Friday, March 23, 2018

On Not Getting What You Want

We are 3 weeks into parenting so far and wow has it been an exciting, emotional, exhausting ride thus far. Today's posts is one that should be filed under "real talk." I'm going to preface this post by saying that we are so incredibly grateful to have a healthy, happy baby boy. I have friends who have experienced infertility and gone to great lengths, emotional and financial, to have a child, and I have friends who have children with serious health problems. We are so very grateful that we do not fall into either of those camps. We got pregnant easily and we have a very healthy boy and I'm vowing to never take those blessings for granted.

But dang, so much about being pregnant and having a child has not gone that way I thought it would or wanted it to. A friend once said that her provider told her that women either struggle with getting pregnant, have a difficult pregnancy, have a difficult labor, or struggle or are unable to breastfeed. The provider said that pretty much no one has all 4 of those things come easily to them. I kept that in mind during the pregnancy.

Clearly, getting pregnant was incredibly easy for us as we got pregnant the first month that we tried. Then as my pregnancy progressed, it became clear that I was not going to have an easy pregnancy. It started with the ongoing, painful RA flares. Then I found out I had gestational diabetes due to being on steroids to keep the pain from my RA flares somewhat manageable. Then I got a terrible blood clot that resulted in a hospitalization and twice-a-day blood thinner injections.

As I approached our induction I thought, "OK, this pregnancy has been hard so maybe I will have a good labor and delivery experience." Except that didn't happen as Paul would not descend in the birth canal so I ended up needing a C-section which was something I was *really* hoping to avoid.

But after the C-section I thought - "Ok, maybe breast feeding is going to come fairly easily to us." I felt like I'd been through so much that I was due for something to come easily for a change.

Oh how wrong I was. As I've mentioned in my last 2 Paul updates, breast feeding has been a struggle. Paul struggled to latch in the hospital so we ended up having to use a nipple shield and even with that, he has been such a sleepy eater that I have to strip him down to a diaper and poke and prod him while breast feeding him to keep him awake and sucking. Then we had a string of doctor appointments, weigh ins and lactation consultant weigh ins which showed that Paul was not gaining enough weight. As of our last appointment on Tuesday with the lactation consultant, he's still below birth weight. We did a weighted feed (they weigh him before he eats and then weigh him after he eats on each side). It wasn't surprising to learn that he had eaten less than an ounce because even with all the poking and prodding and tickling, he was barely sucking and swallowing. Not every feed goes like that - sometimes he will suck and swallow pretty consistently. But a lot of the time he doesn't. So he expends calories trying to eat and I feel like crying (and sometimes do) because something that is supposed to be innate and natural is so very difficult for us. And yes, genetics are at play with his lack of weight gain because Phil and I were slow to gain weight and Phil has a hard time keeping weight on (must be rough, huh?). But he should be gaining more weight than he has and every pediatrician weigh in and lactation consultant appointment left me feeling like I was failing.

On Tuesday at our lactation consultant appointment, the LC reviewed our options and then said, "how are you feeling, mom?" I think she sensed how much I was stressing out over his weight and how defeated I was feeling. She said that this is such a brief and fleeting phase of life and that she wants me to enjoy feeding my baby and that she senses that all the struggles we were having with breast feeding were keeping me from really enjoying the time with Paul - or at least the time he spent eating, which is a lot since he eats 8 times a day. Because for the last week or so, I've been breast feeding him and giving him a bottle of pumped milk and then I was pumping after 5-6 feeds which was just exhausting. So we decided that I would doing more pumping and bottle feeding and only put him to the breast first thing in the morning when I am most full and at the end of the day when Phil is around to help. She was very encouraging and positive and said that as he gets stronger, he may get better at sucking and will eat more efficiently. But until then, we need to get some calories in him and get him growing like he should be.

I've cried a lot since Tuesday because this is just not what I envisioned. I've had friends who have struggled with breast feeding and I've supported them and said "fed is best," which I wholeheartedly agree with. But it's different when you have to tell yourself that fed is best, even when it doesn't look like what you had envisioned. I felt like I had paid my dues with a hard pregnancy and difficult delivery/C-section. And I stupidly thought maybe I was 'owed' a good breast feeding experience.

