Zatera Ul

(Thinking of Guilt-Free Homeschooling’s “If this is HOMEschooling, why are we always in the CAR?”)

I suppose I should get this birth story done and out of the way. I think I left off where we had decided to go to the hospital to get OLC checked over, by ambulance because I was a little too weak to be up and around. MFH’s comments are in brackets.

As part of the birth preparations, I had printed out and filled in the pre-registration form from our preferred hospital, and put it into a “Do Not Open Except in Case of Hospital” envelope, along with a list of things to bring to the hospital. MFH went and opened it, I guess, and tried to get some things together, but didn’t have much time. [This turned out to be a mistake. I knew it was a mistake but she insisted on not opening the stupid thing — some superstition about if I didn’t open the envelope then we wouldn’t go to the hospital. HA! So I opened the envelope and inside is a list of eleventy billion things scattered all around the house. Great. I grabbed about seven things that I could get in five minutes or so, and took off out the door. Really we should have packed a bag ahead of time with everything in it so I could have just fwoop grabbed the bag and took off.]

The ambulance came, and we had three or four EMTs in our bedroom along with us, our midwife, her assistant, and the birth tub. Our midwife explained the situation, and they spent a few minutes just observing. One of the EMTs said they were more worried about me than about the baby. They didn’t seem to believe me when I said I felt just great. (Natural childbirth endorphins, woo-hoo! What a high!!)

Anyway, we had to get loaded into the ambulance. By this time it was about 5 am. The guys very gingerly walked me downstairs, and strapped me into a contraption to get me down all the stairs out front. MFH took pictures; I look like I’m being hauled away to be committed.

MFH rode with us. They gave me an IV, using a generous amount of tape to secure it to my arm.
The ride to the hospital was fairly bumpy, and I was glad I wasn’t in labor. Our midwife drove her car, and her assistant drove our car.

At the hospital, they took us up to Maternity, and put us in a room. OLC was under a warmer for a bit, getting looked over, and then the nurse hooked her up to some machine with an alarm that went off, loudly, every few minutes. I don’t even know what it was measuring, oxygen saturation levels I suppose, but whatever it was, 90 was the threshold for “good”, and OLC was just below that. Every time that alarm went off, I regretted not putting “hammer” on my to-bring-to-the-hospital-list.

They admitted OLC for observation, and me to get some more IV fluids, and to get my tear sewn up (my midwife would have done the stitching if we hadn’t been at the hospital). After a while, they unhooked OLC from the machine.

We had a nurse who had had a home birth herself. OLC had a neonatal nurse who looked just like my (now dead) Slavic grandma, which was kind of providential.

At some point, they drew some of my blood and did a hemoglobin count. Every nurse that heard what the count was said, “That’s low.” So I was definitely anemic from the birth.

With help, I walked to the bathroom and met my new friend, the peri bottle (may-its-inventor-be-forever-blessed!).

The nurses gave me some help with breastfeeding, although their shove-the-nipple-into-the-screaming-baby’s-mouth technique didn’t seem all that effective to me. Better to calm the baby down first. Most of the time, OLC had a hard time latching on–flat nipples and a small mouth. Then when she did get latched on, she often had to let go after a couple of sucks so she could breathe, because mucus was working its way up and out both her nose and mouth. But we were working at it, and not doing too bad.

At some point in there, the nurse took me off the IV.

The resident came by to look at my tear–a simple second-degree tear, he said.

Later in the morning, a doctor and another resident (both female) came by to do the actual stitches. (Plus a nurse and a nurse trainee. Our midwife and her assistant were still there too. The room was a little full.) My midwife said it would just take a few minutes, and I wouldn’t feel anything. Well, probably that would have been true if she were the one doing it. In this case, the doctor was teaching the resident, and it was very slow going. They managed the local anesthetic fairly well, but I could feel much more of it than I wanted to. There was a great big clock on the wall, and I watched it and watched it and watched it and still they weren’t done–they had neglected to tell me that they were going to stitch in layers. Also, the tear wasn’t nearly as simple as the earlier resident had led us to believe. Anyway, it all took a full HOUR. I must have gotten an ORDER OF MAGNITUDE [physicist language for “about a factor of ten”] more stitches than I expected (they wouldn’t even tell me how many, saying that “It’s not like getting stitches in your hand”), and no doubt I lost even more blood. So much for informed consent. A whole friggin’ c-section would have almost been faster.

