First Birthday Birth Story revisit and updated pictures!!!!

nurselochia · #1 September 21st, 2011, 05:37 AM

Ah, to relive Caleb's birth story, fun to remember. And man, what a miserable day leading up to his birth, but well worth it. It really seems like just a couple days ago. Happy birthday little buddy!!

Ok, I'll try to keep this so it doesn't turn into a huge novel

Sunday 9/19 I went to work as usual. I had been a bit uncomfortable all day...had what I called butt cramps and I was just plain uncomfortable. But, really, I've been uncomfortable all pregnancy and so far nothing was changing my cervix. So I go on about work and at one point a couple of the other nurses and I thought we'd mess with the nursery nurse that was working. One of them went to the nursery and told her "Marta, get ready for a c/s. Jaime's water broke and she's only 34 weeks!" Yeah, we nurses have a sick sense of humor, but it was all in good fun. Little did I know what was in store 24 hours later. Anyway, I push with this patient for 3 hours and she finally delivers. I had started gettting really uncomfortable, not with clear cut contractions, but my back was killing me, I felt like I could faint and vomit, and my uterus was just sooo tight, it actually felt like it could pop. The midwife I was working with asked me a couple times if I was ok. I told the charge nurse after the baby delivered that I was not feeling well at all and needed to rest for a bit afer it was all said and done. So delivery done, patient taken care of, and I run to the bathroom to vomit. I also took a brethine, hoping that would help. I feel a bit better after vomiting, but I notice I'm passing pink mucus. I sat down with a huge glass of water, ate my sandwich and finished my charting, but still wasn't feeling good at all. Finally, after much debate, we decided I needed to clock out and become a patient around 4am. I was contracting pretty frequently, cervix was 2cm, soft, but thick, but it was easy to reach. I really thought a few shots of terbutaline would do the trick. Two shots in, I'm still contracting, and my pulse is 130 so they have to hold the 3rd dose. By now, it's 7am and my doc comes to see me. She said that when my pulse slows, I'd get that 3rd dose. If that didn't work, then she'd give me a dose of procardia to see if that helped. If that didn't work, then she'd have to start me on Magnesium Sulfate since I was only 34 weeks. I know some hospitals go ahead and let you deliver at 34 weeks, but in this area, we stop labor at that point. I knew from experience as a L&D nurse that if 2 doses of terb didn't slow the contractions, then the 3rd wouldn't and the procardia probably wouldn't either. Got the third dose and no change in contractions. I get the procardia and you guessed it, no change. By now my pulse was 150 and I felt like complete crap. At this point, I know what's coming: Mag. My IV is started and they draw labs, do a GBS culture and I get a 6g bolus of Magnesium sulfate and then the maintenence rate is 2g an hour. Mag sucks. It feels like fire in your veins, in makes you nauseated, and hot. I did ok with the bolus. Finally, the contractions start spacing out. I begged to not have the foley catheter...doc said fine but I had to use the bedpan and was not allowed anything to eat or drink...just in case. After about an hour on 2mg of mag, the contractions pick up again so I had to have the catheter to keep my bladder empty. They ended up bumping the mag to 2.5g/hour then to 3 g/hour. Finally, they slowed again, cervix still unchanged, thankfully. When they increased the Mag to 3 g, I started to have a bit of a melt down. I started worrying about the baby - I see 34 weekers born all the time and they almost always have problems. yeah, in the long run, they do fine, but initially, they have problems breathing, sometimes need to be ventilated and given surfactant, which my hospital doesn't do, they get transferred to another hospital with a big NICU. They also have problems with their blood sugar, keeping their temp up, weight, etc. Plus my daughter was 36 weeks and had respiratory issues, so I started freaking out. I called DH and he came to the hospital...I texted my sister, DDB Heather, and talked with my coworkers, trying to calm my nerves. They were all reaassuring, but I don't remember the babies that do well...I remember the ones who don't do well. Finally, after my "moment" I got myself together and really needed to turn the labor nurse part of me off. Doc ordered a cocktail of meds that will help with pain/nausea/and will make people sleepy, since I had been up since Sunday a.m and it is now Monday at 3pm. I didn't want this cocktail b/c I didnt' want to be anymore out of it than I already was on the Mag. I was seeing double and couldn't think straight. That combo of Nubain and Phenergan did not help at all with my mental clarity. From about 3;00pm on, I was out