Tuesday, July 20, 2010

The birth of Tyler Andrew Loftesness

**Warning** Contains BIRTH pictures, although honestly, in the water, there really isn't enough detail to be considered all that graphic. :-)


Ryan (my first) was born at 36 weeks and 6 days gestation, so I was anticipating Tyler coming somewhat early, too. Apparently he had other plans. I made it to 37 weeks. Then 38 weeks. Then 39 weeks. And so many people kept asking me if I was ready. I'd say, "Yes, I'm ready, but I'm not impatient." I almost felt like I should be impatient, since I'd made it further along than I ever thought I would, but I was just fine with him picking his own birthday. The one thing I could say was that I definitely felt bigger and heavier and more tired than I ever did with Ryan, but I LOVE being pregnant, so it was okay with me. By about 37 weeks it seems like most women are "just done" and want their babies to come on out, already. I think I might be the weird one. I love holding my baby closer than I will ever hold him again in my life. I love feeling the shifts and movements inside my belly. I love being literally physically connected to another little tiny life. I marvel at my body's ability to so perfectly form and grow and protect my child.

On Wednesday, July 14th, I started to feel "just done." I was 39 weeks and 2 days pregnant, and starting to wonder when Tyler was going to decide he was ready to come out. I was a little disappointed in myself that I was feeling this way, but as I gave Ryan a bath that evening, I asked him if he was ready to meet his baby brother. He said yes, so I told him to tell Tyler to come out! "Come out Mama's belly, Tyler! I love you, Tyler! I want to meet you, Tyler!" We both repeated these things to Tyler a few times, telling him how much we love him and want to meet him and can't wait to see his sweet little face, and that he can come out whenever he's ready. I felt a little conflicted, because although I was definitely ready to meet him, still a part of me was not quite ready to be done with the pregnancy. I'm a bit selfish in that I like being the only one who can touch him, feel him, hold onto him in a way that nobody else can, and I wasn't totally ready to let go.

The next morning, I woke up having to pee. It was 5:43am, 2 minutes before Colby's alarm clock was supposed to go off to wake him up for work. I contemplated just laying in bed until he woke up, too, but decided to just go. On the way to the bathroom, I lost bladder control and thought, "Wow, I didn't realize I had to go that badly!" I got to the toilet, sat down, took my shorts off and went pee. As soon as I stood up, I felt a little more come out of me and thought, "geez!" So I sat back down. And stood up again. More came out. I sat back down. Colby's alarm went off. "Honey...?  I think my water might have broken... but I'm not sure. So go ahead and get in the shower and start getting ready for work. I'll let you know." He had just barely undressed and hadn't even turned on the shower yet when I figured out that it was definitely NOT still pee coming out of me. I stood up and watched some of the fluid pour out. Yellow. Meconium. Hmmm... no contractions yet, but before Colby got in the shower, he pulled up his contraction timer application on his phone and handed it to me.

I called my midwife, who didn't answer, and then called my mom, who lives the furthest away. I told her my water had broken and to come immediately. Then I called Trish, my doula, and told her that my water had broken and that there was meconium. She asked what Mary's (my midwife) protocol for that was, and I said I didn't know exactly but that I was pretty sure it was fine. She asked if I was having any contractions and I said, "not yet." Recalling my 4 hour first labor, she asked if she had time to take a shower. "I don't know." She said she'd be right over. After we hung up I started feeling contractions, and I put Colby's timer to use. Three minutes apart. One minute long. The adrenaline ran through me as I realized, "This is it!!" and I started to shake. I then called my midwife, who again didn't answer, so I got to work calling all the other people who were supposed to come and help out. I called my midwife again, and still got no answer. I called her assistant, Pita (who also happens to be her daughter), and told her that I couldn't get ahold of her mom, but that my water had broken, there was meconium, and just 25 minutes into labor, I was already having minute-long contractions that were three minutes apart. She asked about the color, listened to me breathe through a contraction, and said she'd gather her things together and be on her way.

