Moby Wrap

The NICU nurses strongly recommended a Moby Wrap for Theo over a sling, for fear that the sling might crush his airway.  I haven't ever used one that much because they seemed really complicated.  Walter has to help me put it on, but once it's in place, Theo is a big fan.

September 11, 2014

September 14, 2014

September 28, 2014

Sleep with one eye open, little guy....

She Likes to Move It, Move It!

This evening, Walter took Derek with him to the Marsalis Concert at the Mondavi Center that I really, really wanted to attend.  He reported it was a excellent concert, one I would've really enjoyed.  But, I couldn't see leaving Theo with someone else, given we'd just so recently been able to have him home with us.

And Lulu was awfully excited at the prospect of a special family movie night with Mommy and Baby Bruder.  We gorged ourselves on popcorn and the animated stylings of Madagascar 3 in German.  And I think we can count the evening as a success when it involves a special dance to the closing credits:

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My days.

I spend a lot of my day, just sitting in my recliner, enjoying holding my sweet baby boy.



It it a luxury I didn't really afford myself the first time around with Lulu.



I know that this is my last time to hold a baby, my baby, until I have grandchildren and I'm not going to let it pass by without enjoying it.

Early Literacy

Before she left for school this morning, Lulu wanted to read to her baby Bruder.  She always takes 1-3 books in the car to read during the drive to school and Theo got a preview.

Apologies for photo quality--I grabbed my cell phone off the kitchen counter because I didn't want to miss this moment!

First Bath

His umbilical cord hasn't fallen off yet, so we could only give him a sponge bath today.



Lulu was really excited to help, hence the dirty footprints in the bath tub you see on the left.  We practically had to force her out of the bath tub.



In the end, we swaddled him up in a hooded bath towel and had a snuggly, sweet-smelling baby again.

Parenting isn't for the Weak.

The up every 2 hours to feed him during the night thing is beginning to take its toll....

Round and Round the Mulberry Bush....

Lulu took her old stroller for a spin around the kitchen, showing her new baby brother the lay of the land, so to speak...

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Going Home!!

Over the weekend, the nurse told me that we should bring Theo's car seat on Sunday afternoon because they would do a "stress" test by having him sit/sleep in it with his monitors on for two hours to make sure that he could withstand the rigors of sitting/sleeping in that position without triggering his alarms.

If he could:

A).  pass the car seat test
B).  lower his bilirubin levels (they removed him from light therapy on Saturday)
C).  continue to have no apnea episodes
D).  continue to have no more green spit-up (he had one episode on Friday)

Then we would be allowed to take him home with us on Monday.  Those were a LOT of ifs.  And neither of us really wanted to get our hopes up only to have them dashed.  Case in point:  on Sunday afternoon, the baby in the corner of Theo's room, who had *passed* the car seat test suddenly had a reparatory episode that had nurses running in like Olympic sprinters and his mother shaking and in tears beside his bassinet.  When I arrived Monday, he was nowhere to be seen--he had been moved back into the intensive observation room.



Walter had a big conference call at work on Monday morning, so I showed up at the NICU alone.  The nurses had said that if we were allowed to take Theo home that it wouldn't be until the early afternoon, so we had made plans for me to meet him back home at lunch and then travel to the hospital together.  When I got to the NICU, the doctor told me that they would release him*if* I had an appointment for him with our pediatrician for the next day to have a bilirubin follow-up.  Apparently, his bilirubin had risen slightly overnight and they wanted it monitored to make sure he didn't need to go back on light therapy again.



And thus began my morning from hell.  You see, Walter and I are in a different physicians group from Lulu.  She is still under the UCDavis medical group that Walter and I started off with initially when we moved to Sacramento; however, I switched us to a different primary care physician in a different medical group.  And as a newborn, Theo was technically covered by MY insurance for the first 30 days.  Meaning?  He couldn't be seen by our regular pediatrician because he was in the wrong physicians' network.  And I had to resort to calling our insurance company, in tears, because we didn't have a pediatrician.  I couldn't believe that we weren't going to be allowed to take our baby boy home FINALLY because of our insurance??!

