Madelyn's Birth Novel

  

                                                      Madelyn’s Birth Story

                                                          Madelyn Rachel Ogan

                                                          January 18^th, 3:44PM

                                                           8 lb 11 oz, 21 inches

***** If you are not comfortable reading about the birthing process, birthing terminology, etc. please don’t read any farther! *****

Warning – this is extremely long, detailed, and contains a lot of medical information as it was written for my personal remembrance.

Madelyn’s birth experience was completely different in almost every way from our first two births.  Actually, even Madelyn’s pregnancy was different from the start.  My first two pregnancies were ideal – no nausea, no food aversions, I felt great, I went full term plus some, and had no complications during the pregnancies.

A few days before I took a pregnancy test with Madelyn, I began to suspect that I was pregnant due to bouts of nausea and insomnia.  So I wasn’t surprised when I took a test and it immediately turned positive.  The first trimester I had constant nausea, was plagued with crazy food cravings/aversions, and had multiple yeast infections.  Around 16 weeks the nausea and food cravings/aversions went away and for the next few months I felt pretty good.

When Thanksgiving rolled around I was 28 weeks and feeling great, so we traveled 9 hours to TN for Thanksgiving with some of my family.  When Christmas rolled around I was still feeling great, and after receiving an ok from the doctor, we drove to Colorado for Christmas with Jeff’s family.  We split the drive into two days both ways, Jeff did all the driving, I stayed well hydrated, and we stopped frequently – I was 33 weeks driving out and 34 weeks driving back – the trip went well and I felt great. 

The last few days we were in Colorado I noticed that my urine was a bit darker than normal and I was having some itching.  I passed it off as not drinking enough water, and dry skin from the dry Colorado climate.  Shortly after arriving back home the itching began to intensify – it was mainly on my back, chest, shoulders, and arms.  I did some online research for “intense itching and pregnancy” and came across the condition “cholestasis of pregnancy”. Cholestasis of pregnancy is a rare condition (occurs in 1 in every 1,000 pregnancies in the U.S.) in which the normal flow of bile (from the liver) is interrupted by the high amounts of pregnancy hormones. I had an appointment with my OB, Dr. Singleton, at 34.5 weeks on a Wednesday, and when I mentioned that I was very itchy he said the only thing that might be a concern would be my liver, and he ordered some labs to evaluate my liver function.  I knew from my research that the LFTs he ordered were one of two labs used to diagnose cholestasis.  The next day they called to say that my LFTs were within normal. 

The following week my itching increased greatly – this is not a normal itch!  It feels like you are itching from the inside, you feel like your skin is crawling, it is generally worse at night making it difficult to sleep, lotions and Benadryl don’t help, I would wake at night with spots of blood on my shirt from itching, etc.  I remember itching so badly that even the water hitting my skin in the shower that day was miserable!  I called my OB office on Wednesday and talked to a nurse.  I asked about having my Bile Acid levels tested (the other lab used to diagnose Cholestasis).  After the nurse talked to my OB, she called back and said that he said testing my Bile Acid levels was the next step.  I went in the next morning to have that lab drawn.  The bile acid test takes a few days to get the results. 

The following Wednesday I saw my OB again at 36.5 weeks, where I found out that my Bile Acids were 97 (normal is 20)! Remember, this lab had been drawn six days earlier, so for all we knew my bile acids could have been even higher by then.   Dr. Singleton tried to get me in to see the high risk OB as soon as possible, but the earliest he could see me was the following Thursday.  Dr. Singleton was able to talk to the high risk OB on the phone and he prescribed Ursodiol, a medication that could possibly reduce my bile acids and help with the itching.  I was scheduled to return the following morning for a BPP ultrasound (a detailed ultrasound looking for specific movements and measurements).  Good news from that appointment was that I was 3-4 cm dilated!

