Thursday, July 7, 2011

Big update!

I've been slacking in updating, but up until the last week or so, there hasn't been much to report.

Last week, I was lucky enough to be invited to a wonderful workshop centred around healing birth trauma. Thank you so much, Arie for organizing and hosting it, I found it to be a valuable experience and look forward to the next one.

She gave us some "homework", that I've been working through. Just a few questions about what I feel about this and that, and ultimately how I'd like to feel about it. I'm still sorting through a lot of those feelings, but I'll be happy to share them once they become a little more cohesive.  She also encouraged us to share our stories, which I have in this blog. You'll find the details of Lyra's birth a few entries below this one.

In other news, and the news many have been waiting to hear: We had our big ultrasound yesterday!

I went in feeling nervous and frightened. I feared going through what we did after Lyra's scan:

My ultrasound was on a Friday at around 2 PM. If I had been more receptive, I probably would have picked up that something was wrong at the time. The sonographer kept leaving the room, and coming back saying that she needed to get more measurements. Little did I know she had been reporting back to the radiologist about all the abnormalities she was finding. By 4 PM I had two voicemails; one from the clinic I was currently seeing and another from the obstetrician who ordered the scan. I wasn't home in time to receive the messages and call back. Though I knew in the field of medicine that no news was good news, and that a phone call this urgently was surely not good news. 

So I waited all weekend on pins and needles. Monday morning, both clinics called back. Momcare gave me a brief synopsis of the findings and asked me to come in. My boss drove me to the clinic right away. I was told that there were a handful of markers for Down Syndrome and Cystic Fibrosis. My baby girl had echogenic bowels (commonly found in babies with T21 and CF). Her umbilical cord was uncoiled and smooth, and she had several heart decelerations which were sluggish to recover. This could have indicated a congenital heart defect. The did some math with the results of my quad screen and told me I had a risk of 1:100 for chromosome disorder.

I was crushed.  They quickly made arrangements for me to have a targeted scan at the Perinatal Clinic, and set up an appointment for us to meet with a genetic counsellor.  

We had the follow up scan at the Perinatal Clinic a week or so later, and their result were inconclusive. They urged us to consider an amniocentesis, but I wasn't comfortable with the risk of losing what could be a perfectly healthy baby. We met with the genetic counsellor, who drew a confusing graph made of triangles and squares all joined with convoluted lines, and established that because my partner isn't caucasian, that it was unlikely for him to be a carrier for the CF gene. CF is a recessive allele, so we both would have to be carriers to result in an affected child. 

We decided to decline any further testing, and hope for the best.  

Of course, she is just fine.

You can imagine, after an experience like that, that ultrasounds are a nerve-wracking event for me. I was on edge initially, as we had the same "I can't find it!" sonographer as our early scan (go back a few entries for that gem of a story), but she didn't beat around the bush and she didn't force me into small talk. Though I wasn't allowed to seethe screen, she did walk me through what she was measuring. she didn't get edgy or nervous, nor did she leave me a lone at any point to go talk to someone else. She answered my questions to the best of her ability: I wanted to know the location of my placenta (it is posterior), and the lie of the baby (transverse/oblique at that time), and she answered them with no hesitation.

She finished her measurements quickly and allowed me to empty my bladder and get Chris, so we could look at baby together. She showed us the heart and we watched it beating, and she took a measurement of 144 BPM, she showed us baby's face and nose, arms and legs, shoulders, feet and spine, and then all the internal organs- stomach, intestines, kidneys. she assured us that everything looked great and baby was a perfect size per gestational age.  Our baby, so perfect:

She was about to shut off the machine and go get our prints when I spoke up and asked her

"Do you think you could tell us what the baby is?" (I almost lost my chance! And I certainly didn't want to pay $125 at a private clinic just for gender determination)

"Oh, of course! I don't tell unless I've been explicitly asked, as I don't want to ruin anyone's surprise"

So she put the transducer back down and found baby's legs, showed us the thighs and zoomed in

"Well, if baby is a boy, there would be a scrotum hanging right about here..."

She pointed at the are with her cursor

"But, I don't see one.. So, tentatively I will say you've got a little girl. But that's not conclusive so lets get a closer look..."

