November 27, 2008: The Baby Is Coming

Dominica is now 40 weeks and 6 days pregnant…

We had really been hoping that the baby was going to decide to come last night.  When Dominica’s contractions started at three thirty it seemed pretty likely that we were going to be heading to the hospital pretty soon.  Not so.  Dominica decided to see if it would be possible to get some sleep before the contractions got so bad as to send us to the hospital.  She needs some antibacterial medicine at the hospital that is going to force us to go there long before we would go there otherwise under more normal circumstance.

Liesl Enjoying the Nursery

Dominica ended up getting no sleep at all last night and I got only a smidgen more.  I may have gotten two hours at a stretch but one hour is far more likely.  It was a really rough night.  I’m not sure that the sleep that I did get was valuable at all anyway since it was interrupted so often that I really felt pretty ill after not too long.

At roughy three in the morning, almost exactly twelve hours after Dominica’s contractions really started, she decided that it was time to get into the hospital.  I carried Oreo in and set him up on a pillow in the nursery with Dominica’s parents.  He was very drowsy but would panic if we just left him all alone without knowing where he was supposed to go.

We got to the hospital and were checked into delivery room four, the same room that we had on Monday for several hours.  Not our favourite room.  It does have the more comfy chair for me, though.

For the first hour Dominica was getting tests run.  At a quarter after four the hospital said that they were confident that we were staying this time and really having the baby.

Our first many hours were spent with Dominica going through light contractions.  She really did really well.  She didn’t really need me at all for the first several hours until she needed to start walking around the birthing area trying to push things forward.

Around six thirty the midwife on duty predicted that the baby would be coming around noon based on Dominica’s progress and contractions.  She was at 2 centimeters dilation when we arrived and was up to 3-4 centimeters about an hour later which but everything on a pretty good trajectory.

She his 5 centimeters just before seven.  At this point she was getting rather uncomfortable.  We spent quite a bit of time walking around the halls of the maternity ward trying to keep her in an upright position to let gravity help out.

Around nine in the morning Dominica was up to 6 centimeters.  She was in quite a bit of pain now.  She wanted to try the whirlpool to see if that would feel better but the midwife didn’t want her to get into too much of a non-upright position so, instead, they got us a postpartum room that had a shower and a rail to grab onto.  The warm water on her back helped and we probably did that for half an hour or more.  It allowed her to stand for much longer than she would have been able to do simply walking around the halls.  The hard floors were really taking a toll on her back.

We had to stop using the shower because there wasn’t enough ventilation in the room for Dominica to be able to really breath after very long because the room got all steamy and hot.  So we headed back to “room 4” and Dominica tried laying down for a little while.  At a quarter after ten she managed to get in a tiny little “nap” between contractions.  This was really important as she was so worn out that she was running out of energy.

Dominica’s parents came around a quarter after eleven.  I tried to use that opportunity to grab some lunch because I was running on empty, but the cafeteria was not open.  So back to the delivery room for me.  It turned out to be good because I was around for when Dominica’s water broke at eleven thirty.  At that point she was measuring 7-8 centimeters.

At eleven fifty we got the bad news that there was meconium in the amniotic fluid so that raised the level of concern about the baby’s health.  This is not uncommon but it does mean that we have to be careful about how long the baby remains inside.  Meconium can be aspirated which can cause infections and other potential issues.  They have also had some concerns about the baby’s heart rate which has been slightly high.

Because of these concerns the midwife decided on the need for a “head monitor” which is a device that uses a small, metal corkscrew and goes into the baby’s head.  They claim that it doesn’t hurt but we are pretty sure that it really does.  We saw one of these monitors in our Lamaze class and thought that it was pretty nasty.  It is necessary, however, because they need to really know what is going on with the baby’s heartrate and the external monitors just aren’t giving us very good information.

Just after noon, Dominica’s father and I were able to get away for a quick bite in the cafeteria.  Dominica’s mom stayed with her while we ran down there.  It turned out that as today is Thanksgiving the cafeteria was doing a free Thanksgiving dinner.  I had stuffing, sweet potatoes and green beans.  The vegetarian selection is not exactly the best.  You tend to get lots of carbs and practically no protein, but at least I was no longer starving.  The food was all very good and there was pecan pie as well.  Frank, of course, had turkey as well.

Dominica is into the serious pain now and at one in the afternoon the midwife and nurse began to prepare for delivery as it could happen pretty much anytime.  We waited and waited.  After almost an hour and a half the midwife decided to get Dominica’s doctor because the labor progression had halted and the baby was not getting lower nor was the cervix dilating additionally.

Dominica’s doctor concurred that things were not moving forward as they had hoped and, with concerns about stress on the baby, they decided that we would try Pitocin (a labor inducing drug) for one hour and, at the end of the hour, decide to whether or not a Caesarean section would be necessary.

The Pitocin definitely had an effect almost right away.  After about fifteen minutes Dominica’s labor pains increased dramatically and she was in extreme anguish.  This is the “desired” result of the Pitocin because it meant that the contractions were really pushing the baby hard.

With half an hour of Pitocin contractions Dominica needed to move to pain killers.  Up until this point she had done everything without the use of any drugs at all, but this was just too much for her.  I can’t believe how much she had handled already.  She was losing the ability to focus and becoming exhausted extremely quickly.