Thankfully, after being on the phone for the better part of an hour, I was able to find a pediatrician in my doctor network who agreed to see us the next morning.  It was awful stress on what should've been a happy day.  And the worst of it is that I'm not particularly happy with our primary care doctor anyway and have been thinking of switching.

I bought this outfit, thinking we'd be bringing him home in October, not Sept!
And I thought he'd be a LOT bigger!

So, I ran back home to meet up with Walter and we were able to finally take this little guy home with us.  I couldn't believe our luck.

The doctor warned us that he was not allowed to ride alone in the back seat of the car because his neck muscles were weak and if his head slumped forward, then he could cut off his airway and suffocate to death.  So, as long as Walter was at work, I was effectively housebound with Theo unless I could find someone else to drive us around.  But, it was a small price to pay to get this little guy home:

Pietá.

I wanted a photo with my son, so I had to take a selfie.



The blog post title is tongue-in-cheek by the way.  Theo's middle name may be Emmanuel, but I'm certainly not the Madonna....

Open Eyes!

Theo opened his eyes for the first time today.  Up to this point, he was largely either asleep or awake with his eyes closed, so this was a huge moment for us.

Theo in the NICU

The hospital where Theo was born doesn't have a NICU.  While I was pregnant, this didn't particularly concern me because who wants to think that they will need a NICU, right?  It feels like planning for something bad sort of makes it happen, you know?

When Theo was born, he wasn't breathing, at all.  And the neonatologist demanded that he be kept for at least 7 days observation to ensure there wasn't a repeat episode of apnea...and if he had a repeat episode, then the 7 day waiting period would begin all over again.  They also gave him forced air through tubes inserted into his nostrils to help inflate his lungs and make breathing easier.  Because of his early birth, he still had residual fluid in the bottom of his lungs that would take some time to get reabsorbed into his body.  Until that happened though, it made him breathe very rapidly and shallowly which the doctors did NOT like.  It's something we all take for granted, but watching an infant struggle to learn how to breathe makes you hyperaware of how difficult the transition to living outside the womb actually is.



They also placed three sensors on him to monitor his heart rate, how quickly he was breathing, and his blood oxygen saturation.  Unfortunately, the stickies that held these sensors in place aren't very sticky because a newborn's skin is extremely fragile, especially when you're talking about preemie skin.  So, they became dislodged really easily which made really LOUD alarms go off to alert the nursing staff.  Fun.

look at all that monkey fur on his shoulders

They also monitored his blood sugar for hypoglycemia and started him on a glucose drip to make sure that his little brain had sufficient energy to keep developing.  And they started an IV line to administer his antibiotics.  Because he was born so early, I had not yet had my Group B Strep test to know if I had it and his white blood cell count was elevated, so they started him on antibiotics as a precaution to keep him from getting sick.



Anyway, because of the lack of a NICU, the doctors wanted him transferred to Mercy San Juan, the nearest hospital in the Mercy hospital group that had a NICU.  They were willing to let him stay at Mercy General until I was discharged, but given that San Juan was technically closer to our house and we were anxious to have him in a place with all the necessary equipment, I left the hospital after only one day's stay rather than the two days' I was legally allowed.  I didn't particular enjoy being subjected to hospital food and hearing other mothers rooming with their newborns on the postpartum hallway either.  And if I was going to get up every two hours to pump my breasts, I'd rather be sleeping in my own bed in between pumping sessions.

The transfer took place by ambulance with two NICU nurses and two paramedics.  They put Theo in an isolette to keep him stable, but it was really hard for me to see him in that box.  It was the first time since he had been born that they had put him in one of those boxes and it was heartbreaking to see.  I kept crying as I signed all the paperwork to let him go.  I'm so glad Walter was there because I was a basket case.  Seriously, a total wreck.



So, while the ambulance took him to San Juan's NICU and the nurses got him all checked in, Walter and I went home and I showered for the first time in two days and we ate some lunch (I think it was In-N-Out?) on our way to the NICU.  Once we arrived, we had to learn a whole new set of procedures.  We had to keep on our wristbands that Mercy General gave us that had the same code as Theo's ankle band and identified us as his parents.  And every new nurse/staff change required us to identify ourselves and show our wristbands.  Upon entering the NICU, we had to wash our hands and arms up to the elbow for at least 30 seconds at some surgical sinks (think Grey's Anatomy) before drying them off and them rubbing antibacterial foam/gel on them, too.  They also discouraged us from wearing rings or watches as possible sources of infection/contamination.