I was still sitting on the toilet and getting tired of it, so I asked Colby to get me a towel. I shoved it between my legs and got up. I told him to get the tub out and start filling it, and I changed into my labor outfit: a black sleep/nursing bra and a black skirt. We took a picture of me, my "last belly picture," got out the video camera and filmed for a few minutes, mostly just talking about being in labor and acting a little silly, when suddenly my contractions got pretty intense. I was caught pretty off-guard; the first two hours of my labor with Ryan were easy-peasy, super light contractions that I hardly noticed. These were not going to be cake.

Julia and Trish were the first to arrive. I was still pacing around the house at that point, but I finally grabbed a chux pad, threw it down on the floor, knelt on it and leaned over my birth ball. Trish sat down next to me and Colby continued getting things set up. At 6:34, I posted a picture on facebook of the tub starting to fill. Ten minutes later, I posted this as my status: "It's time. Don't call or text. I'll update."

I put my phone down and Colby came back to me and started giving me a back rub while I breathed my way through each contraction. Bethann and Alicia showed up, and my mom arrived quickly after. Soon I couldn't just breathe through the contractions, and I started to vocalize through them by letting out a low moan. Colby asked me if I wanted to get in the tub, and I said not yet. I really wanted to hold out until I felt like I couldn't handle NOT being in the tub any longer. As his hands moved down my back during a contraction, I told him to STOP right where he was and just push hard, harder, HARDER! The counter pressure felt amazing.

Trish suggested that he get his shorts on so he would be ready to get into the tub with me whenever I wanted him. I wondered what he'd say. Last we had talked, he wasn't sure whether he'd want to get in, and was a little grossed out by the idea of everything that would end up with us in the water after the birth, so I was a little surprised when he got them and went into the bathroom to change without hesitation. A few minutes later, he asked me again if I wanted to get into the tub. I opened my eyes, looked up at the others and asked, "Is it really going to help that much?" Of the five other women, three have had water births. They quickly encouraged me to get into the tub. "I would never do it any other way," seemed to be the unanimous agreement between them. I gave in. Trish shooed everyone but Colby and I out of the room so I could have some privacy while I took my skirt off and climbed in.

For a little while, Colby stayed outside the tub, rubbing my back and applying counter pressure. Just after 7am, Ryan woke up and came to see what all the commotion was about. I was so thankful that my mom was there and could devote her attention to him, because he would've been way too much of a distraction for me if she wasn't. She told him that Mama was going to have baby Tyler soon, and took him to the living room to read one of his favorite books, "I'm a Big Brother!"

Within a few minutes, I started feeling nauseous, and I asked for a bowl. The bowl didn't get to me in time and I threw up into a towel. There was a quick break between contractions and then the bowl was in front of me and I needed to use it. I knew from my experience with Ryan that I was in transition and it wouldn't be long until I was pushing. Soon, my moan involuntarily turned into a small grunt at the end of a contraction. I opened my eyes and looked up at Trish to tell her I felt my body pushing, but before I could say anything she asked, "Are you feeling pushy?" "Yes!" I exclaimed, grateful she was so in tune with me. From then on, every contraction came out as more of a grunt than a moan. I wasn't putting any effort into it, but letting my body just do it's thing. It was so nice to be able to feel that and let it happen and not have anybody checking me and saying, "No, don't push, you're only at an (8, 9, 9 with a lip, etc) and you don't want to swell!" Just full faith and trust in the process, knowing that my baby and my body are working together to bring him out. Around 7:15, Mary called. I couldn't answer, so Trish did. Pita had gotten ahold of Mary, who had been fishing, and they were now on their way. Trish told Mary I was sounding like I was starting to push, and Mary listened over the phone. The last words I heard Trish say before she hung up were, "I hope you make it."'