The previous week I had been reading anything I could find online about cholestasis, as I was fairly certain I had it even before my bile acid results returned.  And the things I had been reading were not comforting.  Cholestasis is typically not a danger to the mother, and usually goes away shortly after birth.  But cholestasis is potentially dangerous to the baby.  These dangers include risk of premature birth, risk of meconium aspiration, risk of fetal distress, and risk of unpredictable sudden infant death during late pregnancy.  Oh how thankful I was to feel every little kick and movement!

Wednesday night I was having a difficult time sleeping due to the itching, and I began searching online yet again.  I found a very informative website with links to medical journal articles about cholestasis of pregnancy.  From what I was reading, standard procedure is to deliver women with mild cholestasis (bile acid levels of 20-40) at 37 weeks, because fetal deaths clustered between 37-39 weeks.  And to sometimes deliver women with severe cholestasis (bile acid levels above 40) as early as 36 weeks.  I was 36+5, so the thought of waiting 8 more days (I would have been almost 38 weeks) to see the high risk OB was not very reassuring.  I also read that some believe for every point your bile acids are above 40, the baby had a 1%-2% increase in risks.  Before my appointment Thursday morning, we printed off some of the medical journal articles, highlighted pertinent information, and Jeff and I agreed that we were not comfortable waiting a whole week to see the high risk and were going to ask Dr.Singleton to induce us that weekend unless he had good reason to convince us otherwise.  Our prayer was that if Madelyn needed to come out sooner rather than later, that the BPP ultrasound would indicate a need to deliver, and that Dr. Singleton (who is wonderful and we love and trust) would feel likewise.

So all of that was background information!  Now we get to the actual birth story.

I had slept very little both Tuesday and Wednesday nights due to the intense itching.  Our sweet friend Krista was scheduled to keep our kiddos Thursday morning while I had the BPP, so Jeff could get some sleep.  He was supposed to attend class that night, and had gotten very little sleep the day before.  He was going to keep the phone by his bed “just in case”.  I didn’t take my hospital bag, because I thought at the earliest, we would induce Friday or Monday.

I was running late and on the way to drop off the kids I totally lost it – the kids were in the backseat trying to tell me something while I was talking on the phone updating my Mom.  The kids started screaming at me trying to get my attention, and I lost it and began screaming at the kids not to scream at me (definitely not effective parenting!).  I then began crying, told them how much I love them, and asked them to forgive me for screaming and not talking kindly.  I dropped the kids with our friend (Thank you Krista!  I know the kids had a wonderful day with you and your girls, and I didn’t worry about them even once.), tearing up as I left, and headed to the OB clinic.  Thankfully, the crying was under control by the time I arrived.

My appointment was for 10:30 and I didn’t have to wait long before being called back for the BPP.  Madelyn was moving well and her heartbeat was great.  But she was measuring bigger than her gestational age, her abdomen was measuring disproportionally large, my amniotic fluid level was high, and she wasn’t doing the practice breathing movements they like to see.  I heard my phone receive a few text messages during the BPP and assumed it was my mom calling to see how things were going.  After the BPP I was sent back into the waiting room, where I waited a few minutes before being called back to a room to see my doctor.  While in the waiting room I checked my text messages and found a text from Krista asking where I was and saying that our friend Diane wanted to come sit with me while I waited.  We have such a wonderful church family!  I replied to the text saying that the ultrasound was already over, and that I was almost finished and would be seeing the doctor soon, but to please tell Diane thank you for offering to come!

I was called back to a room, and while waiting the nurse stuck her head to ask if I was expecting anyone.  I said that Diane might have shown up, and if that was who is was she could come back.  Diane had searched until she found me – thank you Diane! 

When Dr. Singleton came in I was all prepared to convince him of why I needed to be induced soon.  But I didn’t have to.  He said he didn’t have a good feeling about things, to which I agreed that Jeff and I didn’t either and that we wanted to ask him to induce me sometime that weekend.  He said, “Not this weekend, today.”  I laughed and showed him all of the highlighted journal articles I was going to use to convince him!  Our prayers had been answered – the BPP showed some concerns, and Dr. Singleton felt that we needed to be induced sooner rather than later.

