Tuesday, August 9, 2011

My Little Pike: The Birthing

So last weekend was very unexpectedly the big weekend. A lot happened between Saturday night and Sunday morning including the birth of Pike Alexander Howard - My Little Noob.

So first the short details (and a spoiler on how this long tail ends) that are always first on everyone's mind:
  • His name is Pike Alexander Howard
  • He was born Aug 7, 2011 at 8:18am.
  • He was 7 weeks premature and weighed 4 lb and 2 oz
  • He was 17.25 inches long

 So the road to the delivery room was harrowing and very sudden. To start with, Beth had had a normal stress free pregnancy all along. No complications and a enviable small amount of morning sickness. All sonograms and measurements were normal, her weight gain was on target and healthy, and all markers that regular prenatal care monitors were exactly what expecting parents and their doctors want to see.

The only major discomfort that she had was regular Braxton Hicks contractions. These are the practice contractions that a pregnant body goes through to tone the muscles for The Big Push. On Monday we spoke to the midwife about them and she gave us some parameters and told us that if these contractions ever exceeded this to go to the ER and be checked for pre-term labor. If this was found to be the case it was treatable and the labor could be slowed and even stopped and put off until the right time.

Saturday we went to visit a friend in Wichita Falls. On the way home the Braxton Hicks started at about the same time they had been starting nearly every day all week. We got home and she bathed and everything calmed down for a bit. Around 10:00 pm they started again and we started tracking them loosely. She got a small break from them, but at 11:00pm we were tracking more closely and by 11:30 we realized that she was getting the Braxton Hicks contractions at a pace that was the "Honey It's Time" rate that we were coached for by our birthing class.

We hustled to the car and drove to the ER expecting a sleepless night and standard labor slowing treatment and then a return home. We arrived at the ER and I signed the paperwork at 12:25 am exactly. We were taken immediately from the ER to a labor room which is standard practice for what our expectations were at that point. The nurse in the labor room took Beth's blood pressure, switched to a new size cuff, switched arms, and finally had to  admit that the readings were not an error. She consulted the on call doctor from our midwife's office and started the process of admitting us. She told us that the contractions seemed to have stopped, which Beth agreed to, but that the blood pressure was at a very critically high level and the doctor was on her way in.

She started going over the things we needed to be concerned about and how they would treat them. She ended by saying that if things continued that the only real way to get Beth's BP down was to deliver the baby. At this point it seemed a little surreal and like a far off possibility. Blood labs were done and the technician was finishing as the doctor came in and the doctor made a very firm point with the tech that these needed hand-to-hand delivery and priority processing.

The doctor went over with us what she was concerned about and again the subject of delivery was brought up. She told us that there were a couple of possible conditions that we could be experiencing here and that the blood work would confirm that. In any case they were brought on my the pregnancy and the only real way to fix them was for Beth to stop being pregnant. She then went on to say that she wanted to transfer us to another hospital because if things did not reverse we needed to be someplace with a level 3 Neo-natal ICU.

At this point it still seemed like a far off possibility that we would be giving birth soon, but it was very clear that Beth was going to have a hospital stay of at least a day so I went ahead and called Beth's mom and left a message for her explaining the situation and to not worry or rush up, but that we wanted her to know what was happening. I also started getting a hold of my friend Chris to see if he could come get a house key from me and help us out with the dogs if I wasn't able to get home in a reasonable time. This was about 1:50 am

They explained the blood work results to us and explained that what was happening was referred to as HELLP Syndrome (Read about it on Wikipedia) in addition to gestational hypertension. By now she was vomiting and being monitored for seizures and had one hell of a headache. Later as I was heading in to the ER one of the delivery nurses told me that we had probably arrived at the ER just in time.

The staff came in and told us that they were talking to the doctors at Lewisville Medical Center and that we would be going there. I asked about driving or if Beth would go by ambulance. The doctor told us that she would go by ambulance and that I would have to travel separately and that Careflight was on their way. I noted that I did not know that Careflight operated regular ambulances and she corrected me at told me that she would be flying there.

The Careflight team showed by about 2:10 and started getting her loaded on their gurney. I talked to the crew captain, Scott, and got expected travel times from them, confirmed by understanding of where we were going, and decided to leave with a head start. I handed off the key to Chris who was just getting off the elevator and gathered everything we had brought with us and then started out the door to drive while they finished loading Beth in hoped of getting there shortly after them.

I went ahead and called Beth's mom, Barb, again while on the road and told them that things were looking more like we were going to deliver but that it was still only a possibility. I told her to get some reast and maybe throw some things together in case I called her later to come on up. She made the very good decision to let Beth's sister sleep. If not for this no one would have been fit to drive, so Kathy was a life saver there. I also left a message for my brother, Shannon, and told him about what was going on and the possibilities but told him that it was still a far off thing.

In hindsight I have to say that putting all the conversations we had up to that point together they were doing more than telling us it was one possibility that we would give birth today. It was a well executed introduction of stressful news in bite sized bits that allowed us to handle it well. There had never really been any "maybe" about it when talking about delivering. I just did not realize it yet.

I missed my exit by a couple miles and doubled back to the hospital and still managed to beat the helicopter. I watched it land and then them unload Beth. Later she told me that they were delayed when the battery on the lift mechanism on the gurney died and they had to get 6 orderlies from the ER to assist them in lifting several hundred pounds of steel with a pregnant lady on top into the air ambulance.