Except that's not how life works. You don't always get what you deserve. You can do all the right things and still experience disappointment over how things play out. And these feelings aren't only limited to the experience of getting pregnant and raising a child. I remember feeling frustrated over how long it took to meet my life partner. There were times when I was so hyper-focused on my love life (or the lack thereof). But then I met Phil and I realized that he was worth the wait and that we both needed to have our time apart to do the things we were meant to do (career development, MBA, CFA, traveling, etc.). Would it have been nice to have met him sooner? Absolutely. But I can look back and see that it all worked out the way it was meant to.

And now I'm having that experience of wanting something else so badly (the ability to breast feed our son) and wondering if it will ever play out the way that I envisioned. But I also know that this is a period of our life where I'm so hyper-focused on how he is getting fed and that in the grand scheme of things, it really doesn't matter. No one has ever really asked me if I was breastfed. I was, but it's so not relevant once you are out of the infant phase (yes, there are wonderful benefits to breast feeding but sometimes it just doesn't work). And at the end of the day, Paul is still getting my breast milk (plus some formula because right now I'm not producing enough to satiate him right now).

I know that with time this will feel like less of a huge disappointment and a failing on my part. Logically I know that it's not at all a failure on my part - but post partum hormones/emotions really mess with your mind. I keep reminding myself that he's healthy and happy and that I've done everything possible to try to make breast feeding work and that if I need to exclusively pump to feed him for awhile, indefinitely, or until I need to stop due to the stress and exhaustion of exclusively pumping, then that it OK. But it's hard to get that message from my head to my heart.

Friday, March 16, 2018

Baby Paul's 2nd Week

I will eventually blog about something besides baby Paul, but right now that's about all I can focus on! Paul turned 2 weeks old yesterday. I feel like the 2nd week was better than the first week and I think each week will just get better as we'll get more and more confident about what we are doing. We also got more sleep during the 2nd week as we were able to stop waking him to feed so he got some 3-3.5 hour stretches of sleep at night which feel pretty amazing for mom! 

That milk drunk life

Likes: pooping right after we change his diaper, his pacifier (I know they say not to use them before they are 4 weeks when you are breastfeeding, but it helps soothe him so much and the pediatrician in the hospital told us to not worry about using it as he used them from the get go with his children, too), making funny faces at us, laying on his side and being bounced when he is upset.

He loves to pose with his little first by the side of his face. It's kind his 'thinker' pose, with a lip purse added in for some extra sass!
He also likes to houdini his legs out of sleepers so they can have them in a 'frog'pose with his ankles crossed. One time he ever got both feet in one leg of a sleeper. In hindsight we should have gotten some 'sack' type of sleepers. It would make diaper/outfit changes much easier!

Dislikes: still hates diaper changes and getting changed, being cold, and having to work to eat (he thinks mom's milk should flow like tap water it seems).

Firsts:  We started to do tummy time. He's usually not a fan.

He also had his first bath. He loved his first bath. He was not a fan of the 2nd one, though. We are only giving him a bath every 3-4 days as I don't want to dry out his skin. If he liked baths, I might do them more often but until he consistently likes them, we'll do as few as we need to do.

Lastly, he met his sister as she came home from Grandma's last Sunday. Phil thinks that Oscar has aged several years in the past week. She doesn't like loud noises we think the crying kind of stresses her out. She has mostly kept her distance from Paul but she does peek at him throughout the day. Sometimes during the night, she sits on the corner of our bed and watches him sleep in his swing.

Feeding: every 2-3 hours, but usually goes 3-3.5 hours between feeds at night. Breastfeeding continues to be challenging. He did well at his weighted feed last Wednesday but then when we had his weight checked on Tuesday, he had not gained an ounce, even though he cluster fed quite a bit over the weekend. So we saw the lactation consultant again on Wednesday and he did not eat much during that feed. She thinks he is not working very hard to eat when I am less 'full' so I have to pump after every feed, except during the middle of the night, and we give him a 1-1.5 oz bottle after every feed. I had no idea that breastfeeding a newborn could be so much work. I mean, I kind of new because I know other moms who strugged with BF'ing, but until it's you, you don't realize how much work it is and how anxious it can make you when your baby isn't gaining weight. 