 At around 7:30, Colby finally got into the tub with me. Things start to get a little fuzzy for me here and I honestly don't remember if I asked him to, or if somebody suggested it, or if he just decided to get in, but he was in a much better position to do counter-pressure on my back. It seemed like every contraction would change where the pain was, though, and I kept making him move up a little bit. We continued this way for what seemed like forever but was only about 15 minutes, and I realized Mary and Pita had arrived. I have no idea how long it was that everyone just observed and supported, but at some point my grunting and growling turned more into roaring. Mary asked if she could check me. I let her, and she said I had a small lip and then asked if I had peed lately. I hadn't peed since labor started, so I got out of the tub to try and go, since a full bladder can make it harder for the baby to descend. As quickly as we could, Trish and Colby helped me get out of the tub and to the toilet between contractions. I sat down. Nothing. "I can't peeeeee!" I wailed at Mary, who told me it was okay. I had another contraction and screamed into Trish's arm, then I hurried back to the tub, and Mary suggested I try pushing with one knee up to open my pelvis a little bit more. Until then, I hadn't been putting a lot of effort into pushing. I was more or less just following the urges and sensations and letting them happen without actively trying to push Tyler out, but I soon started to get discouraged and tired of the pain. I had originally wanted to just let my body do all the work on its own and deliver Tyler without a bunch of bearing down, but I started to hit a wall. "I just want him OUT OF ME!" I yelled.

My vocalizing started to go from low register grunts and growls and roars to high-pitched, tense screaming, and then I heard Trish's voice in my ear, helping me get back in control. At that point I didn't want to wait anymore and decided to help my body along. I started really pushing hard, but I was still roaring through it and losing a lot of energy through that, so Mary and Pita reminded me to "keep your noise in your chest and push with your belly," so I started holding my breath while I pushed and I felt like it was a lot more productive.

I could feel the sweat dripping down my forehead and I was so thankful when Trish grabbed a cool wet washcloth and wiped my face. I also decided to get up on both feet into more of a squat because I didn't feel like I was making much progress in the position I was in. Mary kept asking me if I could feel him moving down and I just kept saying, "I don't know." I felt so discouraged. Why couldn't I feel him coming down already? A small, irrational part of me started to doubt that I could do this and I wondered if he was stuck. I started crying. "I can't do this anymore!" Mary and Trish reminded me that everything was normal and working perfectly. Everyone kept telling me how great I was doing, and that I was almost done and Tyler would be here soon.

Mary checked again and held her fingers up in front of my face, showing me how far in his head was. About an inch, maybe a little more. "He's right there," she said, "reach down and feel." I did and there it was! I so needed the strength that gave me, he was so very, very close to being here! I tried a few more pushes in that position but didn't really make much progress. Mary thought that I might be able to push more effectively in a different position, so she suggested I lean back against Colby and try that. It didn't sound like something I wanted to do at the time but I knew it couldn't hurt to try. I leaned back against him and sunk into his arms. It felt so warm, loving, comforting, and relaxing.

I tried a couple of pushes in that position. Finally I could feel him moving down, and soon I felt the burning and stinging, the "ring of fire." I don't really remember being able to feel so much during Ryan's birth, even though it was unmedicated, so this was a totally new experience for me. One thing that I found helpful during his birth, though, was the nurse putting her fingers on my perineum and telling me to push against them. I didn't think I'd want anybody touching me during Tyler's birth, but Mary did the same thing and again I found it so, so helpful. It gave me a physical focus point where I didn't feel I had one before.

After a few contractions, Mary and Pita handed me a towel and told me to pull on it with the next contraction. This was what I needed. In the next couple of pushes, he started to crown, and Mary told me to ease up and just let him come out slowly. It was SO hard to not just give it my all and shove him out, but I really wanted to avoid tearing so I backed off and tried to just breathe him out. One more push and his head emerged. Mary told me to reach down and touch it. There are absolutely no words to describe this moment.

Mary felt for a cord and then told me to go ahead and finish pushing him out with the next contraction, and I said, "But I don't have a contraction!" No sooner had Mary said, "It's okay," I was having another one and pushing again. And then he was here.

