Matthew's Birth - Part 2

If you haven't read the first part, click here

One last belly shot

By 2 hours after the first dose I was contracting (painlessly, but I could feel it) every 2-3 minutes so they said that they couldn't give me another dose yet and we would wait to see what happened before going to the next step. It continued that way for the next 2 hours (during this time the contractions became a little painful). At the end of the 2 hours the doctors came in and said it was time to make a decision on what to do next. They gave me the option of something called a cook catheter which would essentially be two balloons that were inflated on either side of my cervix to put pressure on it similar to the baby's head or something else that I can no longer recall the name of that would be something like a tampon with a medication on it to introduce an artificial hormone similar to what my body would normally produce to start labor. I decided to go with the cook catheter.

Since it was 3:30am and Jon was sleeping well, I decided to let him keep sleeping while they placed the catheter (he is a hard sleeper and had no idea what was going on). I was informed that they normally give pain killers for this procedure but since I wanted a non medicated labor and delivery they asked if I wanted to have it now, wait and see, or not take it at all. I opted for the wait and see method. It was very uncomfortable (it felt like menstrual cramps a lot of the time) but not too bad so I ended up not receiving the pain meds. They said that I handled it better than a lot of people who have the pain meds and were amazed that I was able to go to the full inflation of 80mls internally and externally (inside the uterus and in the vagina) right away instead of starting with less and increasing as we went. The doctor told me that they would now essentially leave us alone until the 12 hour limit for having it in unless the catheter fell out (which would mean I was dilated).

After they left I got up to get a few things and go to the bathroom and the cramping got a whole lot worse. I woke Jon up to help me deal with it and he couldn't believe that I had let him sleep through that! We tried laying down but pretty quickly I was on the verge of tears and feeling like I couldn't handle the contractions. I remembered reading that when that happens we needed to change what we were doing and find something to help me deal with it. I texted my mom and the doula, Carolynn, (the photographer, Renee, was with her so she came too) and let them know that I was ready for them to come. We got up and began using a birthing ball we had found/asked for and tried rocking and swaying a couple of different ways. We were able to find something that worked for me and my mom arrived shortly. The doula and photographer were delayed a while. After a while we decided to walk the halls (it must have been around 5:00am or so) and as we did that my water broke! It wasn't a gush, just a trickle but, EEWWWW! It had some blood in it so we were pretty sure it wasn't the catheter leaking. As we walked back to the room to clean up I had some more leaking and the nurses and their station down the hall guessed what had happened by my “EEWW!” as I came around the corner :)

Getting ready to go walking

The continued leaking/gushing was grossing me out and I didn't want to keep walking as I leaked so I stood and rocked over a waterproof pad for a while then decided to try the tub so I wouldn't notice and to relieve my backache (the backache stayed with me most of the whole labor). It worked wonders on my back but also slowed the contractions. Carolynn and Renee arrived while we were in the tub so they came in and said hi and Carolynn chatted for a bit to see what had happened so far and how I was doing. After that we were left alone for a while and we had the lights turned off so I could rest my eyes. I didn't want to slow the labor too much so we didn't stay in the bath too long.

The next few hours were a bit of a blur, we did a lot of different coping methods, I got a 1 hour nap, I kept contracting and we waited for progress. Around 2:30pm I decided to try the bath and rest in there for a bit so my mom, Carolynn and Renee decided to go do other things (mom and Renee went for food and Carolynn needed to nurse her son who was being cared for by a grandparent). In the bath it relieved my backache and the contractions were spacing out but after a little bit the contractions became extremely painful and super close together. I couldn't handle it so we got out of the tub. The contractions felt like they were right after each other and were so bad I began crying during them uncontrollably. Since it was so close to the 12 hour mark for the catheter and it almost seemed like I was hitting transition we had the doctors come to check me. They started by pulling on the catheter to see if it would come out. It did, but it hurt a bit. They checked me and said I was a generous 3cm, but not quite 4cm. They told us that they would wait an hour or so to give me a break before starting pitocin. I said that I would like to take nap during that time so we planned to start pitocin around 5:15 to give me a 1/ ½ hour nap (that is usually how long I sleep when left alone for a nap). Everyone left me alone to sleep and I slept for about an hour in spite of the contractions still being a bit painful.

