The 1st Casualty

Alas, the day has come all too soon.

Lately, Audrey and I have been playing a game together when I’m changing her diaper. She can win a round by either of (so far) two methods. The first method is that she waits for me to look away for a second to get a baby wipe or something and then pees quietly. She deftly stops peeing just before I look back at her, and then waits for me to discover the surprise. The second method is to hold a turd or some urine in wait for the split second when I’m sliding out the soiled diaper and in the fresh one. When the timing is just right, ka-boom!

Audrey won a round today while I was changing her on the ottoman in the living room. I spent too much time cleaning her up to notice that our J.J. Cole changing pad is not—despite being plastic—waterproof. Here are some pictures. The pad is plastic on top and canvas underneath. In the shot of the pad’s underside you can see where the pee seeped through.

1st Pediatrician Visit

Our pediatrician came to visit us in the hospital twice to do some routine check-ups on Audrey. We also scheduled a routine first visit to the pediatrician’s office on Monday (we were discharged on Saturday).

Things went really well. We really like the pediatrician, and they have an office both near the hospital (near NI) and one in Cedar Park near us. This was our first time at the Cedar Park location and it was very nice. Our appointment was at 8:45, which was pretty early for us. This was Audrey’s 2nd time in her carseat, which she likes once she’s in it, but gave me quite a fight until then.





The doctor said Audrey is doing fine. They took a blood test to be doubly sure of her jaundice; the test came back fine. We were also a little concerned about her cord since she occasionally has some bloody spotting there—most of her clothes have a little blood on them from the cord. The doctor took a look and said this was a normal part of the cord breaking down and nothing to be concerned about. Also, Audrey was weighed, and was up to 6.89, which is a slight improvement over her weight in the hospital.

After the visit to the pediatrician, Audrey had her first trip to the eye doctor. Amber quickly realized that the antibiotic given to treat her corneal abrasion did nothing for the pain she felt in her eye. Since Amber still can’t drive, we all had to go together. They made us wait an hour and a half to see the doctor, but Audrey slept through the whole thing. Amber got a prescription for some eye drops, so we took that to the pharmacy drive thru and went to have our first restaurant meal with the baby in order to kill time while we waited for the prescription. For this gourmet meal we went to Sonic and ate in the car. Finally, the prescription was ready and we made it home. We couldn’t believe how well Audrey did with all the running around today. We were basically gone from 8:00am to 2:00pm and she didn’t fuss one bit.

Grandma Karen & Grandpa Perry Come to Visit

Mom and Perry came to our house Saturday evening and left Sunday evening. Like the day before with dad, I was happy to see the look on her face when she first held Audrey. I knew my parents were looking forward to being grandparents, but I guess I never imagined the moment when they would first meet her. It makes me happy to see them so happy. Saturday night we just visited, hung out with Audrey and ordered Chinese food. Mom gave us some gifts. Her neighbor, Ouida, sent a glow worm stuffed animal. Another neighbor, Scott and Melissa, sent a cute outfit. Audrey’s Great-Grandma Messick sent a hand crocheted sweater and bonnet. It’s pink and white, beautiful and delicate. Since I started knitting, I really appreciate the work put in to handmade things. It’s also something that Audrey will always be able to cherish since it was made with such love and came from such a special woman. Mom got Audrey some soft building blocks so we could take pictures with her name spelled out with the blocks and she got her a Baby Einstein gadget that plays music and lights up. She surprised (in more ways than one) with a gorgeous necklace. It’s a silver heart with a diamond in the middle. One half of the heart is a mother and the other half is a child. I was surprised because it was such a thoughtful, beautiful gift. I was even more surprised, because it was identical (except the diamond was different) to the necklace Chris gave me in the hospital right after Audrey was born. I don’t know how they picked out the same necklace! Mom knew it already because we had emailed her some pictures from us in the hospital and she saw me wearing it. I felt really bad that they both bought me the same beautiful gift because it was silly to keep both but I didn’t want to hurt the feelings of either one. Later that night Chris told me that he liked the placement of the diamond in hers better and I confessed that I did too. We decided to keep the one from my mom and return the one he got me. Now I’ll just think of this necklace as being from both of them, and in a way, that makes it even better because when I wear it I’ll think of them both.