It was 8:42am. Three hours almost to the minute from the time I had woken up and realized my water was broken. Trish picked Ryan up and showed him his new baby brother. He wanted to get in so bad! I asked if they could bail some water out and help him get undressed so he could get in, too. He was so excited to finally be allowed in the "bath" with Mama, Daddy, and now baby Tyler, who he gave lots of kisses. After a few minutes, Trish helped him back out and took him to have a REAL bath and get cleaned up. Colby and I stayed in the tub a while longer just holding Tyler and looking at him. I let him sniff around and see if he was interested in nursing, and he made a half-hearted attempt at latching on, but really just wanted to cuddle.

Pita felt the cord and said it had stopped pulsing, so she clamped it and gave Colby the scissors to cut the cord. I can't remember if I birthed the placenta before or after this, but I was surprised at how quickly it detached. Ryan's took 30 minutes so I was expecting to wait a while, but I think it was only about 10 minutes before Mary told me it was ready and to push it out. We spent a few more minutes in the tub, but it wasn't too long before Tyler started to complain a little bit about the water temperature, which had cooled down some, so we decided to get out. I handed Tyler over to Mary, and Trish and Colby helped me to the shower to get cleaned up. Colby got in with me and helped me out of my bra and helped me lay down in the tub, because I was EXHAUSTED and didn't feel like standing at all. Tyler was brought back to us for some more skin to skin contact in the shower, and Julia left to pick up breakfast for everyone. McDonalds! Haha.

As soon as I was out of the shower, Mary checked me out and Colby helped me into a clean nightgown. Even with the slow pushing at the end and being in the water, I still tore, but when we finally weighed and measured Tyler, I wasn't surprised!

He weighed 8lbs, 9oz, and was 22.5 inches long with a 14.5 inch head! He's my big boy, two full pounds bigger than Ryan was and almost two inches longer. His head is half an inch bigger, too. Luckily, though, Mary said my tear doesn't need any stitches and will heal just fine on its own. We all settled into bed and ate our breakfast. Ryan was so excited to sit with us and just look at Tyler and give him kisses. I'm so amazed at how much Tyler looks like Ryan did when he was a newborn! He's got less hair and more of a square shaped face, but other than that, I'm sure I would mistake pictures of them for each other.

So now we're a family of four and are definitely making adjustments. Ryan is still excited about baby brother Tyler, but he's definitely a little jealous. Colby was able to stay home with us the first four days, and now my mom is helping out for a few days, too. Trish, my doula, is also a post partum doula and will be spending some time with us, too. Plus, I have some pretty great friends who have come over and helped out by bringing meals or groceries and doing whatever needs to be done, making sure I stay in bed recovering! Thanks to all of you, you know who you are. :-)

Tuesday, July 6, 2010

Reinforcing trust in myself- my night in urgent care/L&D

I have always been very in tune with my body. I am not a doctor, I have very little medical training (CNA certification at one point and took some MA classes in college), but I consider myself educated enough to have a basic knowledge of my body and how it works, especially since it is MY body. Nobody lives in it but me. So in the past, I have had various things go "wrong" with my body and I always have a pretty darn good idea of what it is. I'm thankful that in the past I have had doctors who work WITH me and LISTEN TO ME instead of acting like I am stupid and, because I'm not a doctor, therefore must have no idea about anything medical at all.

A few days ago I woke up at 5:30 in the morning with what felt like a constant contraction. It wouldn't let up. It was more like a Braxton Hicks contraction, but it was painful and uncomfortable and just wouldn't stop. I knew it wasn't labor but I was very confused by it. I got in the bath, called my doula and my midwife, and told them I'd keep them updated. Within a few more hours I was throwing up. I called my doula and midwife and said, nevermind, I seem to just have the stomach flu. It was Saturday so Colby was off and took care of me. A friend also came over, brought me gatorade to rehydrate, crackers to nibble on, and some anti-nausea meds to hopefully help stop the vomiting. She also ran another bath for me and I hopped in. By the end of the day I was feeling quite a bit better and was thinking it probably was a bug.