Fever time

When I woke up (around 5:00pm) I decided to see if the contractions would pick up more if I was more active so we started walking the halls. The nurse told us that all of the doctors were busy at another birth and they could come see us about the pitocin when they were done with that. My contractions picked up speed and stayed about 2-3 minutes apart and mildly increased in intensity over the next 3-4 hours but I also developed a fever from infection. I began to lose strength and emotional stability and began crying almost uncontrollably and the contractions became stronger. I believe the strain of the fever on my body combined with the emotional nature of the situation led to my emotional break down which made it so that I couldn't handle the pain of the contractions, which made me more emotional, etc. Most of the labor I had been genuinely upbeat and normal (we had processed our initial grief before coming to the hospital) but I could no longer handle the strain at this point. I also was becoming too weak to stand/rock/kneel etc so I decided to try laying down even though up to that point it had prevented me from coping with the contractions. I had almost immediate relief due to not having to hold myself up and I had gotten to the point where I felt super cold (from the fever) so laying down enabled me to be kept warm in blankets. Around the time I laid down they started IV antibiotics and had me take Tylenol to keep the fever down (I had reached around 103 F). For a while the contractions stayed about 2-3 minutes apart but as time passed the became weaker and farther apart until around 9:30pm they were 5 minutes apart and not very strong (I didn't have to do anything to cope). I also became less able to handle pain.

Matthew's birth - Part 1

Warning: This is a very detailed telling of the birth story (it may gross you out), and will include pictures that may not be easy to look at.

On Sunday, October 4^th, 2015 in the morning we used the doppler we were borrowing to listen to Matthew's heart beat. A few days previous it had suddenly jumped to a normal heart beat of 150 bpm even though he had been happily having a heart rate of 90 bpm. The doctors had said that it looked like he just had a normal heart rate now and not to worry, but we were still concerned enough to listen once or twice a day. As the days went by it was slowly lowering and Sunday morning it was 70/130 bpm depending on where you listened (I believe that that was the lower/upper heart chamber reading). I was super worried and tearful, not sure what to do. Jon encouraged me to wait a couple of hours until 1:00 and listen again since we had an appointment with the OB the next day.

As we prepared for church I began to feel tired and weak (sometimes that happened in the mornings during the pregnancy) so we decided to stay home and I took a nap. I slept for 2 hours. Once I woke up we ate lunch and by that time it was after 1:00 so we decided to listen again. This time we couldn't find a heart beat no matter where we tried. He was normally easy to find.

Making calls and knitting his blanket

We called our OBs in Seattle (a 1 ½ hour drive away) and they said we could come straight there or we could go to the local hospital first for confirmation. We decided to go with the latter so we could have time to prepare and plan if he had indeed passed away. We arrived at the hospital and explained our situation and we were shown into a small room for an NST. The nurse was unable to find the heartbeat so she had the doctor come in with a portable ultrasound machine. The doctor (we were watching too) was able to see where the heart should have been beating and was unable to see any movement but, because it was a low detail machine she offered to order a better ultrasound for us. Jon felt that that would be best so we waited about 30 minutes for that. The technician told us that she would send the ultrasound to a radiologist but because she was just the technician should would not tell us what she was seeing (I understood). As she went along we were able to follow because of how many we had seen previously. We were able to see (and it was confirmed by the radiologist later) that he had one valve in his heart that was still moving a tiny little bit but nothing else was, and that there was no blood flow through the heart, vessels or umbilical cord. Our little guy was gone. We waited for a little while longer and the doctor came in to tell us that and that she would call the UW hospital to see what they wanted us to do. They were able to tell us that our preferred OB was not on call until Friday and that we could wait a day or two but shouldn't wait any longer than that.

We went home and began to try to make plans. After talking with our doula we called UW and asked what kind of induction method they would use (they said it would be the same as if he was alive) and also found out that they would recommend coming in that day because the longer we wait the more risk there is of infection and extra bleeding. We decided to go in that evening.

After a few hours of preparation and a few more of driving we arrived at the hospital. Because of our previous conversations they had a room and a nurse waiting for us and were shown in quickly. She told us that the doctors were currently in conference talking over possible plans for us and that they would be in soon to run them by us. The room was beautiful and spacious and on the end of the hallway so that we wouldn't be surrounded by other families. As we waited I began working on the knitted blanket that I had hoped to finish before his birth (I didn't get it done, but I plan to now).