About halfway through the ordeal, I started getting dizzy, and no wonder. I’ve fainted after only a single needle poke before. The nurse lowered the head of the bed, and that helped some. Once they were done, the stitches didn’t hurt all that bad, but I had to be careful when I moved. After all that time, and all the fluids I’d been getting, I really had to go to the bathroom, but felt a little too weak to want to walk. Well, it turns out that not only does the hospital not have hot-water bottles anymore (as we learned in June), it also doesn’t have real bedpans, only little plastic tubs.

I think most of them were still in the room when I told our midwife, “That was WAY worse than any part of the labor.” It was a different and much worse kind of pain, about ten times worse than transition during my labor, I figured; I would rather have ten hours of transition than one hour of THAT.

After this, the midwife and her assistant went off to clean up our house. MFH and I ate lunch and tried to take a nap, but various hospital personnel kept coming in, every twenty minutes or so. I didn’t get any sleep then.

MFH went home to get things for staying overnight; I had been desperately wanting my hairbrush and toothbrush all day. The nurses came by, wanting to get the new parent education stuff over with, but decided to wait until MFH got back.

Time dragged on pretty slowly, largely because I was watching the clock again, wondering when the dinner tray would appear. Well, by 8 pm neither dinner nor MFH had shown up, so I called him at home, and told him to BRING FOOD. A few minutes later, a nurse came by, I told her I was starving, and after clarifying that I wasn’t just some picky eater who hadn’t touched her supper, she brought me some Maternity ward food–a sandwich, some crackers, an apple. Not a very good postpartum meal. MFH brought me a kid’s meal from Wendy’s and a frosty. That really wasn’t a good postpartum meal either, especially because I was eating quickly to finish it before the nurse came back, and I ended up with a stomach-ache.

Months later, I had MFH make me some beef stew from a really good recipe our friends gave us, just to make up for that missed meal. I’m still upset about it.

The nurses never did come by to teach us how to bathe the baby. MFH went to bed on his fold-out chair, and pretty much conked out, but I was still too much on a birth endorphin high to sleep, and I spent most of the night watching OLC sleep and feeding her.

In the morning, OLC was looking better, and it looked like we were going to be discharged. The nurse-who-looked-just-like-Grandma asked if we wanted a bilirubin screening done, and I said ok. The bilirubin came back rather on the high side.

We kept having to put off doing the paperwork for the birth certificate, since we were having our midwife do it.

Of course, the nutritionist lackey came through (unlike the day before), asking about dinner preferences. I gave her my choices, not being sure how long it would actually take before we got out of there. It turned out that it wasn’t that long, though. (I bet they brought the meal to the empty room later.)

The doctor came by and talked over stuff with us. OLC was Coomb’s positive: basically, from a blood type incompatibility between her and me, some of my blood crossed over to her, and my anti-A antibodies (I think) were attacking her red blood cells, and producing the bilirubin for the jaundice. (Hemolytic disease of the newborn.) But she had a high hemoglobin count, so she wasn’t expected to end up anemic. The doctor decided to discharge us from the hospital, but to prescribe the use of a bili-blanket at home to treat the jaundice, and for us to bring her back the next day for a blood test to see how that was working.

So the nurse that looked just like my grandma walked us out, advising us on the way to keep the baby well hydrated, and we went home, and got everything unpacked and settled. The medical equipment company delivered the bilirubin zapper. It was a bunch of fiber optics embedded in a flat pad, with a thick fiber optic cable going back to the unit with the lamp (the Wallaby II, I think it was called). The pad was to be taped around OLC’s middle.

It turned out that this contraption made breastfeeding really, really awkward. Plus, OLC was rather sleepy from the jaundice, and tended to slip back into sleep after a half-hearted attempt at rooting around, until she was really hungry, and then she would wake up screaming, too upset to latch on. So it was a pretty rough night, feeding-wise. I didn’t hear until later how the second night was often one of the hardest ones.

The next day, we took her back to the hospital (ugh–I really didn’t feel like getting out of bed and running around). Newborns sure are popular–everyone was looking at her. Our poor baby had some more blood drawn. Later in the day, the doctor called back with the results. Her bilirubin was still going up, so he wanted us to bring her back in for more intensive phototherapy in the nursery.

