One month old!

As of January 15th, 2011, little miss Madeline turned one month old. Jacob and I had decided that we were going to celebrate milestones (1 month, 6 months, 1 year) until her first birthday. In order to properly celebrate, we went to the grocery store and got ourselves a submarine sandwich, chips, sodas and two jumbo cupcakes. We went to another store and picked up some 'happy birthday' party hats, and then we headed to the park.

When we got to the park, we snuggled her up in some warm clothes and the blanket her great-grandmother made for her; due to the overcast day and the fact that it was late in the afternoon, it was quite chilly.

Madeline napped through most of the 'celebration' (which is fine, because it gave us time to eat), and after we finished our sandwiches, we put on our hats, lit the candles and took some pictures.

I know it may be silly, but I'm glad we did it and I'm even more glad we have some pictures to show for it.

I love my baby girl so much, it's hard to believe she's already a month old!

The first two weeks of my daughter's life.

As you already know, Madeline was born December 15th, 2010 at 11:23pm, perfectly healthy. 

We were released from the hospital December 17th. The first night home was wonderful - she slept like a charm, eating only every 3.5 to 4 hours through the night, and eating every 2 to 2.5 hours during the day. We even went out for breakfast with my family the next morning. It was wonderful.

December 18th, around 8:30pm, I tried to wake her up to feed her. I had a very hard time getting any response from her, so we called the pediatrician, left a message, and headed to the ER. (We suspected Jaundice, but were unsure). Halfway to the hospital the pediatrician called back and we discussed Madeline’s symptoms, we were then advised to go to the ER.

Once we arrived at the children's hospital, they ran some tests, put Madeline on IV fluids and told us they would keep her over night for observation. Her bilirubin levels were average for a three-day-old, coming in at 13, and she seemed to be responding well to the IV fluids. The diagnosis was dehydration due to a lapse between my colostrum production and my milk production.

The doctor visited and checked her out, he gave us the option to have a 48 hour blood culture done, to test for any possible underlying cause for dehydration - just in case. Over the 48 hour period, Madeline was doing so well, that I finally felt comfortable leaving her to go home (a 30 minute drive) to check on the cats. When I returned to the hospital, I went up to the NICU floor and signed in. As I was signing in, I hear a baby my baby screaming. I rush back to her room to find a nurse catheterizing my infant daughter. I asked the nurse what she was doing, and received the explanation that she needed a urine sample, and had to use a catheter to get it. I pointed out that Madeline had already been catheterized - hours earlier - for a urine sample, and asked what happened to the previous sample. The nurse said something about the prior sample getting lost. I was furious.

Not only were they needlessly putting my baby in pain, but they did so without my consent, or even notifying me. When my husband got up to Madeline's room, I explained what had happened. He then confronted the nurse who told my husband that the reason the urine sample had to be taken was because they needed to take a urinary drug screen, and that 'catheters don't hurt the babies, the reason they scream like that is because they hate their feet being touched.', she also mentioned that she somehow didn't get enough urine for the UDS and may need to put another catheter in.(Luckily, she managed to get her urine sample using cotton balls in the diaper,) The next morning, Monday, the doctors made their rounds and Madeline was doing so well that the doctor even made jokes ("My diagnosis? acute baby!") They told us that Madeline would be cleared to go as soon as the 48 hours were up and the blood culture came back. Tuesday morning at around 7:30am, Madeline suddenly spiked a fever of 39.4 degrees C [about 103 F].

They decided to keep her another 24 hours for observation, 12 hours (or so) later she spiked another fever of 39.4 C. At that point they knew she had some sort of infection, and ordered a Lumbar Puncture (to test for bacterial meningitis/infections in her cerebrospinal fluid), urine culture (test for UTI), and a second blood culture (test for bacteria in her blood). As a preventative measure, they put her on 3 different IV antibiotics, and an IV antiviral.

The LP came back negative, no meningitis. The urine culture came back positive for gram-negative rods (which we later learned were E. Coli), and later her blood culture came back positive for gram-negative rods. So, the infection started in her urinary tract and spread into her blood. 

Luckily the antibiotics she was on had an almost immediate effect, and once they narrowed it down to E. Coli, she was taken off the Claforan, Gentamicin, and the antiviral. She was receiving only IV Ampicillin every twelve hours, and she was on a 10 day regimen.

She had another set of cultures done after three days of the antibiotics and they came back negative, but they needed to finish her course of antibiotics before she could be released.

Due to the fact that Madeline was in NICU, both my family and Jacob's family decided to postpone celebrating Christmas until she was released, but the lovely folks at the unit decided that the babies all deserved to get a visit from Santa.