And then we were allowed to enter the NICU to see Theo.  Initially, they had him in an open box sort of thing in the more intensive observation room (see the photo above), so it wasn't too different from seeing him in the nursery at Mercy General.  The nursing staff was great and so were the two neonatologists that we worked with.  They were the complete opposite of the dick-head guy from the night Theo was born.  They made sure to explain everything to us and called every morning to fill us in on how Theo was doing.  There was even a lactation consultant (something sorely lacking at Mercy General) who walked us through renting a hospital-grade breast pump to help ensure my milk supply came in and increased like it needed.

Not looking my best.

So, Walter and I stayed at the NICU as late as we could that afternoon until we had to leave to go pick up Lulu from her after school program.  And thus began a hellish week.  I would wake up every two hours during the night to pump so I could bring it in to the NICU for them to feed to Theo.  We would wake up and Walter would get ready for work while I got Lulu ready for school, and then he would drop Lulu off at school on his way to work and I would leave for the NICU.  I would pack a sandwich in my purse for lunch and stay there until about 4-5pm when I would need to leave to go pick up Lulu from school.  And repeat.

wearing the hat Nanny knit for him

Feeding Theo was a challenge.  The nurses inserted a gravage (sp?) tube into his nose that led straight down to his throat.  They did this for a couple of reasons.  As a preemie, he hadn't yet mastered the suck-swallow-breathe coordination that eating requires.  And while breastfeeding is instinctual, even for preemies, it's also very tiring.  So, depending on a preemie to get his nourishment solely from breastfeeding is sentencing him to slow starvation because he will tire himself out before he can suck enough to stay alive.  I was determined that they would not have to give him formula, and I was successful in that regard--they put my expressed breastmilk through his gravage tube to help him grow.



I started off with small 45 mL bottles for my colostrum before my milk came in, but eventually, I was able to move on to bigger 90 mL (and even bigger!) bottles during my pumping sessions.



So, my days in the NICU were largely spent within a 4 foot by 4 foot space centered around his bed/isolette.  The nurses encouraged me to try to breastfeed him at feeding times while they warmed up a bottle of my milk for me to feed him.  I quickly learned which chairs were most (un)comfortable to sit in and how to maneuver the curtains for maximum privacy.  And then I just sat and held him against my chest.  I imagine there are topless dancers who spend more of their day clothed than I did in the NICU!  I would sit in a hospital gown with him against my chest, doing skin-to-skin, rocking and singing to him as he slept.



One of the complications of being born premature is the inability to regulate your body temperature and on Theo's second day in the NICU, I walked in to find him in one of the serious isolettes.  That really freaked me out because those were the ones reserved for the seriously premature babies, not for my baby boy.  Luckily, he was only in it for a couple of days before he was able to prove to them that he could regulate his temperature just fine.  Apparently, his temp fell during the night and they wanted to be sure he was warm enough.

And you can also see the strange blue cord on the right hand side--that's the light therapy for jaundice.  Yet, another complication of prematurity.  His bilirubin levels started to rise, so they put him on light therapy to keep them from rising further.  This was old-hat to Walter and me.  Lulu developed a pretty severe case of jaundice and we had to have her on a light pad at home for about a week when she was first born, too.



The light therapy gave him a radioactive glow that was kinda cool.  To prevent any damage to his eyes, they had to wrap his head in this white bandage thingie.

Walter took off early from work on Friday afternoon to spend time in the NICU with me and our wonderful friends, Todd and Delia, drove down from Grass Valley on Sunday and took Lulu with them to the Sacramento Zoo so Walter and I could both spend time with Theo in the NICU that weekend.  Likewise, our friend Summer offered to take Lulu for a playdate with her daughter Scotland after their soccer game was done on Saturday.  I was really grateful for the opportunities for Lulu to do something fun and also to have someone to back me up in the NICU.  I felt horrible mom-guilt every time I had to leave Theo there without me, but I also felt horrible guilt when I was there that I wasn't spending time with Lulu either.