Saturday night was our first night at home. We were a little nervous about how it would go because at the hospital, Audrey hardly slept. She wouldn’t sleep in the hospital bassinet at all and would only sleep in your arms for about 15 minutes at a time. We went to bed and put Audrey in the bassinet next to my side of the bed. She woke up every 30-90 minutes. I would hear her cry (Chris was knocked out) and feed her if she was hungry or wake Chris and ask him to change her if she was dirty. I’m still on pain medication and getting up and down/walking isn’t very comfortable. After taking care of her she fell back asleep immediately. We turned on a teddy bear that makes “womb” sounds that Uncle Adam gave her and it seemed to help a lot. Waking up so frequently wasn’t exactly fun, but it wasn’t all that bad either. The next morning mom took her for 2 hours so we could sleep some more. They sat in the glider together while Audrey slept and mom watched some TV. We felt pretty good after getting the extra sleep.

Sunday flew by. My left eye started hurting really bad. The night before my eyes were dry, but now I was actually in some real pain. Mom took me to the walk in Redi-Clinic at HEB and Audrey stayed home with Chris. It was good that mom was there, because I’m not supposed to drive for a week. I had a corneal abrasion and was given an antibiotic ointment to put in my eye. My theory is that maybe I rubbed it too hard when I was tired. The nurse said that I nicked the crap out of it and it would have been infected by the next day had I not come in. While waiting for the prescription, mom picked out groceries to make us a chicken marsala dinner that night and she also surprised me with a pretty floral arrangement.

After coming back from HEB, the day really went quickly. I finally got my first shower since Wednesday and it felt wonderful. We ate dinner and took pictures with Audrey and also with the baby announcement sign in the yard that Perry got for us. Before I knew it, they were heading back home. She’s planning to come back later and stay for a week. I’m looking forward to it. I think we’ll have a lot of fun together with Audrey.

Hospital Pictures

Here are the pictures Amber's friend Christy took in the hospital.

Hospital Visitors

Grandpa Don and Grandma Mariza arrived Friday afternoon and stayed through Saturday afternoon. They got a hotel down the road and came to the hospital for several short visits. They also came home with us for a little while after we were discharged. It was really special for me to see my dad with Audrey. He held her a lot and was really sweet with her. It was obvious that she captured his heart. Like dad, Mariza was also very excited to see the baby and shed more than just a couple tears.

Amber’s friend, Darcy, also came to visit Friday evening. She got the blow by blow story of our time in the hospital. She thought Audrey was really cute and we, of course, have to agree.

Christy stopped by Thursday night for a few hours. Chris was especially happy to see her because she came with Mexican take out. At this point we were starting to settle in at the hospital and things were calming down. Christy held Audrey and we finally ate our first meal together. Then she busted out the camera and took lots of great pictures of our new family.

The Hospital Stay

I didn’t type this up until today, but I was in a hurry to post some pictures before then so things are a bit out of order. Here is the story of the labor and birth that should have really been posted before the last two posts of pictures and movies.

The Birth Story
Around 3:30pm on Wednesday Amber started feeling contractions. They weren’t too painful, and were in her lower back rather than her tummy area. Hungry, and not sure if it was “the real thing” we decided to have Chris run to McDonalds. When he got back they were but they were fairly regular and about 10-13 minutes apart. We were waiting until they were consistently 10 minutes apart to call the doctor. Shortly after Chris returned, they suddenly became 3-5 minutes apart. We called the after hours number for the doctor to have her paged. Typically, the doctor wants you to come in their office to check you before sending you on to the hospital. After waiting about 30 minutes for her to call back and not hearing from her, we called again and gave a cell phone number and decided to just start driving to the hospital.

In the car the contractions intensified until Amber was pretty uncomfortable. When we finally arrived at the hospital, we got our callback from the doctor. She explained that the call service had screwed up when they called her—she wasn’t on call and didn’t even have her pager with her; they were supposed to forward the call to the “on call” doctor, Andrea Campaigne, instead of her. Anyway, Amber’s contractions were now two minutes apart and the doctor confirmed that coming in to the hospital directly was the right thing to do. She spoke to the on-call doctor about Amber’s condition.

At the hospital, we went directly to the Labor & Delivery department just as they instructed us in the hospital tour we took earlier. At first we were placed in a triage room where a nurse put monitors on Amber, took some basic vitals like temperature and blood pressure, then proceeded to ask us a barrage of wild questions including:

1. Do you have electricity in your home?
   
2. What about a refrigerator?
   
3. Did you happen to bring a prosthetic limb with you to the hospital with you today?

Amber’s blood pressure was still high at this point but not alarmingly high. The nurse did a cervical exam and said that Amber was 4 cm dilated and 90% effaced, just like the day before.

Amber’s pain at this point was pretty intense. She was constantly moving around trying to find a comfortable position in which to have the contractions. She never really found a good one. Ultimately the best one was standing and leaning over the bed while I rubbed her lower back. She later described the pain as similar to the extremely painful abdominal cramping associated with bad food poisoning—like the case she got on our first anniversary in Mexico—except worse.