That said, he's generating MORE than enough wet and dirty diapers and he's a content little guy so we know he's doing well. Both Phil and I were slow to gain weight after we were born and we were kind of underweight when we started kindergarten so I think that genetics is at play here. I just hope he has gained weight when we get it checked again tomorrow (and then again on Monday). So much for cutting down on doctor appointments after the baby is born. ;)  I'm hoping we get a break after his Monday weigh in - fingers crossed!

Sleeping: pretty well. He still HATES his bassinet. I tried laying him up against the wall of the bassinet (it's mesh so he can breathe through it if he turned toward it, which I doubt he would since he is a back sleeper) and that didn't make a difference. So he still sleeps in his swing. Sometimes he sleeps in it without it being turned on, other times he needs it moving and the white noise machine needs to be on. There's no schedule to his sleep during the day. Sometimes he will nap for a couple of hours. Sometimes he is more awake.

Snug as a bug in a rug in his swing 
Sleeping in momma's arms

Dad:  Phil goes back to work on Monday. Boooo! I'm so glad he's been home for 2 weeks with us. I can't imagine not having him around to help. My mom is coming for a couple of days next week so that will help with the transition to being on our own! Phil does most of the bottle feeding, all of the bottle/pump washing, and so many other things. He still pushes me to lay down for a nap or get out of the house for a break, which has been really nice.

Momma: my RA flare kind of came and went but I haven't had any pain for the last couple of days so hopefully the RA flares are a thing of the past now that I'm on great medications again (which cost $1,000/syringe!! Luckily I do not have to pay a penny for them since I met my out of pocket maximum, plus the drug company provides co-pay assistance since they make so much money on the drug.). 

My post partum emotions seem more in check but I'm definitely more prone to tears. Especially over the weight gain issues we've had. I felt really bad at his weight check at the doctor's office and cried as soon as the nurse left the room. It's tough to not feel all the mom guilt at times! But I'm reminding myself that I'm doing everything I can and that Paul seems healthy and happy. 

I start a new momma class on Monday which I'm excited about! It's a 6-week class led by an RN/Lactation Consultant. Each week there is a topic that gets discussed during the 2-hour class and then the instructor encourages all the moms to meet one other time. I think it will be really good for us to get out of the house at least 2 times a week! 

Friday, March 9, 2018

Baby Paul's First Week

The last week has felt like the longest, shortest time! We had a longer than usual hospital stay and were discharged on Monday afternoon (Paul was born on Thursday), just in time to get home before a nasty snow storm hit! We had to stay an extra day beyond what they keep C-section moms because we needed to do an ultrasound of his renal system. During his in utero level II ultrasounds, one of his kidneys was measuring a bit large so they wanted to make sure that urine wasn't backing up into his kidneys. They did the ultrasound on Monday to make sure the images were as crisp as possible. Luckily there was no other dilation in his renal system. One kidney is still measuring large, but they aren't too concerned. We'll go back for a follow-up ultrasound in 4-6 weeks.

While we were in the hospital, Paul slept like a champ. We had to wake him up for every feeding but after he ate, we put him down in the bassinet and he went right back to sleep.

He didn't wear clothes in the hospital because we did a lot of skin-to-skin time in between feedings.

He likes to sleep in a fleece halo sleep sack but we can't swaddle his arms because he gets pissed if they aren't by his face!

I was so happy when we got discharged on Monday afternoon. We were soooo over being in the hospital. Between the OB, Hematologist, and Pediatrician that would round each day and nurses (who were amazing!!) coming in with medications through the day, there were so many interruptions. Plus Paul's blood sugar was low the day he was born so they had to test his blood sugar 4-5 times that first day to make sure he didn't need to go to the NICU. Luckily his blood sugars went up once he ate. He also ended up with jaundice so he had regular blood draws to check his bilirubin levels. His little heels are so sad as they were poked so many times.

Obligatory family photo before breaking free of the hospital

Paul still spends a good amount of time in just a diaper at home. He's a very sleepy eater so we have to strip him down to a diaper when he eats. I also try to do skin-to-skin time with him each day as he loves it!

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Skin-to-skin with momma
This is one of my favorite pictures of him. I just love the look on his face. It's like he's a little embarrassed to be naked but also posing at the same time.

Phil has 2 weeks of paternity leave. We are really enjoying having him around as he is a huge help and he pushes me to lay down and rest/nap.