As you can see, both of us were pretty well exhausted by this point.  The strain of the week was really starting to get to us, and Lulu.  Thankfully, her teachers were really understanding but it was a loooong week for all of us.

our new open bassinet = progress!

Over the weekend, we were moved out of the intensive monitoring room into the less intensive monitoring room as more days elapsed without a repeat of Theo's apnea issue at birth.  His bilirubin levels continued to fall and eventually they stopped his light therapy, too.



One step closer to home!

Aaaaaaaand then *this* happened....

So, at 6pm on the Sunday evening of Labor Day weekend (a title which will only appear humorous in hindsight), we are finally getting showered and dressed after our day of recovering from backyard camping the night before.  Our plan was to run to Whole Foods and grab some ingredients to make dinner before turning in early for the night.  I was sitting in my recliner in the living room, helping Lulu put on her shoes and socks (not in that order obv) and stood up to go get myself dressed.

When I stood up, I suddenly had fluid gushing down both legs.  And not a trickle of fluid.  I'm talking full-on gush.  I panicked, my first thought being "Oh my God, I've lost complete control of my bladder!" and I immediately sat back down.  And just as suddenly the fluid stopped, so I stood back up again to another Niagara Falls and that's when I realized no matter how hard I was clenching my PC muscle, the fluid wasn't stopping and I run to the bathroom to sit on the toilet.  (I know, I know, not exactly the most sanitary place in the house, but the only place I could think of where I could leak fluid without causing a huge mess)  I called for Walter in the most panicky voice you can imagine (while simultaneously trying to keep it together for Lulu who was within ear shot and wondering what was going on?) who came quickly from the other part of the house to be confronted with a full wad of wet tissue paper and the question, "Does this smell like pee to you?  I don't think it's pee??!"

At that point, both of us looked at each other and realized exactly what was going on.  My water had broken.  At 34 and a half weeks.  And all our well-laid plans suddenly flew out the window.  My doula was out of town for the week at the Burning Man festival in Nevada and with the baby coming this early, there was a very, very high likelihood that I was going to have a c-section or some other type of intervention to stop my labor or something.

I asked Walter to grab my cell phone and I texted my friend and neighbor, Melissa (who threw me the baby shower and has been a big support for me through this pregnancy).  Usually, Melissa and I text each other because with her two small, rambunctious boys and Lulu, it can be difficult to have a conversation in real-time.  When I texted her "I think my water just broke," she called me.  Immediately.  We had already discussed her taking Lulu when I went into labor, so her first words to me were "Have you called Dr. Knight?  Tim and I are with the boys at the drive-in movie theater to see a double feature, but my parents haven't left yet.  Do you want me to have them swing by and pick her up?"  I said, yes I had talked to Knight (who told me to go immediately to the hospital), and please come get Lulu, and felt reassured that at least we had Lulu taken care of while we confronted this emergency.  Walter helped me get dressed and I completely soaked two sanitary pads with amniotic fluid in the 30-45 minutes that it took for Melissa's folks to swing by and get Lulu and for Walter to run around the house like a mad man, packing a bag to take to the hospital for us.

Once the bag was packed, we got in the Jetta (because the Audi needed a new alternator and Walter had been debating starting the change-the-transmission-to-a-stick-shift project that very weekend and had ultimately decided that he wanted to wait until the following weekend and enjoy Labor Day instead) and drove expeditiously to the hospital.  On the way to the hospital, I started to feel very mildly crampy and that ironically made me feel a bit better that I wouldn't need Pitocin to start my labor (one possible intervention avoided).

We had to check in through the emergency room because Mercy General is in the middle of some massive renovation.  There was a guy in obvious pain talking to the checkin guy ahead of me, but he was quickly forgotten by the staff when I said that my water broke and I was 34.5 weeks pregnant.  They got me shuttled upstairs to the labor and delivery floor.  The L&D nurse who was assigned to us helped me get into my hospital gown, took my vitals, and paged Dr. Knight (who, as luck would have it, was on call that evening).