By the time that we had packed and loaded up (again) and had made our way toward the hospital, it was late in the evening. Because of construction, and of not knowing any better way to go, our route went right past the Xcel Energy Center (arena), just as the stupid hockey or whatever game was getting out. The police were slow to set up any traffic direction, and the crowd was crossing the street against the lights, so we were stuck for a few minutes, and when we did get going, it was slow and the crowd got some very rude hand gestures from me: Get out of our way, I don’t care if your team won, we’re taking our baby to the hospital.

By the time we made it to the nursery, the nurses were changing shift. We did meet the neonatologist, a woman who right off told us “If your baby needs a transfusion, I’ll be the one to do it,” in a tone that clearly said that she was really hoping she’d get to. Instant dislike, on my part, but I was confident that we wouldn’t need one. The nurses told me that I could nurse OLC before they started the phototherapy, and curtained off a section for us. By this time, OLC was hungry and crying hard. Three minutes into it, while I was still trying to calm OLC down so she could latch on, a nurse came in and said something about starting (formula) supplementation. When I said that I didn’t want to supplement, she said, “But your baby will get brain damage!” Nothing like jumping straight to the worst-case scenario, eh? Particularly when that was the whole reason we were there in the first place. Anyway, I had heard (through the curtain) someone saying that I would be given twenty minutes to nurse, and I wanted my full twenty minutes, darn it. (In retrospect, twenty minutes seems ridiculously short.) I dug my heels in and told her that I wanted to talk to MFH about it (he was out unloading the car), so she gave up and went back out and told the other nurses, “She doesn’t want to supplement.” They had our doctor on the phone, or quickly called him, and he said it was ok to not supplement if I didn’t want to.

I think I ended up standing up and bouncing OLC gently to help her to calm down enough to nurse. Actually, I was doing this while she was nursing; somehow it was the right combination of soothing and stimulation for her. Rocking just wasn’t enough. But did I get some funny looks from the nurses, now and then. I made up a little bouncing song to go with it.

So I nursed OLC and they put her in the isolette, with a light overhead and a little foam eyemask (that kept sliding around) on her head. By this time, things had settled down some; only the one nurse on duty was there, and OLC was the only baby. The nurse got me started with the hospital breast pump (though I had to ask her to show me how to use it; this nurse wasn’t all that energetic). MFH showed me the room they were letting us stay in. Plainer than the fancy LDRP room we had been in before, but that was ok. We decided that he should sleep first, and I would sit up with OLC (not wanting to leave her alone), and we would trade off in a few hours.

Our midwife visited us somewhere in there, I think. I remember talking to her about MFH–we were worried that he was burning himself out taking care of me and OLC. [Yeah, I pretty much was. But who else was going to do everything?]

Anyway, I sat up with the baby for pretty much the rest of the night (fourth consecutive night of little to no sleep). I was still running on natural childbirth endorphins, though I could feel them starting to run out. The nurse made a half-hearted suggestion that I should go and rest, but I felt like I was doing ok, and that I was actually learning things about our baby and getting to know her better, though I can’t remember now what it was that I learned.

Feedings were supposed to be limited to 30 minutes each, followed by pumping, but this not-so-energetic nurse, bless her heart, didn’t enforce it and let us go on as long as OLC wanted to nurse.

Finally, around five o’clock am or so, I went to wake up MFH. He was pretty worn out, and it took a while to get him moving. He and I were up for a while with OLC, and then I went off to bed, at about 6:30. At first I was cold and shivering pretty hard (not that the room itself was cold), so I piled on all the blankets that we had, and that helped.

Then, at 7 am sharp, just as I was going to sleep, the noise started. It reminded me of a tractor, when in the spring my dad would start up one of his tractors that had been sitting out all winter, but it was far too loud and building-shaking to be a tractor. Must be mining, I figured. RIGHT OUTSIDE MY WINDOW. AT 7 AM. I tried to look out the window, but it had been boarded over. It turned out that our room (on the second floor) overlooked the construction project, and that if I had been able to look out of the window, I would have seen an extra-large, machine-mounted version of a jackhammer at work, within spitting distance of our room. I gave up on sleeping and went back to the nursery. MFH came back to the room, and, mining notwithstanding, was able to fall right back to sleep.

