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03 May 2009

Cas's Birth Story

On Saturday, April 25, at 1250am, I woke up to use the bathroom, like I normally do all night long since I got pregnant. As soon as I stood up, I felt a huge gush of liquid and thought I had peed on my self. I mean, I was only 31 weeks 2 days, there's no way it could be my water breaking, right? I rushed to the bathroom, figured out it was amniotic fluid, and yelled for Chris to wake up. The liquid kept gushing out, so Chris grabbed me some clothes, got himself dressed and we ran out the door with a towel to sit on in the car. I called Tripler Hospital on the way to let them know we were coming in. We arrived at Tripler about 10 minutes later, around 120am.


We got ourselves upstairs to Labor and Delivery, where we were rushed to a triage room. They did an exam and a test to confirm that the fluid was, indeed, amniotic fluid, I was not dilated, and sent some things down to the lab for other tests, such as possible infections, to try and figure out why my water broke so early. I was not having any contractions at this point, but the doctor wanted me to stay, so Chris and I moved into the hugest Labor and Delivery room EVER. The primary concern at that time for Cas was that a) we had an infection of some sort, and b) that his lungs wouldn't be mature enough if he was born that night. To combat those issues, we were given antibiotics in the IV as well as two steroid shots, the first at 230am that night and the second 24 hours later. Shortly after we were admitted, I started having mild contractions and over the next several hours, until about 900am, we were given medication to stop labor, which worked. At some point that night, we were given an Amniotic Fluid Index (AFI) test. It is basically just an ultrasound where they measure the amount of amniotic fluid. At that AFI, Cas was head down (perfect) but I only had a few pockets of amniotic fluid measuring about 7cm total. Little did I know that that would be the most fluid he'd have protecting him all week. I was hooked up to a baby heart rate monitor and contraction monitor all week.


Our first day in L&D, Saturday, was pretty uneventful after stopping labor that morning. We had a super awesome nurse, Nicci, that really helped make the days go by faster and she seemed to truly love her job, which made it less embarrassing to ask for awkward things. I was on complete bed rest: using a bedpan, eating in bed, doing everything from an almost totally supine position. Nicci was the greatest nurse there, making me feel that she wasn't grossed out by what I needed her help with or anything that happened. Some of the other nurses weren't so great but everyone was perfectly capable and took good care of me. The days eventually blurred together so much that I can't remember when anything happened except the really big events.

When we checked in our goal was to make it 24 hours, so Cas would have received both steroid injections that would help his lungs mature. After we met that goal, we decided we had to make it to 32 weeks, which would be on Wednesday. The differences between a 31 week and 32 week preterm baby are huge. The doctors told us that they would not induce or undergo a csection unless the baby or myself was in distress or had an infection. We were all hoping I would make it to the next goal of 34 weeks, though. If we had, they would have scheduled an induction on that day.

Sunday was also pretty uneventful, I think. The food was awful (of course, it is hospital food) but the Salgueros and Laurions brought us food and that made it easier. Jon and the boys stayed and ate dinner with us on Sunday, that was really appreciated.

Monday was another ultrasound, this one in the Antepartum Diagnostic Center with the ultrasound technician. This ultrasound was called a BBP: The biophysical profile (BBP) is a pregnancy medical test which measures the health of your baby during pregnancy. A biophysical profile includes a nonstress test with electronic fetal heart monitoring and a fetal ultrasound. The test measures 5 things, giving two points for each observed item for a total of 10 points: a heartrate strip with variables, like peaks and valleys; amniotic fluid amount; gross body movements; fine motor skills like moving his hand; and breathing movements such as inhaling or hiccups. We received a 6 on this BBP: we had 2.5 cm of amniotic fluid, gross body movements, and a good strip. 6 is considered stable. Although I knew that Cas had had hiccups several times, they weren't counted unless they were seen on ultrasound because they need to occur every 30 minutes. In later BBPs our amniotic fluid went down to 2 cm, and it took a few more tests before he got points for breathing movements and fine motor skills. At one point we had an 8, I don't remember what day. The worst moment of Monday? When Cas turned on his side halfway through the ultrasound and then proceeded to become footling breech before the ultrasound was finished. Footling breech is a breech position in which he is sitting on his feet at the bottom. A normal breech position is the frank breech in which the baby is presenting butt first. The doctors began speaking about c-section due to the breech position.

I had several ultrasounds over the next few days to keep an eye on his position, but was mostly just bored. Chris stayed the night, went home twice a day to see the puppies. We also asked a close friend to stop by and check up on them, and he truly went above and beyond to help us, which made my time in L&D much easier.

Wednesday I met our goal of 32 weeks. Stephanie and Justin (who was checking on the dogs) brought us spaghetti for dinner and homemade garlic bread. They also stayed for a couple of hours just hanging out, it was really nice and so appreciated.

Thursday... I started having regular contractions around noon. Not too bad, but the doctor wanted to see if I was dilated so he did an exam. I wasn't dilated, but after the exam I started discharging bloody and brown liquid, which they thought might be meconium. The contractions got worse, and he did another exam, which said I was not dilated again. My contractions got much worse, but I was not allowed to get up and move positions or get in the shower to manage the pain because he was breech and we couldn't risk infection, either. Chris was so amazing, he breathed through each contraction with me, encouraged me when I was tense from the pain. I focused on his blue eyes, and got through each contraction. I wouldn't have been able to do it without him. I was getting upset because I was not dilating, and the pain was getting worse, but I hadn't planned on taking anything, instead hoping to take advantage of natural pain management techniques. But because I couldn't move around, Nicci offered to put a little bit of morphine into my IV to take the edge off and let me try and rest between the contractions. They were coming every 3 minutes and lasted 75 seconds, according to Chris. I received the morphine at 400pm, and I thought it wasn't working at all, but he later told me that I was even able to sleep through a few of them. Around 600pm, another doctor came in to do a digital exam. She was nervous that the previous exams hadn't worked correctly and that I was dilating since my contractions were so intense. Turns out I was 4cm dilated and she felt Cas's foot there. The decision was made to do an immediate csection.



There was no need to do an emergency csection, so they started prepping me for the surgery. It went pretty quickly. Nicci, the nurse I mentioned earlier, got off shift as we were supposed to go into surgery, but she stayed with us until my surgery was over. I was so thankful for that because Chris was not allowed in the OR while I was being prepped and he went to the NICU with Cas after he was born. I was so scared and Nikki took such good care of me.



I received the spinal block, and Chris came in. There was a whole team of people, at least 12-15. The NICU had been expecting us since we were admitted the week before, so they were there, as well as my surgeon and a ton of nurses. Chris came in and held my hand and the surgery started. They got to Cas quickly, pulled him out and Chris was able to cut the cord. He was cleaned up and started breathing on his own, and Chris went with him to the NICU. It was meconium in my discharge, but since he was breech it is unlikely that he swallowed any or that there was an infection. Nicci stayed with me while I received my stitches, and I received more drugs that helped me sleep a little while I was closed up. I was brought to recovery for a couple of hours, and eventually it was deemed ok to take me to our new room in the recovery ward and to stop by the NICU on the way. Chris was with me while I recovered and they got Cas situated in his new home. Chris was so happy to have a son, you could see it in his eyes, he was so thrilled. It was scary seeing Casper for the first time all by himself and with tubes and IVs all over, but in the past couple of days he has really strengthened and I am pumping a little milk now, so he will just get better and better everyday.



We are so in love with him and can't wait for him to come home from the hospital.