She zoomed in a little more. Lo and behold, there were the telltale three white lines. Little tiny labia.

We are having another little GIRL, and we are so incredibly thrilled. I wanted Lyra to have a baby sister SO badly. Being a big sister and having a sister is the most wonderful blessing and gift. I am so glad that she will have the same chance to have a built in best friend forever. I am so very excited to see them grow up together.

What a wonderful, healing ultrasound experience!

Saturday, June 4, 2011

I'm  been having some "holy shit" moments. I had an appointment with Noreen last week and heard baby's heartbeat for the first time. It's real. This is happening. I have it in my head that babies don't happen on the first try. My mind thinks you get pregnant and lose a baby before you get pregnant and have a live one.

Not this time. This is a baby that wants to be born.

Holy shit, right?

I've been reading a lot. I plowed through "Silent Knife" faster than I've ever read anything else. Though it's old, it's still so relevant today. It was so reassuring, and laid out the facts about cesareans and VBAC in a way that makes it hard for me to go on feeling scared or uncertain.

I also read "Baby Catcher: Chronicles of a Modern Midwife", which at some points had me howling with laughter and at other points sobbing into the sleeve of my shirt. It was so refreshing, either way, to read such a vast collection of stories about NORMAL BIRTH. I'm beginning to forget that what that even means.

I attended two births this month; the first was a stat c-section with no trial of labour, and the second was a very emotionally charged birth, my oldest friend, who was attempting a natural childbirth with a midwife, who stalled out at 4-5cm with a macrosomic and asynclintic baby after labouring for hours. Needless to say I feel a little like a kicked puppy.

What makes me think I can do it? I'm trying my best to prepare and I'm pulling all the stops, but lingering in the back of my brain is that horrible nagging fear of failure. What if I don't succeed?

Sunday, May 1, 2011

Moving right along

I'm feeling so much better about everything knowing the details of my birth. I know there's nothing wrong with me. Of course I'm angry that my c-section was completely unnecessary, but at the same time, I am safeguarded against it being at home rather than in a hospital.

I have a little reading list compiled, and I'm slowly working through it. I just finished Diana Korte's The VBAC Companion: The Expectant Mother's Guide to Vaginal Birth After Cesarean. Much of this particular book I skipped over, as it's geared mostly towards mothers birthing with an obstetrician in a hospital, but I found the birth stories to be a good read.

My friend Shannon loaned me her copy of Grantly Dick-Read's Childbirth Without Fear and I'm going to start on that tonight. Of all the books on my list, this is the one I've been looking forward to the most. It's come highly recommended by people that I trust, and I've actually used some of the information from this book (accessed through databases) to write an essay last fall.

I've also received shipping notices from Amazon for my copy of Silent Knife, which I'm also very excited to read.

Good things are happening in the universe. I like it.

Here is my 10 week belly photo. I think I'm about the same size as I was around 20 weeks with Lyra Go go gadget uterus!

Thursday, April 28, 2011

My Birth Story. In Two Parts.

I've wanted to share the story of Lyra's birth, but I needed to understand it before I could share it in it's entirety. I had my appointment with Noreen yesterday, and she was able to pull up the O.R. report from my surgery.  I'm going to try and format this entry in a way that tells the medical facts and my perceptions of them side by side. I hope it doesn't get too confusing, so I'll try and keep my side in a different font format than what I copy from the report.

Some of the details are hazy to me, and somethings I have probably forgotten entirely, but I'll try my best to give an accurate account of what happened

The Birth of Lyra June

Thursday, October 22, 2009 (39 weeks, 5 days)
My sister's eighteenth birthday. She chose to have her birthday at Dadeo's, a local cajun joint with awesome food and a 'no minors' sign on the door. I can't think of a better place to have been at that time. She was celebrating her new adulthood, and we were taking advantage of one of the last opportunities we had to dine in such an establishment without having to hire a babysitter. If I remember correctly, I had the veggie jambalaya. After dinner, we went across the street to Flirt for cupcakes.

Shortly after, we were in bed (Chris and I, not my entire family), watching Grey's Anatomy. I felt a little, um, wet. Honestly, I didn't think much of it because I had had some episodes of stress incontinence late in my pregnancy. I waited till a commercial (LOL!) and went to the bathroom and put on a pad. At the next commercial, it felt wet again. I hadn't laughed or sneezed, and I couldn't think of any reason why  I would be peeing, so I smelled it. Not pee. It had a sweet odour, which I knew to be characteristic of amniotic fluid.