Eventually the doctor on call, Andrea Campaigne, came in and spoke to us. She said we were going to be moved to a Labor & Delivery Room. Once there Amber could get her epidural and then they’d break her water. Andrea also said that she’d be at the hospital all night, which made us both very happy. Amber even cried since most doctors just come to catch the baby. It was reassuring for her to know that she would be in good hands.

Once in the Labor & Delivery Room, we met our nurse Jessa (who is in the previous picture with the tired postpartum Amber) who was great. She was with us throughout the labor and delivery and for a while in postpartum. At this point Amber was 5 cm. Jessa started an IV to flush two bags of fluid into Amber. This is apparently a necessity before an epidural can be administered, and takes around 45 minutes. The time actually went by pretty quickly, and soon the anesthesiologist was there. He put in the epidural pretty easily and Amber was pretty quickly feeling *a lot* better. Afterwards she also had to get a catheter, which, since you can’t feel your legs or walk with an epidural, is a requirement. With the epidural she could hardly tell when she was having a contraction.

While the anesthesiologist was there Amber started asking him some questions and he said something interesting. Amber asked if epidurals were linked to difficult deliveries and he said there was evidence that they aren’t. Apparently there was an older study that did imply that epidurals were linked to difficult labors, but since then it’s been shown that the study was flawed because the only labors they studied were difficult. More recently, different studies have shown no link between epidurals and complications.

With the epidural now in place, Dr. Campaigne came in to break Amber’s water. Because her blood pressure was elevated it would be best to help get things moving along. This is a pretty routine practice—most women need to have their water broken as opposed to having it break naturally. It also almost never gushes when broken—that’s usually just in the movies. At any rate, Dr. Campaigne went to do the procedure, but then stopped and said that Amber was fully dilated. Everyone was shocked by this because it usually takes about an hour to dilate 1 centimeter, but Amber had dilated 5 in a single hour. None of the staff had ever seen anything like it. So instead of getting her water broken, it was time to push! At this time it was around 11:15pm on the 8th.

At first the pushing was pretty casual. Amber’s epidural prevented her from feeling the pain of the contractions. We could only tell she was having one because either she felt some pressure in her abdomen or the monitors detected it. Neither of these worked consistently however. Since Amber’s contractions were largely in her back, the monitors didn’t do a great job, so there was some guesswork in determining when she was actually having a contraction. Often the nurses would physically determine when she was contracting by feeling Amber’s belly. There were only four people in the room—Amber, me, the doctor, and Jessa. The doctor just casually sat on the end of Amber’s bed and watched the action while Jessa and I each held back one of Amber’s legs—we didn’t really use the stirrups. The doctor asked if I’d like to cut the cord and I said yes. She said I could even ‘catch’ the baby if I wanted. I happily agreed and she put in an order for an extra set of scrubs when the time came. Amber asked for a mirror, which some nurses found and brought in for her to watch. The doctor tried to use this to help Amber know where to direct her pushing. The whole environment was actually very relaxed for Amber. The lights were dimmed, she was comfortable, and everyone was very supportive.

To our surprise, the pushing went on for about two hours, and was getting pretty exhausting for Amber. I was even getting tired of just holding her leg back :) It actually didn’t hurt at all; she was just frustrated that she seemed to not be getting the job done. The doctor was getting a little concerned at the baby’s heart rate monitor which was dipping during the contractions. The dips and the contractions weren’t perfectly correlated, so the doctors weren’t sure what the cause of the dipping was. To get a better reading, Andrea put in a direct heart rate monitor on the baby. This is a cable that is inserted in the vagina and attached to the crown of the babies head. This sensor gives a more reliable heart rate measurement. It’s a little scary because it is basically screwed into the kid’s head like a corkscrew, but it doesn’t permanently hurt them (there aren’t even any marks). Here are some pictures of the sensor I found online.





Andrea was visibly concerned with the heart rate behavior. While we helped her push, Andrea just stared at the monitors with a straight face. Her demeanor was much different from the cheerful doctor sitting on the edge of the bed. Also, Amber’s pushing seemed to be correct, but the baby wasn’t making much progress along the canal. More nurses came in the room, and the pushing continued. They had her pushing on her back, her side, and tried putting a raised bar over the bed that Amber would push her feet against. Andrea changed into scrubs and told some of the nurses to get the NICU ready (Neonatal Intensive Care Unit). This freaked us out. We knew the heart rate was low, but didn’t really understand how dangerous it was. Andrea kept us updated, but obviously didn’t want to scare us. Amber also had to wear an oxygen mask, which we later found out was because the baby’s oxygen level was low too.