Our plan to have one or the other of us stay with OLC all the time quickly fell apart. I ended up having to crash between most feedings. Since we weren’t patients, they weren’t feeding us or “taking care” of us, so people weren’t coming in and out of the room all the time, and I was able to get some rest. But I was pretty exhausted, running in a nurse-pump-sleep cycle. Also, we were eating poorly, though we had brought some food in a cooler, and MFH went down to the cafeteria now and then. (Wisely, he had stocked up on chocolate at some point, and was doling it out to me as needed.) Plus I was feeling rather babyish myself–hormones, I guess, and being puffy from excess fluid, so I looked more like a baby to my eyes. MFH actually caught me mirroring his expression, like a baby would, at one point. Also, I was much paler than usual.

The hardest thing was the separation from OLC. She was stuck in the plastic box with the lights almost all the time. The day nurses actually enforced the 30-minute limit on nursing sessions. We were near her a lot, talking to her and touching her, but she clearly wanted to be held, and was pretty restless. MFH discovered that she slept better on her tummy, but the nurses would only allow it if someone was there keeping an eye on her, in case of SIDS.

MFH printed out a bunch of the baby pictures with his photo printer, and stuck them all around the room.

We found out that there was a breastfeeding room in the nursery (something the nurse from the night before had neglected to mention), with a comfortable couch and more privacy than the curtains afforded.

The other thing going on was that my milk hadn’t really come in yet, partly from the anemia probably, but it was only day four. We asked to talk to a lactation consultant, but it was the weekend and no one was available until Monday. I wasn’t a patient after all, only OLC was, and breastfeeding problems were MY problem, never mind that she was depending on me for all her food. Yet another place where the hospital failed to provide the care that we needed the most.

This excerpt from an article on kernicterus struck me later:

Phototherapy can interfere with maternal-child bonding at a critical time in the dyad’s development. If a mother is breastfeeding, initiation of phototherapy introduces mechanical barriers to the breastfeeding process, which can be overwhelming at this critical time. Any comments about the role of breast milk in the development of hyperbilirubinemia may further sabotage this process. Altered parental perceptions of their infant from healthy to ill may further influence their short- and long-term interactions with their infant.

Anyway, it was a hard day for us. Our situational awareness was poor. The nurses didn’t tell us much, except that boobs shaped like mine made less milk (NOT helpful), and that babies could have a hard jaundice rebound after phototherapy, and that OLC’s numbers weren’t getting all that better. I felt like the bar that OLC had to meet for going home kept getting raised and raised on us. I’d get my hopes up that the jaundice was something that was going to be easily fixed and we could go home and get on with the babymoon, but things kept coming up.

The next bad news was that OLC was getting dehydrated, which made her jaundice look worse because she couldn’t flush out the bilirubin. The mildly creepy neonatologist and nurses pressured us to supplement with formula, and we consented. But, to help with breastfeeding (ha ha), they would show us how to use a supplemental nursing system (SNS), which is where the liquid is sent through a little tube into the baby’s mouth while nursing. Then the baby is fooled into thinking the stuff is coming from the boob, and doesn’t get nipple confusion.

Well, our baby wasn’t fooled. She quickly discovered that when we were using the darn SNS (which dripped all over me), she didn’t need to work at sucking; the formula would just flow. I did NOT want her to give up on sucking; we needed it to stimulate my milk supply. The other problem was that the SNS tube just made latching OLC on that much harder, one more thing to have to get positioned correctly.

On the second or third feeding with the SNS, the nurse didn’t even bring the thing to us until OLC had been latched on and nursing for a few minutes. So there went our half hour: getting latched on the first time, nursing just a little bit, then having to unlatch to put the stupid SNS on and in, and then another struggle to get latched on. Then she got the hiccups, and had to unlatch. Not a good feeding.

Then, after I had pumped the few mL that I could pump, I came out and the neonatologist and a nurse or two were at the isolette. They said that OLC was even more dehydrated, and pressured us into letting them give her a bottle. Well, ok. Of course, OLC sucked it right down, and the neonatologist said, “This baby is STARVING!!”