I woke up the next day feeling mostly alright, but somewhat off, and the pain continued to get worse, and I also noticed it was in my back, mostly on the left, around my kidney. I thought, well isn't this great, stomach flu and then the start of a kidney infection within a day of each other! I have had kidney infections in the past, including during my pregnancy with Ryan, so I was fairly sure I knew what I was feeling. I have also been able to kick an infection with home treatment before when I catch it in the early stages, so I figured I'd just guzzle water, cranberry juice, and nettle tea and it would go away. At one point the pain got so bad I was throwing up, but that's how pain of a kidney infection affects me. It's very intense and I have a hard time keeping anything down. By the end of the day the pain had diminished quite a bit, and we were able to go get a few fireworks so that Ryan could enjoy his 4th of July with a tiny celebration. I was really bummed not to be able to celebrate this year because the 4th is my favorite holiday. I'm used to being surrounded by family and friends, good food, and a lot of fun. This year it didn't even feel like a holiday.

When I woke up the next morning my pain was completely gone and I thought, YAY! I have kicked it! But halfway through the day it started to return. I took Tylenol and it wasn't even touching it. By about 5pm I was laying on the floor, crying, and thinking that I should probably give in and go get some antibiotics. I had held off because I could go into labor any day and I didn't want to risk being on antibiotics when Tyler is born if I could help it, because I didn't want to be worried about yeast and the possibility of passing it on to Tyler and him having thrush and creating breastfeeding difficulties right off the bat. I know there are probiotics for this purpose and of course I take them whenever I am prescribed antibiotics, but most people know I like to avoid medications whenever possible. Anyway, I decided it had gotten to the point where I couldn't deny help any longer. It wasn't going away, the pain was just horrible, so we went to urgent care.

I walked in, told them I'm fairly sure I have a kidney infection as I have had them before and know what they feel like, and am also 38 weeks pregnant and NOT in labor. They took a urine sample and sent me into a room. They took my vitals and when I heard what my blood pressure was I was surprised but not worried. My baseline is 110/60 and it was 140/90. This is very high, but I contributed it to two things: first of all, I was in SO MUCH PAIN, and second of all, I was at the doctor's office... a place I really hate being. This alone can send people's blood pressure through the roof. I knew the high numbers would concern them, so I was not TOO surprised when the P.A. came in and asked me if I knew anything about pre-eclampsia. I told him yes, I'm aware of it, no, I don't believe I have it, I know what my pain is being caused by and I know why my blood pressure is high. At that point he told me they could not do anything further for me there, and that I would need to go to the hospital to be evaluated for pre-e and they would call an ambulance for me. I asked if Colby could take me and he said no, because "you could have a seizure on the way there!" I told him to please give us a few minutes to talk about it and he left the room. I told Colby that first of all, I don't want to go to the hospital as I have no other indications of pre-e, second of all if I do go I am NOT going in an ambulance. When the P.A. returned we asked him some questions. Colby asked if we could be allowed a small amount of time to try and calm me down and retake my blood pressure, and I asked what my other indications for pre-e were. He acknowledged that if it really were pre-e, my blood pressure would most likely not go back down into a normal range, and told me that my only indications for pre-e were high blood pressure and back pain. I asked if I had protein in my urine and he said it looked fine. I told him I was not swelling and he said, "Well, this could be the very beginning of symptoms." It was very obvious that he did not expect questions or enjoy being questioned by us. I looked at him and said, "I am not going to the hospital in an ambulance." He then told me I would have to sign out against medical advice (AMA) and I said, fine. Paperwork was brought to me a few minutes later and it listed possible consequences of not going in the ambulance and leaving AMA as, "seizure, coma, death, death of baby." I signed and we left with paperwork to give to the hospital if we decided to go, and they said they would call the hospital L&D unit and tell them we were on our way.