The next half hour or so is a bit blurry. Diane was going to meet me over at the hospital and stay until Jeff arrived. Lots of phone calls were made – first to wake up Jeff, who hadn’t gone to sleep, but had instead cleaned the house!  I think he was a bit nervous and anxious to hear how the appointment had gone!  I told him where the hospital bag was and asked him to put a few more things in it and then to meet me at the hospital.  My mom was called and updated on everything, and began preparing to drive here from KY the next day.  And my sister-in-law Jenny in Memphis was called – she and her kiddos had been packed and waiting an entire week to come take care of the kiddos if needed.  Thank you Jenny, I know the kids had so much fun with you and their cousins!

Diane and I met up at the hospital (I am guessing this was around noon or 12:30) and proceeded to L & D where I was checked in, shown to a room, changed into a gown, answered some background questions, etc.  During this time Jeff called to ask me if I knew where his keys were!  After searching the house, he found them locked in his truck!!!!  Thankfully he found his extra keyless entry in the house and was able to unlock the truck, lol J

Jeff arrived sometime a little later, Diane visited with us for a little while before leaving, IVs were started, my nurse (we were blessed with wonderful nurse that day) checked my cervix (4cm), fluids were hung, and around 2:00pm Pitocin was started.  I think we were all expecting me to dilate over the next few hours as they upped the Pitocin, and then have a baby that evening sometime.  I was having some contractions on the fetal monitor before the Pitocin was started, and as the Pitocin was slowly increased over the next few hours the contractions became closer together and regular, about 2 minutes apart.

I had decided before the induction was started that I was very open to the idea of an epidural.  I knew I was already physically exhausted from not sleeping the previous two nights, and emotionally exhausted from all that had taken place the previous 24 hours.  I also did not feel mentally prepared for a natural delivery as I thought I had a few more weeks (Jonathan was born at 41+5 and Kellen was born around 41 weeks) AND I had never had Pitocin before, but had heard it was much worse than natural contractions.  Jeff told me later that everything we talked about that day I managed to turn back to the topic of epidurals and how I might want one :-D

Dr. Singleton and Dr. Simmons both came by that evening. Dr. Simmons was on call for that night.  I had never met him before, but had always heard wonderful things about him.  And I will say all the things I had heard were true – he is a wonderful doctor and we were very thankful to have him caring for us that night!  We love how he grabbed our hands and prayed with us and how he had such a calming presence about him.  What a blessing it has been to be at a Christian OB clinic with Godly doctors!

By that evening the Pitocin was running at 18 (20 is the highest rate), and I was very surprised to find the contractions very bearable; I felt tightening, but they really weren’t painful.  I am not sure the timeframe of when they checked me, but even with the Pitocin at 18 with regular contractions, I was dilating very slowly.  I think by midnight I was only at 6cm. We had tried walking laps, sitting/bouncing/swaying on a birthing ball, relaxing and watching a movie, etc. They also said that Madelyn wasn’t engaging in the birth canal – every time they would check me they would feel her head go up.  They said I had so much amniotic fluid that it was cushioning her during the contractions.  That is why my contractions weren’t painful and why she wasn’t engaging.  She had too much room to move around!  Also, they didn’t want to break my water with her so high, because there was a danger of cord prolapse (the cord comes down in front of the baby’s head, the baby’s head would put pressure on the cord, and oxygen would be cut off from the baby = emergency c-section).