Getting the IV placed

The doctors came in and introduced themselves. There was a head doctor and two residents (one or two of whom was the doctor(s) that ended up presiding of the delivery). They said that we would start by doing an ultrasound to confirm the one we had gotten earlier, do an external version if needed, and do a vaginal exam to decide our course of action. The ultrasound showed that he was transverse so we did the external version. The version was more painful than I had anticipated but it was successful. The findings of the exam were that my cervix was externally 1cm, internally (approximately) a fingertip, long and firm so we began an oral medication called Misoprostol that would begin the process of ripening my cervix. They said that it would be given to me every 2 hours as long as the contractions were more than 3 minutes apart and that it could be given up to 6 times. Jon and I attempted sleep at that point. Jon slept for several hours but I only got a catnap.

Ultrasound!

September 28 we got to have a full ultrasound again! This one is probably our last before he is born and it was so sweet to see it again.

Our little munchkin is still moving around and is still breech! He seems to love sitting in my pelvis with his feet up by his head. When they tried to get a good look at his hands for me they had trouble because his hands and feet were all right next to each other! He was also doing lots of breathing practice.

Looking at his measurements he is approximately 4lbs 4oz and is measuring quite small. His chest is 8 weeks behind, his belly is around 5-6 weeks behind and his femur and head look around 3-4 weeks behind. He is growing though! They would be concerned about how small his chest cavity is (his heart is big in comparison) except that his abdomen is small too. If only his chest was small they would be worried that he wouldn't have enough room to develop lung tissue.

The amniotic fluid measurement seems to be normal and at one point during the ultrasound he had his eyes open and we could see his eyes! It was kind of creepy :)

It looked like he was blowing us a kiss :)

The cysts in his brain appear to be really small, though they didn't measure them so we don't know if they have gotten smaller or if they appear smaller because his head is bigger. For his brain they were still unable to see the CSP and the ventricals are still dilated but that is nothing new, it just tells us that we are looking at other possible brain issues.

After the ultrasound we met with Dr Jolly again and let her know that we have now decided to do full code, full interventions. This means that they would do anything for him that they would for a normal child (oxygen, CPR, intubation, etc) but at the same time, we still want to follow Matthew's lead. For us this means that we are giving him every chance to fight for life, but if he doesn't want to fight then we will respond accordingly. She didn't even bat an eye. We love that about her! This is against her's and the neonatologist's recommendations but they are totally going with our lead on this without a fight. I think it helps that they have seen us working through this decision and that we are carefully considering the doctors' recommendations before deciding.

He even has tooth buds! They are the white below his nose.

We asked her if she could foresee any NICU doctors or any nurses refusing to do things like chest compressions and she said that no, she doesn't see that happening. They have been and will be told to follow what we want and that we have made these decisions carefully. We are really happy to hear that.

At this point we have an induction and a c-section scheduled for October 16th. What this means is that if I come in and his heart rate is great and he is in position then we will induce, but if either of those are not lined up we will do the c-section. She said (and I agree) that it would be easiest to schedule the c-section and cancel it than to try to schedule a last minute one. They are letting me have two (and possibly three!) support people with me in the OR! Right now that is going to be Jon and our birth photographer with possibly the doula (so that I can have someone with me when/if Matthew leaves the room with the other two). We are really glad that we will be able to have his first few minutes and hours photographed!

Our next few appointments are on the 5th and the 12th for regular check ins with the doctor to monitor blood pressure and whatnot and to make sure we have any questions answered or discussions talked through. After that there is only the induction/c-section! In some ways I hope I go into labor on my own the week of the induction so that I can know that we didn't bring him out to early but in some ways I hope he stays in there because it would be so easy to have everyone there already for the planned induction/c-section! I guess we will just have to wait and see what God and Matthew have in store for us :)

More Appoinments - Day 2

On Tuesday we had another Fetal Echo Cardiogram done. The cardiologist seemed to be very particular about what he wanted to see and kept sending the technicians back in for more footage! Probably a good thing in a doctor.

I am including a picture of what a normal fetal heart looks like (the labeled one) and what Matthew's looks like (the one with diagnoses written on the side).

He thought it would be best to start from scratch and tell us what he saw. Along with the previous findings (ASD, VSD, DORV, small left side, irregular beat, poor strength of beat) he said that the right side of Matthew's heart is too big and the left is now too small. Also, the Pulmonary artery's valve is small and the artery is narrow near the valve. He also said that the  Mitral Valve (between the upper and lower left chambers) is small and may not be functioning well.