At one point, Andrea mentioned that she may have to use the forceps if things didn’t improve. She said that, with forceps, you only get a few pushes, and if that doesn’t work you’re committed to doing a C-section. This was scary but a no-brainer decision for us—we wanted whatever was best for the baby and trusted the doctor’s judgment. Amber pushed a few more times, and after no improvement, Andrea put in the forceps.

The forceps looked like large salad tongs. Each side of the tong was as large as the kid’s head. The tongs are first split apart, then each side is inserted individually, finally the forcep joint is linked. Apparently there are many varieties of forceps out there—the pictures below are the closest ones I could find to those that Andrea used.



This next part was really scary for us. Amber pushed a few more times while Andrea tugged. The tugging was pretty rough, actually, but I suspect that’s all normal. When Audrey came out, she was limp, blue, motionless, and quiet—not screaming at all. Amber and I were totally freaked out. Andrea quickly cut the cord and Audrey was rushed to the other side of the room where the nurses did their Apgar assessment. (Agpar is used to quickly assess the newborn’s health--Wikipedia gives a good summary of the test’s criteria here).

I remember Amber asking the doctor “is she alright?”, to which the doctor had to reply truthfully “we’ll see”. After less than a minute which seemed like an eternity to us, we heard her cry and knew she was okay. In fact, she ended up scoring an 8 and 9 on the two Apgar tests they administer, which is normal (I’m told a 10 is practically unheard of).

I took a few pictures of Audrey at this point, which I posted in the previous posts. This is just right after the tests. I brought her over to Amber, who finally got to see her for the first time. Amber decided not to hold her yet because she was still delivering the afterbirth and needed some stitches from the forceps. She wasn’t in pain, but she was distracted by what was going on. When the placenta came out, Andrea showed it to us and pointed out where it was attached to Amber and where to Audrey. It looked like a raw pot roast. I looked to see how badly Amber was cut, but couldn’t make it out too well. There was a lot of blood but otherwise she looked okay. It was a 3rd degree cut, which is about as bad as you can get.

Andrea explained that Audrey was face up rather than down (she called her a “stargazer”). Apparently this explains the heart rate issues and Amber’s difficulty pushing. A little while after the birth Andrea came in and said they’d done some tests on the cord blood—the tests confirmed that Audrey was in distress and was just about to enter dangerous oxygen levels. So opting for forceps at the time we did was the right decision. No amount of pushing was going to get her out.

Audrey has two lumps on her head from the delivery. The doctors believe that these were caused by Amber’s pushing—that she literal pushed part of Audrey skull out of shape. They refer to these lumps technically as cephalad hematoma. They believe they should go away by themselves, but we’ll have to keep an eye on it. Here’s a picture of Audrey’s “horns”.



Pretty much during the whole stay in the hospital, nurses were coming in every one or two hours to do something, like take Audrey’s or Amber’s vitals. This made it even harder to get Audrey to sleep. On some of these visits Audrey would get special treatments, like a jaundice test. Overall, it was a very busy time, with something happening constantly. It was hard to find the downtime to call folks and let them know what’s going on. It was even hard to find the downtime to eat; we had a few meals that we pecked at for a few hours because of constant interruptions.

About an hour after Audrey was born, they sent her to the nursery for a few minutes. I went with her on all her nursery trips. This is when she got her first bath. They also gave her a vitamin K shot, the Hepatitis B vaccine, and some eye ointment. On later trips she got blood tests for various maladies and her jaundice tests. She was also weighed in the nursery every night at midnight.

Diapers
It quickly became apparent that daddy is the diaper man. The nurse changed the first diaper and showed me how. After that I was on my own, and I’ve been changing most of them since. Since Amber has generally been busy with other things (e.g. recovery or breastfeeding) this is something simple I can do to help.

Audrey has been having good bowel movements. In the first few days, she was going through up to four dirty diapers a day. She went so well, in fact, that she was out of meconium by the 2nd day. This was great, since I’d been having trouble cleaning it with the crappy gauze they give you for baby wipes in the hospital. I was complaining so much that Amber asked Christy to bring in a box of baby wipes, which was a vast improvement.

Having frequent bowel movements is great because it helps combat jaundice.

Weight
Audrey was born at 7 lbs 2 oz. At the first postpartum weighing she was down to 6 lbs 12 oz, then at the second weighing 6 lbs 8.3 oz. This represents a loss of 8% birth weight, which is a safe amount of loss. We saw the pediatrician twice while in the hospital, and she was pleased with this amount and recommended that we stick with breastfeeding and don’t supplement.