Dr. Knight did a quick ultrasound to make sure that everything was okay with the baby's heartbeat and then he had her check me, saying he didn't want me to hate him for causing me discomfort.  At approximately 8pm, the nurse said I was 3cm dilated, 90% effaced, and the baby was at -1 position, that she could "feel hair."  At that point, he turned to me and said, "Well, we're having this baby tonight."

FYI:  Thirty-four weeks is an important turning point in gestation.  If the baby had been younger than 34 weeks, then they would have tried to stop my labor (although that wouldn't have been successful given how much fluid I had already lost) so that they could administer two doses of steroids to quickly mature the baby's lungs.  The only issue is that those doses have to be administered 24 hours apart, meaning the mother is given magnesium sulfate to try to stop the contractions for 24 hours until the second dose.  Thankfully, we were able to escape that.  Unfortunately, because it was so early, I hadn't yet been tested for Group B strep, so I was given a dose of antibiotics through an IV as a preventative measure and the baby would have to have antibiotics as well.

I had an ultrasound done on Aug 20th and the doctor estimated the baby's weight to be about 5 and a half pounds, but when I pushed him on the accuracy of that, he admitted that he could easily be off by as much as a pound in either direction.  So, we didn't know how big the baby was, how developed his lungs were, or exactly what we'd be dealing with once he came out.  Both of us were really worried but neither one of us had much time to really think about it at the time.

The two nurses who were there were a little taken aback, I think, when I refused pain meds, and it wasn't until Dr. Knight said, "Let her labor on her own and see how things go" that they backed off from asking me if I wanted "something for the pain."  (I don't think Mercy General sees many moms doing natural labor??)  He also gave his permission for me to have something to eat since I hadn't eaten anything since lunch that day, so the nurse found me a turkey and cheese croissant sandwich and a big glass of ice water in a styrofoam cup (I think those are standard hospital issue?  I've had one at every hospital room I've ever been in!).  Having something to eat and drink made me feel a LOT better!

The mild cramps from the car ride to the hospital steadily turned into stronger and stronger contractions.  At Dr. Knight's insistence, I was on continual fetal monitoring, with these elastic straps around my abdomen that kept sensors in place so the nurses could monitor things from the nurses station.  The L&D nurse came in after about an hour of me trying to use the birthing ball while connected to all these cords and set me up with a wireless sensor instead.  I also had them turn the sound down on the machine in our room because the sound of the baby's heartbeat made me nervous and took me out of my headspace.  That made things a LOT easier!  Walter was desperately trying to remember the timing between contractions part from our childbirth and delivery class with Lulu (he meant to bone up on that part but didn't have the chance!) and I was lost in the moment.  Eventually, sitting on the birthing ball felt really uncomfortable, so I transitioned into standing (unfortunately the fetal monitoring kept me from being able to use the shower like I had with Lulu at UCDMC).  I would lean into Walter and put my arms around his shoulders when I felt a contraction...and boy, were they getting STRONG!

A little before midnight, the L&D nurse came in as a contraction was starting and said, "Okay, I'm going to check you after this contraction is done because that last one was really big."  No sooner had the words left her mouth then I said, "HE'S COMING!!"  I could feel his head squarely in my pubic area, make no mistake!  That's when all hell broke loose!

She made me get up in the bed and Walter, at her insistence, made me lie on my side (I wanted to be on my hands and knees, like I was with Lulu, because that felt most comfortable).  He said afterwards that it was really obvious to him that the nurse was going to be delivering the baby and he wanted to make things as comfortable/easy for her as possible.  I think she hit a button or called Code Red or something because within about 5 seconds, the room was swarming with frantically moving people (none of them the doctor!).  In maneuvering the bedside table out of their way, one of the nurses knocked the large styrofoam cup over and there's nothing like giving birth and having ice water thrown at your abdomen!  It took maybe, maybe, 5 minutes of pushing (if that), and he was out at 10 minutes after midnight (on Labor Day no less--hahaha).