At 1:30am Dr. Simmons came in to check on me.  He decided to turn the Pitocin completely off for a few hours to give my body a break and to let me get some sleep.  We would turn the Pitocin back on in the morning and see if things progressed better then.  Jeff and I were both very tired, but I was having trouble sleeping.  I had Benadryl ordered if needed for itching, and the nurse said it might help me sleep too, so I decided to take a half dose (this would have been only ¼ of a normal dosage most people take at home.)  I don’t know if I have ever taken Benadryl before!  I was given Benadryl through my IV and it is the only thing I would have done differently if I had it to do over again.  It immediately made me feel weird!  I very rarely take any medications, and I think I am more sensitive to them than most people.  I felt like I was floating and that the room was sort of, I don’t know, maybe wavy?  And it didn’t help me sleep!  I began to have a lot of cramping in my back, and thought maybe it was back labor with contractions.  But the cramping was more continuous than the contractions (I am not even sure if I was really having many contractions.) and I couldn’t get comfortable in the bed. I think my back muscles were just worn out from toting my big belly around (I had been having problems getting in a comfortable position with my back to sleep at home the past few weeks too) and from all the Pitocin contractions.   We had a super sweet and friendly nightshift nurse, who stayed in our room and visited with us for a few hours while doing her charting.  I finally fell asleep around 6am and slept for an hour.  When I fell asleep my sweet husband went out to the nurses’ station and told them I was sleeping and to please not let anyone disturb me.  Our nightshift nurse abided by his wishes, so we didn’t get to see her again before she left that morning, but she left a sweet note telling us goodbye!

I am not sure of the time, but at some point that morning the Pitocin was started back and they slowly began to up it.  Dr. Simmons came in that morning around 7:30ish, told us he would be leaving soon and Dr. Singleton would be taking over again.  We couldn’t have asked for two better doctors – we were excited that Dr. Singleton would be the one caring for us that day.  Dr. Simmons told us about a procedure that Dr. Singleton might want to try.  Instead of rupturing my water like they normally do, he could try to make a few very small pricks in my amniotic sac, having a shower head type affect to slowly release my water instead of releasing it with a big gush.  I don’t remember if Dr. Singleton came in then to discuss things, or if the nurse talked to him and she came in to discuss things.  I was considered a failed induction because I wasn’t progressing, and we could either do a c-section or try the small pricks to slowly release my water.  We opted for the later.  There was the risk that it would not work, that my water might completely rupture and gush, and that the cord could prolapse.  If that happened, the nurse would have to hold the baby’s head off the cord while I was taken to a stat c-section.  I opted to get an epidural, so that if the above scenario did happen, I wouldn’t have to be put under general anesthesia for the c-section.

So we called for an epidural, but before the nurse anesthetist came in, a resident nurse anesthetist came to talk to us, and asked if I would mind if he performed my epidural under the watch of the nurse anesthetist. I asked him how many he had performed, he said about 20, and I told him I felt like a total dog but that I really wanted the nurse anesthetist to do mine.  I totally understand his need for experience, and I have been in his shoes as a nursing student, but I just really didn’t want him to do it!  Thankfully he told me he understood, and that he would get to do plenty more that day, which made me feel much better about rejecting him :-P

They said they wanted to give the epidural a little higher than normal and wanted to make sure it took well, in case we ended up with a c-section.  So they came in, looked at my back, etc.  While the nurse anesthetist was poking around my back he said, “Wow, you are tiny!”  I realize he probably says that to everyone, but when you are sitting there half naked with a ginormous pregnant belly it is nice to hear J.  The epidural was non eventful, took better on my right side than my left, so they tried positioning me on my left side, etc. 

After getting the epidural

The nurse put in my catheter, and shortly after that I began to have a weird and urgent sensation that I needed to pee.  The catheter was draining urine, so it was weird that I had that sensation.  It began to get worse and worse, the nurse said to hit the epidural button to see if that would help, and she then called for the nurse anesthetist to come back in.  He came in and said that this does happen sometimes with the epidural and he gave me a bolus.  That completely took care of the bladder problem, but then my blood pressure began bottoming out.  The machine kept taking my blood pressure and alarming, the nurse came in the room, and I began to feel lightheaded as I watched my blood pressure readings slowly going down.  The nurse anesthetist was called back into the room and he pushed Ephedrine.  This raised my blood pressure some.  I think he had to push Ephedrin once more before all was said and done and my blood pressure stabilized.