Breastfeeding
All the nurses were trained in breastfeeding, and while none of them are specialists, we got advice from many of them during our stay in the hospital. Later we requested to see a lactation consultant. She came by and corrected Amber’s breastfeeding posture, which helped a lot. However, she was also very abrupt and didn’t spend as much time with us as we’d like. So we ended up having her come back a second time while in postpartum. This time she was really helpful. She must have been with us for an hour. We tried several different holds and she observed Amber try them several times on her own and corrected her errors. Fortunately, Amber produced a lot of colostrum, it was just a matter of learning how to get Audrey latched on correctly. If you don’t have a pro to help, you would never know you were doing it wrong and the baby would learn an incorrect technique. The other issue with feeding while in the hospital was that Audrey was always “rooting around” like she wanted to be fed, but then when Amber would try to feed her she would lose interest quickly. The nurses said that’s normal and what they call a “grazing” baby. After all the help, we ended up leaving the hospital feeling pretty solid about breastfeeding. The lesson learned is to always ask for help and not worry about bothering the nurses and consultant. That’s what they’re for.

Gifts
Audrey received her first birthday gifts in the hospital. She got a stuffed hippo and a balloon from Aunt Cindy and a stuffed lamb and a balloon from Uncle Michael. Audrey also got a nice arrangement of mums from Amber’s friend Christy.

Phew, that was a long one.
All for now!

Short Movies from the Hospital

My camera also films short movies; unfortunately, there is no audio.

Here is a short conversation I had with Audrey in the hospital. Amber is asleep and I'm trying to convince Audrey to sleep also. The film quality is bad because the lights are dim.

Here is a film of her first bath in the nursery. The nurse positioned her in this "butt in the air" pose and she just laid there quietly during the bath, like a rag doll.

Here's Audrey also in the nursery warming up after her bath. She's sitting under a radiant warmer--the gold sticker on her left lower abdomen is a sensor that measures her skin temperature so it's just right. She's getting hungry here.

That's all for now!

1st Pictures

Here are Audrey's very first pictures

T-48 Hours

On our weekly doctor's appointment yesterday, we had a cervical exam done and found out that Amber is already 4 cm dilated and 90% effaced. Most women don't reach this point until after a few hours of active labor. The doctor was very happy and said this indicates very good chances that the baby will come naturally without the need for medical intervention (e.g. inducement). She seemed pretty confident that the baby would come before Friday, probably within 48 hours.

To speed things along even further, the doctor "stripped the membranes" which is a manual procedure where the doctor physically separates the membranes containing the amniotic waters from the cervix. This is believed to stimulate the release of natural hormones (oxytocin) from the brain that precipitate birth. Oxytocin is related to pitocin, which commonly used in hospitals to speed-up or to stimulate a stalled labor. Pitocin has a bit of a bad rap (at least in the lay community) because its associated with painful births or complications that ultimately end in a C-section.

Given how dilated Amber is already, with no contractions or other symptoms, and also the fact that her mother delivered her three kids *very* quickly, the doctor told us to come in to the hospital as soon as the contractions are regular and 10 minutes apart. (which is sooner that normal).

Unfortunately, there was also a bit of bad news in this visit. As part of routine tests we take every week, we discovered that Amber's blood pressure was high (I think around 130/100) and she was dropping some protein in her urine. These are both signs of a common condition called preeclampsia. This is a relatively new condition (discovered around the 90s, I think), and it can come on very suddenly--Amber is checked every week, and was fine last time. Preeclampsia can be fatal in rare instances, so the medical community are naturally very cautious with it, but in the vast majority of cases it can be managed with little trouble. The most likely treatment will be inducement if the baby doesn't come quickly on it's own.

To determine for certain whether Amber has preeclampsia or not, the doctors want to run a more involved urine test, which requires Amber to capture all her urine for a full 24-hours and turn it in for testing. Which I'm sure will be a fun process. They also took a blood sample and are running some tests on that. At the rate we're going, the baby may come on it's own before we even get the test results back, at which point the whole thing would be moot.

I went ahead and took off work for the remainder of the week so I could be home and ready to go whenever we need. We were a little panicked when the doctor first told us the news (I'll never forget the look on Amber's face-- ha ha!), but now we're really excited.

Hey, could you get me some water?

Just since you're up. Also, we're out of milk. Oh, and while you're downstairs, grab some Zantac, and get the pillows off the guest bed for me, then come paint my toenails, rub my back, and tuck me in bed.