We got hustled up to the maternity ward and got settled in our room right around 2:45 am and the nurses started getting Beth comfortable and processed in. We went over the possible outcomes with just a little more emphasis on the delivery possibility. We were given a talk about the process of a c-section and how premature babies are handled. A neo-natal ICU nurse came by and talked us through what to expect and gave me a trip back to show me where everything would happen and gave us the procedures for the post-birth process and explained the roles of everyone that would be there. They also started shaving and prepping the c-section site - "just in case".

The anesthesiologist came by and  told us that due to the condition Beth was in she was uncertain of whether she would use a spinal or a general anesthesia. We were prepared for how each would play out. General would mean that Beth would not see the baby until the next day. This was due to the fact that Beth would not be allowed back into the NICU until she was done with the medication treatment she was on which was a regimen that would end 24 hours after delivery. A spinal meant that she would get to see, but not hold, him at birth and then not see him until the next day. She asked if we had a name picked out and we told her it was a secret until he was born.

I called Barb again at 4:45 am and held the phone so Beth could talk to her. We told her that we were getting the impression that we were past the point of no return and that they should start out.

We were still told that a lab panel would be done at 6:00 am, the doctor would look at it at 7:00 am, and we would deliver at 8:00 am. It was really apparent to me that the 6:00 am labs were not so much a confirmation of the course of action, but more like a last minute call from the governor.  They ran the labs a bit early and came in and started getting us ready to go. I called a few more key people and let them know what was going on and started getting ready.

We met with the doctor that would do the c-section and he carefully explained why we were at this point and more detail on what HELLP was and that there was no real reason known for it to start, and that reversing it was not working. He told us that it was medically better for mother and child to deliver quickly while it was just an urgent situation rather than letting it become emergent. He told us that the reason this started with no prior warning was just how it went and that due to the urgency trying to answer the question of why really took a back seat to just getting on with delivery and restoring everyone to health.

I got dressed in my gown and hat and made the last minute calls to Beth's mom as I sat in my spot outside the OR and waited to be called in. I was hustled in and given my seat next to Beth's head while the doctors were already starting. I watched the neo-natal team march in and take their places. Beth was experiencing a little panic and claustrophobia from the spinal and I tried to reassure her. She could not feel herself breath and thought that she just couldn't. After a moment the anesthesiologist asked us what the name was and we told her Pike right as  I saw a baby hand lifted above the curtain and the neo-natal team took over as we heard the first cry. Beth was so fixated on the warming table across the room and the look on her face was intense and anxious.

They called me over and I got to take a few pictures after touching him for a moment. We told him over to show Beth and she touched his cheek and then the nurse held him so we could take a picture of them together. It was only a few seconds and then he was taken from her and I followed him back to the NICU.

The NICU staff let me watch them measure him and have a moment of contact before they had to ask me to leave so they could do the next phase of critical evaluations done. I went back to our room and waited for Beth to come back. I held the phone for Beth and let her tell her mom the news. I made a call to my Mom and my Brother and gave them the news.

Beth continued to have blood pressure issues and was in a lot of pain throughout the day. Her mom and sister arrived at our place. Beth and I were planning to get the Labor Room and Recovery Room bags together this week so had nothing with us at all. I talked them through getting a few things before going over to see Pike at noon. When I was done and came back to our room I gave Barb and Kathy the last list items of things to bring and they headed up to see us and finally arrived in the hospital right before 2:00 pm.

We went down to see him after they said their hellos and I oriented them on where all the things Beth needed were located and explained the procedures for visiting the NICU. Barb and I went back at 4:00 pm for touch time and I held him for the first time after his first ever bath. Premature babies do not have a fully developed breathing reflex and the energy he spent fussing at the bath caused him to fall asleep and stop breathing while I held him. The team in the NICU was really calm and professional and got him back to breathing without even taking him out of my arms. When I put him back in his bed they started getting him ready for being put on a ventilator to help stimulate him enough that he would be safe.

I brought back his hat that they put on him in the delivery room and gave it to Beth. She clutched it to her and when it was set down while shifting her and she lost track of it she became very anxious, She has had it with her ever since.

We went home shortly after and got some much needed sleep. By now I had been up 36 hours and was starting to really feel it. We got up early the next morning and ade it to the NICU in time for the 8:00 am touch time and I quietly celebrated his 24 hour birthday by cleaning up his poop for the first time.

Beth continued to have issues and her blood pressure would not come down. Finally around noon they made a medication switch and she was a different person. the vomiting was nearly gone and she was able to try getting up. Eventually she got in a wheel chair and at 4:00 pm we went to the NICU together for our first time all together as a family and her first time ever with a now 32 hour old Pike. Beth was finally able to hold him.

Pike will stay on a respirator for a while. They have told us from the beginning that premature babies usually stay in the NICU until their actual due date which means around 7 weeks. There is always a chance he could be ready early, but they have been careful to set our expectations at the full term level.

So that is the story. I will say that the experience with all the people at both Denton Regional and Medical Center of Lewisville hospitals was great. There was a very reassuring consistency in how everyone handled us from start to finish in the level and frequency of communication as well as the cheerful and reassuring attitude they had. The fact that everything was not only the same high level as we went through two shifts of nurses in multiple places was great. I was also especially impressed with how each person that came in contact with us from Doctors to the various nurses and technicians was such an identical experience in how they talked, how they acted, how they empathized, the level of concern they showed. In meeting about 20 people through the ordeal every one followed the same careful patient management template and was so genuine in their concern for our comfort and well being. The whole thing was made much easier because of this. It should be noted that both hospitals are in the same medical group which no doubt added to the consistency.