The rest of the stay at the hospital was relatively mild, with the only scares being when Maddie pulled out her IV lines. She ended up having a total of 8 IV locations and some were just badly placed so they were hurting her, and had to be removed.

On December 31st, 2010, at 10am Madeline received her final treatment of Ampicillin. The doctors made their rounds and cleared us to go home, saying that Madeline was a trooper. "She didn't even know she was sick!" and how proud they were that I had brought her in when I did, because apparently most parents would have waited until there was a fever to bring her in. (I maintain the theory that the ITU/sepsis was a direct result of being badly catheterized - Madeline's pediatrician agrees that that's probably what happened.)

The birth of Madeline Victoria

As usual, nothing went according to plan.

During my last two checkups, I was registering elevated blood pressure - the first time it happened, they waited and took my pressure again at the end of the visit and it was back to normal. The second time it happened, I was sent to Labor and Delivery to be monitored.  From the beginning of the monitoring, my blood pressure was normal, and Madeline's heart rate was 'perfect'. I was sent home with no problems.

The next day (December 14th), I woke up at about 6am with some minor contractions, and went about my day. As it was tuesday, I took my weekly belly progression photo:

And then my husband and I went out with my mom. We went walking around parks, running errands and even through super Wal-Mart trying to get things rolling, since the contractions were weak/irregular.  We were at Wal-Greens when I realized I had missed a call from my doctor's office.

The message left said something along the lines of 'Hey Jess, I have your induction orders here. You need to be at the hospital at 10:30 tonight to begin your cytotec, and you're scheduled to begin ptiocin at 7:30 tomrrow morning. Please call us back to confirm.'

I called back and asked why I was scheduled for induction, as I was under the impression that was something we were trying to avoid. Their excuse was that I was 'post-dates' and they were concerned about my hyper-tension and the fact that it may develop into pre-eclampsia. I told them that I would keep the appointment, because I was already having semi-regular contractions, and I thought the cytotec (cervical ripening agent) could only help.

I took 2oz of castor oil at around 3pm, and took a nap. I awoke around 7:30pm to find that Jacob had gone through our checkists and prepared everything for bringing to the hospital. I waited for the side effects of the castor oil to hit me, and right around 8:45, they did. I experienced mild diarrhea, and mild contractions. Around 9:30 my mother arrived to pick us up for our trip to the hospital. We hung around the house for a while, and headed out close to 10-ish. We stopped at Wendy's on the way to pick up a baked potato for me, then went straight to the hospital. I was contracting in the car at 2-3 minutes apart the entire trip to the hospital.

We arrived at about 10:20, signed in,  and waited. Somehow they didn't have me on file for cytotec at 10:30pm, only the pitocin at 7:30am, but since I was having contractions, they set me up in triage for some monitoring. As it turns out, I was contracting too frequently to receive the cytotec. The midwife did an internal exam, I was up to a large 2cm, but not any further effaced. Due to the frequency of my contractions they moved me up to 3:00am for the pitocin.

dancing

I was transferred to a L&D suite sometime around 12:00am and while I waited on pitocin, I walked the halls and danced in hopes of bringing her down or furthering my progress. At 3:00am they started me on a lose dose pitocin drip (2mL/hour), and set me up with external fetal monitoring. By 7:00am, I was up to 6mL/hour and the nurses shift change was coming up, our attending nurse (Phyllis) made jokes about seeing us in 12 hours because she wanted to meet the baby, but hoped that by then I would have already delivered. The nurses (Sandra and Gail) that came in at 7 to replace Phyllis were fantastic, too. They read over my birth plan and clarified that I didn't want pain medications offered to me, they were pleased with how open to change I was and we developed a fantastic relationship almost immediately.

At around 7:50am, one of my favorite doctors from the practice came into my room to check me. I was still a 'large 2cm', so in order to try to help move things along, she offered to rupture my membranes. By 7:55 I was having contractions painful enough to want to get on the birthing ball. At about 8:15, my pitocin was raised to 8mL/hour and at 8:35, it was raised to 10mL/hour and from then on, every half hour they upped the pitocin by 2mL/hour.

Considering the fact that Madeline was in a posterior position (facing my belly instead of my spine) I had the most intense back pain during labor. It was horrible. I made it to 4cm before I was literally screaming with the pain of the contractions. Between contractions I was fine - making jokes, talking, being friendly - then I would feel a contraction coming on and I'd start whimpering 'oh, god, please, no' and by the time the contraction was in full swing I would start yelling to my mom and Jacob "SOMEBODY PLEASE HELP ME" because the only thing that even remotely helped my back labor was counter - pressure on my back and hips.