of it. It was like I was in a daze...not able to really sleep, but I couldn't keep my eyes open. Around I think 4pm, my doc came to see me again...this time I felt like she really didn't think I needed to be there, kept saying "It's your 4th baby, your cervix hasn't changed, you were contracting every 2 minutes last appt and you're probably just someone who contracts. When they hurt, then we are concerned. I'm not going to rush you back for a c/s unless your cervix changes". This pissed me off. Ok, first I was uncomfortable, and that was why I was admitted. Second, I know I contract all the time and when they didn't hurt, I didn't worry about it. Third, the LAST thing I wanted to be was delivered. I don't know if it was b/c I wasn't quite with it, but my coworker taking care of me told me she was just trying to reassure me that she didn't think I would have to be delivered. So I tried to relax. I sent DH home to take care of the kids and said I'd call if anything happened. At that point, I gave up trying to control what was happening because it was out of my hands. The rest of the evening was uneventful. I was in and out of poor sleep, got stuck for a magnesium level because my coworkers were concerned I was getting too much mag, and around 1am, my coworker came to give me another round of the Nubain/Phenergan. Fifteen minutes later, I notice my underwear was wet. Ok, I thought maybe it was the KY Jelly oozing out from the cervical checks, or maybe the catheter was leaking. I took it off, it was covered in mucus, but I had been losing mucus all day. Over the next hour, I finally realized that it was probably amniotic fluid I kept feeling leaking, and the pad under me was wet. I considered not saying anything right away...I had just been doped up with drugs and the last thing I wanted was to be drugged out when my baby was born. Plus, I worried about how he would come out b/c of the drugs, but reason won and I called my nurse. Sure enough, it was amniotic fluid, not that either one of us had any doubts. So I called my DH...and he didn't answer. Ok, I figured maybe he was in the bathroom. I called 7 times and he didn't answer and I was furious! How could he not have his phone next to him! I had called my mom and she was on her way, but she is 1 hour drive away. My charge nurse actually called another coworker of ours who lives a block from me...she was still awake and she walked to my house to wake DH. About the time she knocked on the door, I got ahold of DH - he had been trying to get Isaiah back to sleep. In the mean time, Kelly (my RN) called my doc, told her my water broke and that I wouldn't be going back to the OR until DH was there. My doc, (this ticks me off), wanted to make sure it was documented that I was "refusing" to go to the OR until my husband was there. Baby was fine, I was fine, so I don't know what her problem was. I think it was just the middle of the night thing - she had said half-jokingly earlier that she didn't want to see me at 2-3 in the a.m., and this phone call was at 2:30. It still irritates me, but whatever. Dh gets there, they also called in my pediatrician (who wasn't on call) and the favorite anesthesiologist (also wasn't oncall) and they came in for me. It was really, really nice that they came in for me! I had no idea how weak I was from the mag, but I couldn't even stand up to get myself into the wheelchair. So they help me into the chair, and off we went to the OR. I've been through c/s before and I've seen hundreds, but when it's me, I'm still scared ****less. I get prepped, draped and again, they ask if I want to go through with the tubal ligation or wait until later. I wanted it done then. At 3:47 a.m little Caleb Dean was born with a hearty cry before his body was even delivered! His umbilical cord was wrapped around his body. He did great, as I have bragged already! His apgars were 9 and 9, and he was 6lbs 1 oz, 18 1/4 in long. He was beautiful and looked just like my firstborn - full head of dark hair too! I got to cuddle him a bit before they took him to the nursery for a complete evaluation. He checked out great in the nursery, never needed oxygen. He just didn't seem to realize he was preterm! I finally got to hold him in recovery and he looked like he might nurse so I figured we'd try. I didn't have much hope he would because 1. it's hard to breastfeed on the recovery cart and 2. he was early and they don't always know how to suck. I laid him on my chest and he latched right on. I was amazed! I was laying down, and here is my little 34 weeker nursing better than my other kids did! THe rest of our stay was uneventful - he still nurses like a champ, his temps were always good, his weight was fairly stable and although he was a bit jaundiced, he is fine now. He came home on time! with a biliblanket to help bring his bilirubin down, but the next day it was down enough we didn't need it anymore!