Likes: skin-to-skin time, being warm, and his swing

Dislikes: diaper changes, getting changed, being cold, having to work to eat milk at times when breastfeeding, the hours of 9 pm to 2 am. 

Feeding: mostly every 3 hours but I'm going to try to feed him every 2 hours during the day so we can let him sleep for longer stretches at night. So far we have to wake him up to eat. Breast feeding has been challenging but we've made a lot of progress in the last several days. Initially I had to pump after every nursing session - so 8 times a day. But we saw the lactation consultant today and she said I can drop down to 3 pumps a day (to make sure my supply stays high) which is a game changer. Paul is still below his birth weight so until he is back at birth weight and on a growing trajectory, we need to keep waking him to feed. I hope he continues to be as good of a sleeper as he's been so far!

Sleeping: a lot! At night he sleeps in a halo bassinet in our room, but so far only after the 12 pm and 3 pm feeds. Otherwise he sleeps in his swing or on a boppy lounger. 

Division of labor: Phil has been a huge help. Initially he had to help so much with breast feeding as we had to teach Paul that food comes from mommy! While I was breast feeding, he would have to put a dropper of pumped milk in the corner of his mouth at the beginning of the feed and anytime he got frustrated. Paul started eating better on Tuesday so Phil no longer has this role anymore. Hooray! 

During the day, Phil watches Paul while I nap after some of the feeds. Then at night, I go to bed after the 9 pm feed and Phil hangs out with him until we wake him up for the 12 pm feed. Then I'm on duty until he gets up for his 6 am feed. Besides that Phil does so much around the house - laundry, washing pump parts, picking up prescriptions, etc. I can't imagine going through this without a solid partner!

Momma: the post partum emotions hit me on Monday night. I was doing skin-to-skin time and Phil came out of the office and found me silently crying - happy tears. Tuesday and Wednesday were super emotional and I cried over nothing. I hate not having control of my emotions! 

I got to start RA injection drugs on Tuesday. Hopefully they kick in quickly as I'm still have a flare that moves around from joint to joint! 

My C-section recovery is going well. I noticed a huge difference in pain when we got home from the hospital on Monday. There's just no place like home! 

Overall, I'm doing pretty well but the sleep deprivation is EXHAUSTING. I pretty much only get 1.5 hours of sleep at a time before I need to get up and feed him again. I know it will get better and that we just have to get through these early weeks! Good thing Paul is so cute!

Tuesday, March 6, 2018

Paul's Birth Story

Settle in, because this is going to be a long story. Or just skip this entirely if birth stories aren't your thing! Even before I got pregnant I was fascinated by birth stories - probably because I watched A Baby Story all the time when I was in college! But I know they aren't for everyone - especially those who are struggling or unable to conceive (my heart goes out to anyone dealing with that).

Tuesday, 2/27 - Pre-Induction

Our story starts out on Tuesday morning. I had been having pain in my knee since Sunday evening and by Tuesday morning it was super swollen.

You can see how swollen the left knee is compared to my right knee
I'm no stranger to flares, but I usually get them in smaller joints like my fingers, wrists, or elbows. Getting one in my knee was not something I was used to so we decided to call my OB on Tuesday morning just to make sure it wasn't a blood clot. When you get a blood clot, there is swelling and it's warm to the touch - the same symptoms as a flare. My OB decided to admit me to the hospital since my induction was scheduled for the next morning. That way they could do an ultrasound on my knee to rule out a clot and keep an extra close eye on me.

Phil had already gone to work by the time my OB's nurse called back, so I rushed around the house to get what I needed for my hospital stay. My hospital bag was packed but we were expecting to go to the hospital at 7am on Wednesday so I was not prepared to leave on Tuesday morning! 

When I got to the hospital, the nurse examined my knee and said she didn't think it was a clot based the feel of the fluid in my knee, but they did an ultrasound and then I settled into my room in labor and delivery. 