It eventually got to the point where I was so absolutely exhausted that I would literally fall asleep between contractions and they were only 2 to 3 minutes apart and at least a minute and a half long.

For a while, I was talking about how I completely understand why epidurals were invented, and how much I underestimated the pain of back labor (which I pretty much knew I would have). Soon, the nurse came in, she said 'I know how you feel about the pain meds. I just want to let you know that soon, if you change your mind, you won't be able to get the epidural and if the pain gets worse, you'll be limited to IV medications like demerol.'. After some discussion with my husband and mother, we decided that at this point, after laboring for almost eleven hours, I should get the epidural - if only to allow me to try to get some rest.

The epidural was administered at about 1:40 pm, and they pumped up the pitocin to 16 mL/hour. It was glorious. I fell asleep almost immediately, until they got to inserting the internal monitor and catheter. For some reason, I could feel the catheter make its way in - and then for the next few hours it felt like I had to pee, really badly, but for some reason, the catheter was not draining my bladder. At the same time, I felt this horribly uncomfortable pressure in my vagina/rectum, which only started after they inserted the internal contraction monitor (they were monitoring the baby with an external fetal monitor).

The nurses removed the catheter and put a new one in - the second one hurt just as much as the first. We were all at a loss, they began discussing the possible ways to solve the problem... Basically the only thing to do would be operate. We waited it out and after Madeline changed positions, the pain was relieved and the catheter did its job.

Due to the fact that I had the epidural, I could not leave the bed at all, I could barely even move to roll over when they wanted me to. I was drifting in and out of sleep, and my recollection of the end of my labor is fuzzy. I vaguely remember being checked relatively regularly for progression - I think it was every two hours. It soon became apparent that I was not making any more progress, I had stalled out at 8cm dilated and 80% effaced. I was stuck there for four hours. The nurse came in and told us that the doctor was concerned with the lack of progression and that they may have to move on to other more invasive measures - she was talking about the possibility of me needing a cesarean section while politely avoiding saying the actual words.

I was so lucky to have the nurse that I did, she did everything in her power to avoid the c-section.  She upped my pitocin to try to increase the power of the contractions in order to open my cervix more. She also began helping me roll from side to side every fifteen or so minutes to try to get Madeline to rotate into an anterior position so she could 'drop' further into my pelvis and help my labor progress. By 9:45ish the doctor came in to check me and decide what we were going to do. I was barely at ten, but she told us to try to push through it - I could probably make it.

The nurses told me to expect to push for about two hours, considering the fact that I was still on the epidural (though I swear it was wearing off) and this is my first child. All I could feel was this intense desire to relieve the pressure I was feeling and each push brought a wave of relief, soon to be cancelled by the extreme discomfort flooding back in. I was so sure I wasn't going to be able to do it. I kept trying and trying and every time the nurse gave me instruction, I remember crying to her "I'm trying, I can't do it!". I felt that every time my mother, husband and nurse congratulated me on how impressive each push was was just a way to placate me. I didn't think I was making much progress until my mother grabbed my hand and pulled it down to feel the top of Madeline's head.

At that moment, I felt so close to having her, I remember resolving to try my damnedest. I was so close. I kept pushing and holding and pushing and holding. The nurse told me to expect the 'ring of fire' and that I needed to be sure to push through it or it would only get worse. The next time I pushed I felt the stretch, took a breath and pushed again, feeling the burn. I kept that push as long as I could, gasping, I pushed a final time and there was her head.

My husband was down between my legs, hoping to be as involved in catching as humanly possible. I heard my doctor point out the cord around Madeline's neck, and felt her unwrap it. Then I hear her coaching Jacob on how to deliver the baby. At 11:24pm, I pushed again and Jacob pulled, and together we brought our daughter into the world.

The next thing I knew I was overwhelmed with emotion, I snatched off my hospital gown while repeating over and over, "Oh my god, that's my baby! My baby!". I tore off my blood pressure cuff and Jacob put her on my chest. She was beautiful, though almost greyish and covered in vernix. The nurses were at my side rubbing and stimulating her, she wasn't crying yet.

After the first glorious seconds they took her to the warmer, she had apparently experienced some meconium aspiration and was having a hard time breathing. I watched from across the room as Jacob helped them stimulate her. He was amazing.

While they were taking care of Madeline, I delivered my placenta, and my doctor began to put in my stitches. She gave me some local anesthetic and explained that I had just a minor tear and a couple stitches would suffice.

Shortly thereafter, they brought Madeline back to me, and within 30 minutes she was nursing. She was a perfect baby born at 7lbs 14oz (the exact weight I was when I was born) with a full head of dark hair and she latched on immediately, without difficulty.