I recovered well. The duramorph they put in the spinal for pain control (a form of morphine) always made me itch like a madwoman, so they only gave me half a dose. I still ended up itching myself into a rash. I ended up with a narcan drip to reverse the effect of the duramorph - that also took away the pain control and I then was in quite a bit of pain, but some toradol and fentanyl did the trick. The pain was good and the itching was gone. I don't think the anesthesiologist believed my itching was as bad as they had said until he saw me in the hall - then he went to town trying to figure out what to do for me and we tried to decide if it was the duramorph that I had an allergy to. He suggested I list morphine as an allergy and also that I might have a latex allergy. Gloves dont bother me, but he thought maybe with exposure internally, it woudl cause the systemic reaction I had. But anyway, life was good. Caleb got to stay with me, never had to be in the nursery - I did let him go at night between a couple feedings b/c some of the girls wanted to get their hands on him...we love to cuddle with babies, especially babies of "one of our own". When I saw my coworkers I worked with Sunday night...you know, the one's who were in on the little joke about my water breaking...we had a little laugh. They said when they heard they felt guilty. We nurses are superstitious...but we also know it was just irony at work, but we all agreed - no more jokes like that on the nursery nurses!

Part of me is upset with my physician...looking back over the last several weeks, I had contractions that weren't painful, but were there. She did multiple fFN tests and when one came back positive, she took the approach that b/c my cervix was still thick, so I wasn't at too great a risk. She never changed anything. Never gave me steroids. She did give me brethine to take as needed and cut my shifts to 8 hours, but several of my coworkers and you guys all expressed concern that she wasn't taking me seriously. Even when I was admitted and started on Magnesium, I felt she didn't think I really needed to be there. I didn't want to be off work if it wasn't necessary...I didn't want meds if it wasn't necessary, etc., but I also wanted to be smart about the whole thing and if she felt I needed intervention, then I wanted to do whatever needed to be done to keep him in until term. I trusted that b/c nothing was changing, and that my doc didn't think it would change, so I kept on going, as one of those women who "just contract and their cervix never changes". I was ok with that. I looked to her for guidance as my doctor - I trusted her judgement and maybe in the end it wouldn't have mattered regardless...Caleb was tired of being stressed and I think he took his little finger and just went "pop" and broke the membranes. He did fine, but most don't do that well. It's easy now to look back and wonder if maybe something should have been done differently - I"m not really a complainer, so maybe I could have been more vocal about how I felt, or maybe my doc shouldn't have been so laid back about the whole thing, but oh well, it worked out in the end. There were several prayers said for this little boy and I believe that is partly why he did so well...I am a firm believer in that.

I had my whole delivery planned: I had hoped for 10/22 to have a scheduled 7:15 c/s. My nurse friend Susan would circulate, the baby wouldn't leave the OR and I would get to hold him as I'm wheeled out of the OR. I wanted to avoid working most of a shift and then being admitted b/c I would go into delivery with lack of sleep. Susan was off after carpal tunnel surgery but had planned on being back in 2 weeks. I was admitted after a weekend I worked Friday night/Sunday night - and those weekends wear me out b/c I get very little sleep, plus we had a busy weekend with my daughters bday. I never wanted to experience mag or another preterm delivery. It just goes to show you just can't control delivery - and even though it was full of things I didn't want, all I really wanted in the end was a healthy baby, and that's what I got. I couldn't ask for more! Plus, now I can empathize even more with my patients: I've had a nice normal vaginal delivery, an emergency c/s with a preterm 36 week baby who spent a day in the special care nursery, a nice scheduled term c/s, an incomlete miscarriage and D&C and now a preterm 34 week delivery after trying to stop labor with terb, procardia and Magnesium Sulfate...so I'll be a better nurse for it!