it. And then months and months passed and.... nothing.  We were back to square 1. Suffering in silence again and not even daring to talk much about it because I felt so guilty and ungrateful to even dare to want more. It is so difficult to have a kid and be among fertile people who can just get pregnant when they want or whom the event takes them by surprise. Makes you feel completely isolated.

Anyhow, in November 2015 we went to the fertility clinic again. It had been almost 2 years and things were not moving. They told us Yulia had to be fully weaned if we wanted to attempt treatment  so we had to go through that. Then we planned a trip to Mexico last April and with the whole Zika virus thing going on we wouldn't want to risk it.

So in May 2016 we were ready to start an IVF/ICSI cycle. We went through it all, confident that it would work. When I saw the negative test and my period came I was so incredibly sad. But this time around they were able to freeze 2 embryos so we could try a frozen cycle before starting from scratch, without doing the whole stimulation and follicle aspiration process. When an IVF cycle fails though, they make you wait a month to let your body rest. Come mid July we were ready for our frozen embryo transfer, singing ice-ice baby to ourselves whenever we talked about it to each other. But it was not to be. On the day of the transfer they called us to say that neither of our embryos had survived the thawing process. I cried so much that day.

 So there we were, getting ready for a 2nd round of IVF, hopes renewed, about to start. I remember being at the carousel at the beach when we received the call that we had only 1 embryo growing that time. We went on with the transfer. And waited, and waited, and waited. I did a test a bit too early and there was the faintest line, barely visible.

But I got my period the next day. I guess the line was leftover medication from the trigger shot (that's why you are not supposed to test early) but the devastation we then felt was enormous. I remember sitting on the outside benches of the office, crying, without being able to stop as I felt all our hopes crushing down. I was at work but I could barely do anything. I remember being on the phone with customers and the tears just kept coming of my eyes. I had no control over my feelings.

 After that we had to wait another "resting" cycle. We had a talk with our lovely doctor to discuss our options. Our insurance would cover a 3rd fresh IVF cycle, we had to think about which medication to use during the stimulation period. She showed us numbers and data and how my body had specifically reacted to each of the options. One medication was the one that we used during our succesful cycle (Yulia), on the other one my body seemed to react better (it was the one where we were able to get frozen embryos). Statistically, when looking at the population level, they did not really see differences between both. We went with numbers knowing that our failed cycles were most probably due to genetic factors (as my body responded well to either stimulation protocol) and hoping we would be able to get strong embryos.

We started our 3rd cycle, full of hope, but with fear trailing behind. We were not able to to let go of this just like that. We had agreed that if it didn't work out we would still discuss the possibilities of trying yet another time. And then we got lucky.  Mid October we found out this time it had stuck. We were so overjoyed and are still so grateful. I am now 21 weeks. This time my pregnancy is being followed more closely (at the hospital) and I am getting weekly progesterone shots to try to prevent a preterm birth. I am feeling well, just mostly tired. 2nd time around I have been showing a lot earlier. I was on maternity pants since week 10 or 11 and I just seem to be more achy everywhere. We are so happy that this is happening again and just keep praying that everything will go well.

Pregnancy weight and postpartum body

As girls, as women, it is difficult to talk about our bodies and all the complicated feelings we start harboring towards them as we grow up. It seems one of the biggest taboos is the postpartum body. Everyone seemed so shocked when Kate Middleton proudly showed her belly after giving birth and -oh surprise- she supposedly still looked a few months pregnant. As if by an act of pure magic, women are expected to go back to where they were as soon as the baby is popped out. Bodies are truly miraculous: to think that new beings can grow from what starts as a single cell; that these little wonders of nature can orchestrate their development, coordinate a whole set of new functions, from the synthesis of more than a liter of extra blood** to specifically cater the needs of the wee one, to the creation of a whole, brand new organ (the placenta), and so forth, it is all mind-blowing.