What this means for Matthew is that the blood may not flow well into the Pulmonary artery, the left side of his heart may not work strongly enough and if after Matthew is born the left side is measuring this small there is nothing they can do for him. They are unable to make a small side bigger and a possible surgery on a normal child would be too complex for Matthew's weak heart to sustain.

It is like those "find the difference" pictures!

They said a normal left side measurement falls between -2 and +2 and that his right now is measuring -3.5. They said what they find after birth may be better because of difficulty measuring while in utero and/or it may improve by then but if after birth it is measuring worse than -2.5 they are unable to do anything to help it. Fixing the other heart problems won't fix that one.
He told us that before any medication is given we should wait to see how Matthew is doing for breathing and that if he is breathing well we can do the echo to see how his heart is doing. His recommendation (which we are going with at this point) is that if he is breathing but his oxygen is still low (not because of breathing) that we can do the echo within hours after birth to see if giving him prostaglandins to keep the "Patent Ductus Arterosus" (first picture, top right) open will help blood flow into the Pulmonary artery. Matthew will have an echo done within the first 24 hours no matter what, as long as he is stable.

Right now our biggest prayer requests for him are that his heart rate will increase to 110 or higher and that he will be head down, anterior (ideally so that he can be born vaginally), that after birth that he will breathe on his own and that the left side will be big enough to work with.

Please also pray for peace during this waiting time and that we would be okay with whatever God chooses to happen. Our induction date is set for October 16 provided he doesn't come on his own before then.

I am halfway done with Matthew's layette blanket! Only 12 more squares to make! I may decide to make it square instead though and only do 4 more :)

More Appointments - Day 1

This week we had three appointments scheduled, two on Monday and one on Tuesday. Because of this we asked some friends if we could stay with them for the night and they graciously hosted us!

His profile!

On Monday we first met with the Neonatologist. He was someone we hadn't met before and didn't really get anything new or helpful from him.

Next we met with Dr Jolly again and had a lovely session. We started out talking about him being breech or not (I am pretty sure he had been doing some flipping around) so she brought in the ultra sound machine. He is still (or once again) breech with his rear down and feet up. His heart rate was 95 bpm and his fluid amount is increased (from somewhere around 19 last week) to 23. She said that at 25 it is considered high. We asked her if she was concerned about his heart rate being so low and she said that because he was moving around and seems to be doing fine it is probably his current normal and not a sign that he is in distress or anything. We are going to do a full ultrasound next week to measure him and get more details.

That is his nose, cheeks, mouth and chin just to the right of center :)

Among our questions I asked if an external version (ECV) would be something we could do if he continues to be breech. She said that with his heart rate being so low they wouldn't be able to tell if the version was causing him distress so it would be inadvisable. She told us that knowing our wishes of having the best chance of getting him out alive, if his heart rate is this low when I go into labor or we want to do an induction she would recommend doing the c-section instead because they won't be able to interpret his heart rate to tell if he is in distress or getting oxygen deprived during labor.

We fully understand where she is coming from so at this point we are continuing our plans for a natural vaginal delivery but most likely (pretty much for sure) he will be delivered by c-section. The only way to not automatically do a c-section is if his heart rate is around 110 or higher and if he is head down and presenting well.

(Day 2 is the next post)

OB appointment

On Monday, September 14th, Jon and I went for a regular OB appointment.

Before I write about the appointment I want to do a little preface: during the 3-4 days before the appointment we had been hearing an unusual and extremely slow heart rate when using the doppler. While we were concerned about it we also know that there isn't really anything we can do at this point (if something is wrong) so we waited to talk to the OB about it until our scheduled appointment.

At our appointment we met with Dr Jolly again and began talking over our many questions (as usual!) that we had. We are so happy with her and with their readiness to work with us. They said that if we end up with a c-section that we can have our birth photographer with us! She also answered my questions about what to do if my water breaks. We also talked about Matthew's chances this early and how much of a difference a few weeks will make for his chances. She said that she isn't very sure but she is going to talk to the Neonatologists about that so that we can decide what to do should we find that he is compromised in the womb.