In hindsight, it was probably better that I got admitted on Tuesday because then they were able to transition me to the blood thinner IV (which took 3 attempts to place - ouch!) and I got my consults done with hematology, the OB, the perinatalogist and the anesthesiologist. The consult with anesthesia was the hardest. My OB had thought that I would be able to get an epidural during the induction but it turns out that there is not much data about administering epidurals to someone with a blood clot that is on a higher dose of blood thinners. It increases the chance of a spinal bleed which could result in paralysis. The anesthesiologist was so kind about everything. She reviewed our options after which I said - "Maybe I should just plan on not getting an epidural" and she said that if she was me, she would not get an epidural. I also was able to text my cousin who is a nurse anesthetist to get her opinion and she concurred with the anesthesiologist. My OB came by around 8:30 that night and agreed that an epidural was off the table. We talked about my other options - nitrous oxide and fetanyl - and she reassured me that we'd get through it. Previously I hadn't planned on getting an epidural but I had been open to it when I found out I was getting induced as inductions can be longer and harder labors. So I was pretty upset on Tuesday and cried quite a bit out of fear and anxiety about what was to come. Talking with my OB helped, though, and by the time I went to bed on Tuesday night I was feeling more calm about everything.

Wednesday, 2/28 - Induction Begins

I started the day with a cervical check that showed I was a 'roomy' 1cm and 70% effaced. That was an improvement from the day before so the nurse was optimistic that the induction would take. They placed the cervidil around 8am, which is a gel that is used to ripen the cervix. It needed to stay in for 12 hours so we spent the day reading, playing cribbage (Phil beat me all 3 games - what a stinker), and we watched the monitor for contractions. I had to be continuously monitored because if the baby was under any distress, they needed to stop the induction and stop my blood thinners so they could do a spinal block for a C-section once my labs showed that my blood wasn't too thin. 

Playing the waiting game

Watching contractions come and go
I started to get crampy by early afternoon and started to have some mild contractions. By the late afternoon they were coming regularly so we knew my body was starting to do it's thing.

My contractions are on the top. The monitor below me is the contractions of a woman who was pushing. I so badly wanted to change places with her at this point as I was ready to be done!

The nurse took the cervadil out at 8pm and did another cervical check. Unfortunately I was only at 2cm. But after consulting with my OB, they decided to start the pitocin. Usually they would do something else to increase dilation but they wanted to get the pitocin started so they could see how the baby tolerated it. If the baby didn't tolerate it, they would stop everything and do a C-section the following day.

However, by the time they were getting ready to start the pitocin, my contractions were coming pretty regularly so they decided to hold off as they didn't want things to progress too quickly. During this part I hung out in bed and was able to breath through contractions. Phil laid down for awhile as we knew we had a long night ahead of us. I think they put the pitocin at the lowest level around midnight, though. I was able to sleep from 1:30-3 am but when I woke up the contractions were petering out so they increase my pitocin dose to see if they could get things progressing. 

At that point I started to have some really painful contractions. I got Phil up and sat on the birth ball. I would sort of moan through the contractions while he rubbed my neck and shoulders and told me I could do this. The nurse could see that the contractions were more intense and asked if I wanted to start the nitrous oxide.  I didn't want to start pain meds too soon, so she decided to check me around 4am to see where I was at. I was at 5cm! We were really happy about the progress I had made so she got the nitrous oxide set up. It really took the edge off the contractions at that point and I was able to lay on my side in bed during the contractions which was much more restful. 

The intensity of the contractions continued to pick up so she checked me again at 5 and I was at 6cm. She consulted with my OB - who was on call that day! - and they decided to turn off my blood thinners as they thought we might have a baby in the next 5 hours or so. My OB came in and checked me around 7, I think, and I was at a 7cm so things were moving along. Once I got to this stage of labor, the nitrous oxide really didn't help much. If anything, it was sort of meditative to breath in and out of the mask but I was in a lot of pain during each contraction. 

Things kind of get blurry after this but I know that the OB did another check and I was at 8 cm and then 9cm at the next couple of checks but the head had not descended. And then an hour later I was still at 9cm so she decided to break my water to see if that would get the baby to descend. When she broke my water, there was meconium in it so we knew that the baby might be distressed and not tolerate the increasing intensity of my contractions. 

An hour after she broke my water, she came back and checked me again and I had made no further progress. At this point, I was so exhausted. I had only gotten 4.5 hours of sleep on Tuesday night due to getting to bed late after getting my blood thinner drip started and a middle-of-the-night blood draw to check my clotting levels. And then I had gotten 1.5 hours of sleep on Wednesday night since I was in labor. So I was exhausted and the pain from the contractions was so bad. 