But to pretend or expect that all of these changes, changes that took approximately 10 months to take place, can revert immediately after an event that takes 12-24 hrs is nonsense.

 

When I was pregnant, I tracked and plotted my weight, for scientific curiosity and to keep a record of what was going on. As a point of comparison, I used an online application that gives you an estimate of an expected healthy pregnancy weight gain (within a range) based on your initial weight and height.  During the first months, the increase in weight was slow, you barely saw any difference. My clothes fit well until I was around 20 weeks pregnant when I finally gave in and started wearing the glorious, elastic maternity jeans. I did have a belly, but at the beginning it was not a round, typical pregnant belly. The last time I weighed myself was at 33 weeks, the day my waters broke and I was admitted at the hospital sometime around 4 a.m. By then I had already put 10 kg (22 lb). I think, had I reached full-term, I was probably going to put around 12 kg (26.5 lb).

33 weeks pregnant, 1 day postpartum, 1 week postpartum

 When I gave birth, I lost around 4 kg (baby Y. weighed 1.9 kg), and  my weight stayed that way for quite a while.  At around 8 weeks postpartum, a couple of weeks after the "official" 6-weeks recovery period, I had lost a further 3 kg, which means I still had around 3 kg. left.  At 12 weeks postpartum I was 1.5 kg above my pre-pregnancy weight. However, though, some of my pre-pregnancy pants (albeit elastic corduroys) fit almost straight away. I tried my most beloved pair of jeans at about 5 weeks post-partum. I was so determined to make sure they'd close that in doing so, I ripped the zipper.

2, 3 and 5 weeks postpartum respectively

But I think by around 3 months post-baby and after a trip to the tailor I started wearing them again. I had read stories of women who even when all of the pregnancy weight is gone end up with a different body shape. (This, by the way, is completely natural: bodies change with time, with continual exposition to hormonal cycles, with age related processes, with variations in metabolism). I certainly have a soft, curviness that wasn't there before, but I don't think my hips got wider after pregnancy and birth (probably because at 33, they had already done so).

Weeks 6, 10, 12 postpartum

This morning, 6 months and a half after baby Y's birth, I weighed myself and I am now 1.5 kg under my pre-pregnancy weight. I kind of suspected this because some clothes that used to fit just well are  starting to fall down my hips these last few weeks. I have the appetite of a trucker, I am taking  vitamins specifically designed for breastfeeding as well as lots of good fats and protein sources (plenty of avocados, chia seeds, full fat yoghurt, orange juice, eggs, beans, lentils, and red meat whenever I crave it).  I make sure I am eating enough. (But maybe I'm not?)  I credit breastfeeding for this apparent speed in my metabolism, though I still have to set myself up to start some kind of exercise routine to make my core stronger and to get some kind of semblance of fitness, even if such program takes place in the living room. Do you know of any good programs to follow? Preferably easy ones for a girl who has never been the sporty kind?

This weekend, 27 weeks postpartum. Note the flamingo obsession.

On a related note, have you heard of the 4th trimester bodies project? I think what this photographer is doing is amazing, empowering, and truly needed.

* First image via Elle Nederland
** Blood volume changes in normal pregnancy. Hytten F. Clin Haematol. 1985 Oct;14(3):601-12.

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.
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"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".

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*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)

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.

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(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)

Surprise arrival

  

Y. A.

 born at 23:11. 

1.9 kilograms, 43.5 centimeters. 

"There's no use trying," said Alice. "One can't believe impossible things."

"I dare say, you haven't had much practice," said the Queen. "When I was your age, I always did it for half an hour a day. Why, sometimes I believed as many as six impossible things before breakfast." ~Lewis Carroll

* We are in awe... we'll be back with details and stories soon.
Image via here. 

Mental age: 5

I got this dress a while ago... the one superfluous maternity clothing item. I had been wanting to wear it for so long, but I looked like a big potato sack. And now, finally it fits. I was so happy twirling around on Christmas Eve. Hope you had a fun one too.