I still hadn't decided at that point whether I even wanted to go. I KNEW I had a kidney infection, I KNEW I didn't have pre-eclampsia, but they had refused to address any possible kidney infection until pre-e had been ruled out, so there I was with no pain relief or antibiotics to help me at all... I knew I had to go, so I called my friend and, with basically no explanation, said, "Can you take care of Ryan for me for a little while? I need to go to the hospital... I'm fine, we're fine, baby's fine... don't really want to talk about it but... I need your help." She said it was no problem and to bring him over.

At that point, my stupid insecurities started taking over and I thought, what if I DO have pre-e? What if they want to induce me tonight? What if it doesn't work? What if I end up with a c-section? Those of you who know me and know how I feel about normal, healthy birth know that I would consider this to be a horrible nightmare. Obviously if it is what is necessary, I'm not going to decline medical help, but I am supposed to have a beautiful, peaceful, amazing home birth in the next couple of weeks... I'm not supposed to end up with a c-section! This can't be happening! Colby tried to calm me down, saying, "Honey, you don't have pre-eclampsia... you're going to go in, get evaluated, and they're going to give you what you need and we'll go back home tonight, okay? And if by some chance you do need medical intervention, I will be right there with you the whole time, I will help you advocate for yourself and I will punch a doctor if I have to." Lol, what a sweetheart. :-P I called my parents and told them I wanted them to come down just in case I ended up in the hospital, so they could pick Ryan up from my friend and either take him home to our house to sleep or take him back home with them. Like I said, my fears were really taking over and I was imagining the worst.

We got to the hospital, I got hooked up to monitors, was asked a bunch of questions, and had my vitals taken again. BP still high, urine and blood work were sent to the lab. My doula came and helped to calm me down. Got a phone call from my midwife and my blood pressure while I was on the phone with her was only 128/80. Heh. It did go back up a little bit, but I told the resident who was assigned to me that I was sure my BP was high because of pain and stress. She agreed and said she would check it again after I had some pain medication. While I was laying around waiting for my results and my pain medication, Tyler had a deceleration (heart rate went down from the 140s to 80 for a minute or so). At that time, he was moving around a LOT, making me very uncomfortable, and I was about to turn over when the nurse came running in saying that he was having a decel. I turned over immediately, he recovered quickly and was fine the rest of the time we were in there. The nurse asked another nurse to bring in an IV kit just in case of a crash, which was totally unnecessary and ridiculous. I don't even know why they wanted Tyler on the monitor the entire time I was there, anyway. Whatever. My blood work came back showing no pre-e, but high uric acid, my urine showed some blood, leukocytes and negligible amounts of protein (most likely due to the blood in it). She reviewed my records that my midwife faxed in and said that I have been having a very healthy, normal pregnancy and she doesn't see any indication for pre-e besides the blood pressure, which can be explained and monitored, but then she said, "However, due to that little episode with the baby, we now think it would be best if you stayed here overnight for monitoring to make sure baby doesn't crash and you can go home first thing in the morning." Umm... no? If I'm fine and my baby is fine, just let me go home! Unfortunately, she said if I were to leave, it would again have to be AMA. Fine, whatever, give me the paperwork and let me go home! Before I left I got two doses of dilaudid and a dose of IV antibiotics. I also got a prescription for a 10-day dose of antibiotics and some oral dilaudid to get me through the first couple of days until the antibiotics can really kick in.

So, basically, it took me over 6 hours of BS in urgent care and the hospital for them to tell me what I already knew (that I had a kidney infection and no pre-e) and give me the medication I need to get through it. Once again, I am right about what's going on in my body, they have NO idea and will automatically assume the worst, especially in a 38 weeks pregnant woman, and they should've just listened to me in the first place. My trust in my body, in my intuition, in myself, has been reinforced once again. I wish everybody knew how to trust themselves so much. It is so obvious how so many women are pushed into unnecessary procedures and interventions because of fear placed in them by people who should be practicing evidence-based medicine, but are practicing based on fear instead.