I think I then napped before Dr. Singleton arrived, not sure though, the nap may have been later.  I think it was now midmorning?  Dr. Singleton pushed down on my fundus, which pushed Madelyn’s head down.  He then felt to make sure he didn’t feel a pulsating cord.  Next he made some (I think he said two?) small pricks, and my water began trickling out and was very clear.  He continued pushing down on my fundus through a few contractions while watching Madelyn’s heart rate on the monitor.  And her heart rate stayed beautiful!  Then he stopped pushing on my fundus and continued watching her heart rate – again, beautiful!  He then left and I rested, I think this might be when I napped?  A little while later my water truly ruptured and gushed everywhere!  And let me tell you, I had A LOT of fluid. Jeff called my nurse and they used towel after towel to soak up all the fluid.  I think my belly shrunk in half when all that fluid came out.  Then I rested (this is probably when I napped!) and over the next few hours I dilated from a 6 to 8 and then on to a 10.

At one point while I was resting I rolled onto my left side and Madelyn’s heart rate dropped, the nurse had me roll onto my right side, and her heart rate went back up to normal.  But when I rolled onto my right side the epidural stopped working on the left side and I was feeling the contractions on that side – weird sensation to have the right side totally numb, but not the left.  They had me roll on my back to see if that would help, but it didn’t.  The nurse anesthetist then came in and repositioned the epidural catheter, and gave me a partial bolus (didn’t want to risk blood pressure problems again with a full bolus).  It worked and I couldn’t feel the contractions on either side.  I think at this point I told Jeff that I loved epidurals and was done with natural childbirth forever!  Pretty sure I said that a few times throughout the day and then again while I was pushing J.

Dr. Singleton came in again mid-afternoon, checked me, and said I was complete and we could try pushing.  NICU team arrived for the delivery because of her gestational age (36+6), and setup for the baby.  I pushed with a few contractions and Madelyn Rachel was born at 3:44 pm!  I had been praying that she would cry, and a few seconds after her head delivered she did!  Not a super loud cry, but it was the sweetest sound this momma had ever heard!  Madelyn did great, and had Apgar scores of 8 and 9.  I had a second degree tear, was stitched up and delivered the placenta (or vice versa).  Madelyn did have some low blood sugars, and had a little formula to help with that, but otherwise she and momma both did great.  The doctors allowed me to manage my blood sugars throughout the entire 26 hour labor and delivery.  And they did great, ranging from 60s-130, the entire time.  I don’t think I have ever been as tired as I was after Madelyn was born.  That night I couldn’t keep my eyes open and could barely even hold Madelyn.  Jeff wasn’t in much better shape, so we opted to have Madelyn stay in the nursery except for feedings.  Boy have we relaxed with our third baby – Jonathan never left our sight and Kellen only went to the nursery for assessments!

She's here!

                                 

Holding my girl!

Madelyn and Dr. Singleton

Snuggling with Daddy

Snuggling with Mommy

First bow!

Grandma arrives!  Yay!!!!!

So tired, but sooooo happy!

Sleepy Daddy and Madelyn

Kellen meeting Madelyn

Jonathan meeting Madelyn

We were discharged home at 24 hours.  We had one choking spell the first night home that really scared this momma, but other than that Madelyn has done great and this has been my easiest recovery by far.  Madelyn has been jaundiced, but the pediatrician prescribed a LED light for a few days to use at home and her bilirubin levels have slowly been coming down.  We praise the Lord for this precious little one and are so thankful for her addition to our family.

Sweet little one!

Look at all that dark hair!

Happy to be home with our little girl!

Jonathan woke up EARLY one morning, and Jeff took him back to his bed. In the morning I found them sound asleep in Jonathan's toddler bed!  Talk about one tired Daddy!

Big brother loves Madelyn :-)

Trip to the pediatrician to get our biliruben levels checked.