We talked to the nurse about doing a pain killer via the IV drop (Dominica was on the drop since the beginning because she was Group B Strep positive and had to have antibiotics right from the beginning and then because of the Pitocin.)  She had the option of using either a normal “pain killer” through the drip or to get an epidural.  The drip did not preclude the epidural and Dominica couldn’t decide what she wanted to do because she was already in too much pain so I made the decision to go with the IV drip and to consider the epidural later on.  I would come to regret this decision as the drip did almost nothing for her and made her incapable of telling us that she needed the epidural later.

The drip pain killers did nothing or nearly nothing to ease the pain of the contractions.  What they did do was allow (or force) Dominica to sleep between the contractions.  So she got a minute or two of “rest” here and there.  But one of the most important things that Dominica had to concentrate on was breathing heavily to keep the oxygen levels high so that the baby’s heart rate would stay down.  The drip made her incoherent and she was unable to remember to breath and there was no way for us to remind her.  She would find herself gasping for air in a panic and immediately forgetting to breath again.  So the baby’s heart rate climbed dramatically.

Because the drug made Dominica “pass out” immediately upon the end of the contraction there was never a time in which she could tell us anything.  We were very much mislead to believe that the drug was a pain killer but, as often is the case, that is just a generic term used in hospitals to mean a drug that makes you stop complaining.  Often narcotics are given and you are told that they “take the edge off” or “make you not worry about the pain” which, of course, they don’t do and, in fact in my experience, make you deliriously panicky about the pain but just unable to communicate it effectively to anyone.  This was a similar case.  Dominica was in more pain because she couldn’t concentrate on anything but the pain and kept her from telling us that she needed help.  So for an hour and a half she endured without any actual painkillers at all while on the Pitocin.

Finally, after many contraction cycles of trying to figure out how to reach us, Dominica feebly called out for the epidural.  I went right out and got the doctor who was waiting right outside.  She came in in five to ten minutes and gave Dominica another examination.  They called for the anesthesiologist who was there relatively quickly.  Dominica’s mother and I had to leave while they did the procedure.

It was four o’clock when they started the epidural and it took probably twenty minutes before we were able to go back into the delivery room with her.  She was immediately feeling so much better.  She had been in just incontrollable pain before doing nothing but writhing and screaming but now was sitting up and happy.  She was extremely glad that she had gotten the epidural.

Once the epidural was in there was a chance for Dominica to sleep.  They did about forty five minutes of monitoring and labor work with her but at a quarter after five she was clearly exhausted and needed time to rest.  So she napped for forty five minutes.  The thought was that she would sleep for an hour or more.  So I set up my laptop so that I could respond to people and do some blogging thinking that I was going to have quite a while of just sitting with Dominica as she slept.

Just before six they did another exam because the baby’s heart rate baseline was beginning to climb and this was cause for concern especially with the known presence of Group B Strep in Dominica and the knowledge that there was meconium in the fluid.  At the exam they saw that all progression had stopped and that the baby just was not going to be able to fit.  There was no choice but to do a Caesarean section.  It was five fifty five in the evening when they officially decided to head to the operating room and prep for surgery.

Surgery started at six thirty.  Dominica was extremely fortunate that her epidural was working and that operating room anesthesiologist was able to use that for the surgery.  Had that failed she would have to have been knocked out entirely which would have been much more stressful and she would not have been able to have remembered anything about the actual birth later after twenty seven hours of work!

At six fifty four, Liesl Lee Miller was born.  They brought her over next to us to be checked out by her pediatrician.  Her eyes were open immediately and she was looking at us.  She was extremely active – which Dominica could have predicted as Liesl was very active all throughout the pregnancy.

Liesl was taken out to the NICU after about five minutes.  Dominica had to go through another half an hour or surgery before she would be done.  I went to the NICU with Liesl and her nurse where she was weighed, 7lbs 11.6oz and measured at 20 inches.  She was so active.  I was not expecting her to be so active so quickly.

I went out to the waiting room to tell Dominica’s parents who were waiting there about their granddaughter.  They had heard her crying and thought that is might be her.  They went over to the NICU to see her.  I went back to the delivery room to get my phone so that I could call dad who was with my family at Thanksgiving dinner and let him know that everything was okay and to tell him about Liesl.  Then back to the NICU.

It was not too long before Dominica was wheeled back into room 4 to begin her recovery process.  She was doing pretty well.  At nine thirty I got to bring Liesl in to visit with Dominica.  Dominica and Liesl began their first feeding.  At that point we decided to give them some time together so Dominica’s parents and I went out to dinner at the New City Diner – it was probably the only thing open really late on Thanksgiving night.

At eleven I returned to the hospital to check up on Dominica.  The original thought was that I was going to spend the night in our room there.  We have postpartum room 212 right next to the NICU, but I was exhausted and it would take an hour to get the bed set up in there and to set up my CPAC (it turns out there was nowhere to plug it in actually) and then Dominica would be wheeled in and I would never sleep because they would be monitoring her all night long.  So Dominica sent me home to sleep.

I was home and in bed by a quarter after eleven.  Oreo was quite excited to see me come home.  He definitely had a long day.  We were both really ready for some sleep.

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