And immediately whisked to the far corner of the room to the emergency baby table under a heat lamp.  I kept asking, "Is he okay? Is he okay?" and they kept telling me, "He looks good.  He looks good," but their tone of voice was kind of like the airline pilot who calmly tells everyone not to panic, you know?  And the expressions on their faces didn't look good and one of the nurses stepped in and said, "Rub him harder."  We finally heard a cry and that's when I finally managed to breathe myself.

At that point after they had him stabilized, they let Walter come over and take a few photos before they whisked him away to the "nursery," otherwise known as the not-quite-NICU for "observation."





At this point, the doctor on-call (Dr. Knight had left at 11:30pm to go home for the first time in two days) and the L&D nurse started to work on me, massaging my abdomen.  As Walter had predicted, the on-call doctor didn't make it in time for the delivery and the nurses got to deliver the baby.  I delivered the placenta just fine, but the L&D nurse had to give me three doses of Pitocin to stop the bleeding.  I had just almost lost enough blood to start a whole 'mother protocol for postpartum hemorrhaging.  Thankfully, we managed to avoid that one, too.

Once she had me on a Pitocin drip, she left to go check on another patient and then it was just Walter and me, alone in the delivery room, looking at each other like, "Now what?"  And I think that was the scariest, loneliest moment of the whole night because it's not supposed to be that way.  You're supposed to deliver a baby and then have the happy moments of him lying on your chest and feeling your heart swell with love and pride, not feeling your chest constrict from worry as your baby is God knows where in the hospital without you.

While we sat there together, Walter and I decided on what to name him because we had a list of about 4-5 top contenders prior to that point and were taking our time.  We also texted back and forth with Melissa to see how Lulu was.

Dr. Knight came back to the hospital (I felt badly for him at this point!) and once he was there, after he checked-in on me, he and Walter walked down to the nursery together to see the baby for a few minutes before coming back to the delivery room where I was waiting by myself.

in the not-quite NICU

Then the neonatologist came to talk to us after he had done his examination.  This guy had the worst bedside manner of any doctor I've ever seen (and I've seen plenty in the US and Mexico thanks to the IVF stuff!).  When I interrupted him to ask him a question (which I think is my right as a nervous mother of a now-preemie), he said, and I quote, "Let me finish." Seriously??!  Walter thinks I should give the guy a break because it was 1:30am, but I take no quarter.  Anyway, the neonatologist told us that the baby was breathing very rapidly because he still had fluid in the bottom of his lungs (fluid that normally would've been expelled by the time his due date approached) and that it would take a while for the fluid to resolve by being absorbed into the body.  And he had apnea, so he had to be observed for a minimum of 7 days to make sure that he didn't have another episode of apnea before we could even think of taking him home.  He also had trouble regulating his body temperature (i.e., keeping himself warm), although a minor issue compared to the other two.

The L&D nurse came back in and said that she would wheel me down to my recovery room and I asked her if we could go to the nursery instead?  She said, "Oh!  Of course!" like it hadn't occurred to her that I would want to see my baby??  So, at approximately 3am, Walter and I were finally able to hold our son for the first time.  And it was bittersweet.

The moment I waited two long years for...

Walter spent what was left of the morning with me in my recovery room (they had thoughtfully not put me in a shared room with another mother who had her baby with her--I cried every time I heard a baby cry and mine was down two hallways from me) before he went home to pick up the pieces of the day.  He walked over and got Lulu that afternoon from Tim and Melissa and brought her up to the hospital to see me and her baby brother for the first time.  The hospital was rather insistent that Walter be there to share my "celebration dinner" with me and Lulu was unhappy that she didn't get a hospital dinner, too (if she only knew how crappy hospital food really was!).  Once dinner was over, we walked down the hallway(s) and into the nursery.  Per their protocol, we had to wash our hands with special soap to prevent germs from infecting the baby.  Lulu was very concerned about the monitoring wires attached to him and the mask we proactively made her wear.

Apologies for picture quality--we only had Walter's crappy cell phone camera with us at the moment
(poor planning on our part)

Welcome to the world, Theodore Felix-Emmanuel Schwarm, all 5 pounds 14 ounces and 18 inches of you.  Your family loves you very, very much.