The latest growth photo from 2 1/2 weeks ago :)

We went over the birth plan we have written out and she had nothing negative to say about it and confirmed some of the points I had written. Since this is my first pregnancy I had no idea what to put in there but found a sample one that we adjusted until we were happy with it, I am so glad that she was too!

As we went along the subject of Matthew's heart beat came up and she said that we could do a little in office ultrasound to check up on him (measure fluid, see movement, confirm heart rate, etc). She brought in this little ultrasound machine and began working with it. Interestingly, using the ultrasound it was able to hear his heart beating as it has for a while (a specific arrhythmia) so she pulled the doppler off the wall to see what it would pick up and it picked up the same thing that our doppler did, a slow strange rhythm! She said that she isn't worried because the ultrasound is picking up his heart rate correctly and it is still a good speed! We are so relieved!

We were also able to see him open and close his left hand, open and close his mouth, and practice breathing! We were and are so encouraged to see that he is developing muscle tone and is learning to practice breathing, Jon and I are beginning to have hope that he will make it to the birth alive!

One last thing is that Dr Jolly recommended that we plan for him to be born around 39 weeks because the risk of stillbirth increases a lot after that point. For us that seems like a great plan because that would put him at 40 weeks for our original dates and 39 weeks for the adjusted date. We are now hoping to move to Seattle the weekend before that (just in case I go into labor on my own) then induce on the weekend nearest those dates (around the 16th or 17th). We are hoping to try all of the natural methods of induction before using pitocin :)

The only major down side to the appointment is that we learned that he is breech! Today (Wednesday) it feels like he still is, though he varies a lot in position (breech, diagonal, transverse). I am beginning some exercises to open my pelvis area to encourage his head to go there but if that doesn't do it I am hoping to get the midwife's help next week for more suggestions.

Please be praying that he moves head down and stays that way through birth and that his heart will be strong. Also pray that he will keep growing and will be as big as possible (the bigger he is the better his chances are).

Cardiology

Sorry it has been such a long wait! We had our most recent cardiology appointment on September 1st but I have spent 5 days out of the last two weeks with a fever and couldn't even get out of bed, let alone write a post :)

At this meeting we had an echo cardiogram again and also got to meet with the same cardiologist, Dr Bhat. The echo went smoothly and we loved the technician. She was super sweet and talked with us and made us feel like friends.

A friend hosted a small baby shower for Matthew and I!

Pretty much everything looks the same as the last one! There aren't any changes for the worse and the only new thing is that we have been hearing an irregular heart beat for about a month and they were able to explain that it appears that the normal "ASD" (whole between the upper two chambers of the heart) that everyone has appears to have a large flap (that would normally close it after birth) which seems to move enough to irritate the right or left sides and cause that side to contract too soon. For Matthew it is okay because his heart is realizing that it was too soon and telling that side to wait it's turn. This causes a quick heartbeat then an extra long wait for the next one so that the next one is in time with the rest of the heart.

She told us that as long as it is stopping the early ones we don't need to worry about it but that we can be on the watch for it to start doing all early beats for a long period of time. At that point I think he would need intervention of some sort.

The winners of the balloon diapering contest :)

Since that appointment (sometime last week) she called us personally to tell us that after reviewing the first and second echo she believes that the heart lung artery is having consistent back flow (we had known that) and that it is actually a good thing for the balance of Matthew's heart (I can't remember the reason though!). She told us that she would recommend that as soon as he is stabilized after birth that we start an IV through his umbilical stump to give him prostaglandins to keep the valve open to allow that flow. She said that by giving it right away it will begin benefiting him before we are able to tell if that is what is needed or not. She said the only side effect she is concerned about is that a small number of babies can have more lethargic breathing while on this medicine and that they will be on the watch for that to dial back how much he is getting if it effects him that way.

A few of the attendees

She said another possibility of why that is happening is that the vessel may be small farther down and if that is the case that would probably be his first heart procedure to find a way to reroute that blood back to the lungs again for better flow.

We are super excited by what she told us. Sometimes it seemed like she has been the least optimistic, more hesitant to have hope. Not in a bad way, just realistic I think. But with that phone call we really feel like she is coming on board with us about interventions since she is talking about starting medicines and even a possible procedure! We are super thankful for that!

Our next cardio appointment is this coming Tuesday, September 22nd.

A demonstration of mom's gift - a cocoon!

Opening gifts!

A sweet outfit, one of many! We are so blessed by what we were given.