My OB gave us 2 options around 11:30 am (I think). I'd had a blood draw done that morning that showed that my blood clotting was at a safe level for a spinal block or epidural. So she said we could administer an epidural and see if that got my body to relax enough to let the baby descend so I could start pushing. The other option was to do a C-section. All along I wanted to avoid a C-section but at this point I was so exhausted and I knew that I did not have it in me to potentially work through more contractions and then push - potentially for hours. I was really emotional at this point and started to sob and said I felt like a wimp. My OB, who I love and trust, told me that I had been so strong and that I had given it my all. And the nurse echoed what she said. Phil also told me that this was the right decision and that I had been a warrior. So we decided to go with a C-section. 

Shortly there after, I got 2 really strong back-to-back contractions and the baby's heart rate decelerated. My OB was still in the room at this point and she said that we just got confirmation that we made the right choice because if we had decided to go the epidural route, that plan was no longer an option because we needed to get the baby out. They had me switch back and forth between oxygen and the nitrous oxide to see if we could get the baby's heart rate up and I had to get on my hands and knees to see if the baby would do better in that position. This was the most vulnerable and upset I have ever been in my life. I was crying so hard and writhing in pain but Phil was amazing through all of this (even though I know he was terrified and had the hardest time seeing me in that condition). 

Things moved really fast after that. They pushed off a scheduled C-section and got us into the operating room ASAP. Everyone was so incredibly nice and it was wonderful that my OB was the one doing my C-section. I have such an excellent relationship with her, so it was reassuring to have her talk me through everything. I got my spinal block and then Phil came in and sat by me and reassured me that everything was going to be ok. 

It felt like it took forever for them to get the baby out but Phil said it actually happened pretty quickly. He was able to announce the gender and I'll never forget the look on his face and the emotion in his voice when he told me we had a baby boy. He cried right away when they got him out so we knew that he probably hadn't inhaled meconium and would be just fine.

My doctor showing me baby Paul
 Phil got to cut the umbilical cord

And then they brought him over to my chest for our first family photo.

As I mentioned in my last post, I was able to do skin-to-skin with him while they stitched me up, which was incredible and so calming for both of us. 

After that, I was out of the OR and in the recovery room where we did more skin to skin and tried to start breastfeeding (which didn't go all that great - breastfeeding has been a struggle but we have made so much progress thanks to meeting with lactation consultants each day we were in the hospital).

By the time we got up to our post-partum room, my parents were there and ready to meet little Paul. They ended up being our only visitors in the hospital as I was very overwhelmed by all the people in and out of our room and I spent so much of my time in the hospital topless so we could do skin-to-skin and work on breastfeeding. Luckily my family understood and will meet him later this week when we are more settled in at home. We got discharged yesterday afternoon, so I ended up being in the hospital for a week total! It's so good to be in the comfort of our home, but I am thankful for the excellent care we received while in the hospital. The nurses and lactation consultants are angels on earth.

So there's my LONG story of little Paul's arrival. Like this pregnancy, his arrival did not go how I wanted it to go. But I knew all along that it was out of my control. We are exhausted and sleep-deprived but the baby cuddles are so amazing. We keep looking at him with wonder over the fact that Phil and I created him. It's also been amazing to watch Phil become a dad. C-section recovery is SO HARD so I rely on him so much. He had to do all the diaper changes for the first several days and has just been an all-around trooper. I didn't think I could love him more than I already did, but I do. 

Sunday, March 4, 2018

Meet Paul Donald!

Paul Donald came into this world at 1:07pm on Wednesday, March 1st via C-section after a stalled out induction! He is named after his grandpa's as my dad's name is Paul and Phil's dad's name was Donald. 

He weighed 7 lbs 5 oz and was 20" long. And his head was very average so they were wrong about it being 96th percentile!

Our first family picture
I will share the (long) birth story later this week. I was disappointed that we needed a C-section but luckily he was doing well when they got him out so I got to do skin-to-skin with him while they stitched me back up. I wanted 3 things out of our birth story: vaginal delivery, delayed cord clamping and skin-to-skin, so at least I got 1 out of those 3 things.

Skin-to-skin in the recovery room
He has the blondest hair! Every care provider comments on it as they usually don't see blond babies with so much hair.

We are so in love. We've been through the ringer over the past week - more on that in the birth story post - but he's worth it!