I am still just SO burned about that. Hello, it is day four and I’m anemic and exhausted and ill-fed and flat-nippled and conically-boobed and my milk hasn’t come in yet and my baby isn’t allowed to nurse enough to bring it in and there’s no lactation consultant until tomorrow and you guys just sabotaged her last feeding and NOW are ganging up on me to push formula supplementation. It’s day four, she’s SUPPOSED to be hungry and nursing freely to bring the milk in. (Plus, I know now that those bottles in the nursery have HUGE holes in the nipples, for fast, easy feeding of sick babies. OLC must have been about to drown, she was lying down when they fed her.) I felt, and still feel, manipulated and steam-rollered by that trio.

So we ended up not just supplementing, but supplementing by bottle. They had MFH do the bottle-feeding, so OLC would still associate me with breastfeeding. One of the nurses told us that she had never seen a case of nipple confusion, in over 30 years of nursing. “Yeah, because it doesn’t happen until after you send them home,” I thought to myself darkly. But the alternative to supplementing at this point was an IV, which we really wanted to avoid.

All this for a mostly healthy, though rather yellow, baby. One of the pictures that MFH took of her in the isolette, she had the eye-mask off, and was looking sort of toward the camera. We developed this in-joke that she and I had a plan in place for sneaking off and nursing just as long as we wanted, and that in this photo she was saying, “Remember the plan, mom!”

We had the non-energetic nurse again that night, she warmed to us a little after MFH talked with her about photography and stuff. From what she said, it sounded like the day nurses were STARTING to suspect that I had a low milk supply. (Well, duh, like they hadn’t been handling the few mL that I’d been pumping after each feeding.) This nurse thought we should just do a pumping on one side, and see how much we got. (Didn’t try it, I knew about what I was making because I usually nursed OLC on only one side per feeding, to save on latching-on time, but pumped both sides.)

The next day, Sunday started out a little better: no construction noise! MFH’s mom and brother came to visit us, and brought chicken noodle soup. MFH’s mom’s neighbor is a neonatal nurse, and we heard that she said that we were doing all the right things, which was reassuring. We were pretty well into the we’ll-do-whatever-we-have-to-do-to-get-this-done-and-get-the-heck-out-of-this-joint phase. The day nurses were happier, having won the supplementation battle. MFH thought up a couple of thoroughly disrespectful names for them; it’s probably for the best that I’ve since forgotten them.

This part really blurs together in my memory, I think I might have confused the order of things in places. Somewhere in there, I had a tearful phone call with my mom, who had had similar jaundice troubles with me.

We did see our doctor briefly, I remember, because we asked him to take a quick look at my ankles, which were swollen. Too many fluids, I think now. MFH was making me drink a whole 32-ounce container of water after every feeding.

On Monday, though, the lactation consultant wasn’t free until the afternoon. (Grr.) Then she came for a feeding and observed that OLC was getting the whole nipple, though I knew that she usually got more of it than she did that time. The first LC recommendation was to use nipple shields, which I declined because I remembered that there was some reason to avoid them, though I didn’t remember what. (It was that the baby gets too used to the fake nipple, and won’t go back to the real one; also there’s less breast stimulation with it to get the milk supply going. Good call, me.) I told her I’d keep using the breast shells, and nursing and pumping. She told me that by then (day six?) I should have been producing about an ounce per side per feeding–another little detail that the nurses had overlooked. What was more helpful was that she noticed that the flanges on the breast pump were really too small for me, no wonder I was getting so sore, and she got me a larger pair. But the tubing that was on the pump didn’t fit them, and she disappeared for a long time looking for larger tubing. Then, when the tubing came, it didn’t fit the pump well, and we had to MacGyver it a little.

One of the day nurses, while we were waiting, came in and started going over do-you-really-know-how-to-take-care-of-this-baby paperwork with us, so it looked like OLC was going to be discharged.

I can’t remember now, but I’m sure that we must have packed as fast as we could, once we knew for sure that we were going home (again).

The doctor gave us a prescription for a breast pump rental and info on making an appointment with a hospital lactation consultant. He wanted us to keep using the biliblanket for a few days, and bring her back for a blood test on Thursday. The nurses sent us home with all the breast pump parts that they couldn’t re-use, and the SNS, and a whole ****load of bottled formula to keep us supplementing.

We made it home, and a friend of ours from church very kindly came and helped John unload the car. It was a big help. I think the next thing that he and I did was to just collapse.

This is definitely the longest blog post I’ve ever written. Hopefully I can finish the story up in Part 5.