We finished watching Grey's, and then I decided it would probably be a good idea to pack my hospital bag. Within an hour or two I started contracting. They were about 6 minutes apart, 30-45 seconds long, so I didn't really think much of it. I could talk through them, and was having no trouble coping. Within a few hours they had picked up, getting up to 1 minute long and between 3-4 minutes apart. I called Labour and Delivery at the Royal Alexandra hospital and they said if I was ruptured, that I should come in.

Friday, October 23, 2009
At around 3:00 a.m. we called a taxi and headed to the hospital. I was checked when i came in, found only to be around 1 cm dilated, but the nitrizine test came back positive- I was indeed leaking fluid. There was some debate as to whether or not I should be admitted or sent home. I knew it was in my best interest to go home and let things happen in comfort, but for whatever reason, they admitted me.

This is the start of an awful ride.

I was not admitted to L&D. They put me in Antepartum in a ward room with a woman in pre-term labour.  Because it was ward and outside of visiting hours, Chris was not permitted to stay with me. So we decided to go down to the closed food court in the basement of the hospital so we cold stay together. At around 8, I felt very tired, so I went back to my room, and Chris went home to feed the dogs and cats, and to pack up some edibles and other things I had forgotten to pack. He returned with my mum around 11 a.m. They had swung by A&W and brought me a veggie burger and onion rings. Chris had also stopped by the Safeway deli to get me some coleslaw- my last pregnancy cravings (Which have me gagging as I type this, pregnant yet again)

I ate, and then we decided to start walking. I paced the hallways for a couple hours, returning when they wanted to put the monitors back on. My contractions weren't getting regular, nor were they strong enough to be considered progressive. (Why wasn't I sent home? I clearly wasn't in real labour.)

At about 5 p.m. I was finally moved up into labour and delivery, and they started an I.V. for syntocinon. (Synthetic oxytocin). I lost my mobility, and it was here when I believe I lost my autonomy. I had been very firm in my desires up until this point, but as soon as I was moved to L&D, they insisted that I no longer wear my own clothes and they put me into a hospital gown. I hadn't wanted an IV, and now I had one. I was no longer allowed to eat. I could have ice chips, but I wanted food. The contractions were now starting to come closer together and felt much more strong. I could no longer talk through them. I clamped my eyes shut and breathed. Chris held a vibrating massager to my lower back and I hummed through my contractions.

By 10 p.m. I was exhausted. I had now been up for nearly 40 hours. I accepted a shot of morphine. I was checked and my cervix was 1.5-2cm dilated. I was losing steam and confidence. The morphine did little for the pain, but it did wonders in making me stupid.

Saturday, October 24, 2009
Around midnight, I was checked agan, and found to be stuck at 2cm. At this point they began talking about surgery.  They suggested I consider an epidural, and seeing if being able to rest wold help me to dilate. I accepted their offer and the anesthetist came in shortly. He was very unpleasant. He kept getting short with me, barking orders not to move. I was devastated that my labour had come to this, and trying to hold still for a needle in your spine while you're sobbing isn't exactly easy.

The anaesthesia kicked in shortly, and I slept. Meanwhile, they had increased my syntocinon to maximum per body weight. I was spiking a fever, if I recall correctly it was 105 degrees. Lyra's heart rate was spiking as well, up n the 200's.

At 4:30 a.m., I was checked once more and found to be 2.5cm dilated, and I was wheeled down and prepped for surgery, which began around 5 am. Here is the dictation for the surgical report (and I am including it verbatim): My notes are in black.

Preoperative Diagnosis: Pregnancy at 39 plus 5 weeks' gestational age. Spontaneous rupture of membranes, Failure to progress in first stage. Query Chorioamnionitis (amniotic infection)

Procedure Proposed: Primary lower segment transverse cesarean section after trial of labour

Indications: Patient is a 25 year old, Para 3, Gravida 0 who arrived with spontaneous rupture of membranes at 39 plus 5 weeks' gestational age. On arrival, her cervix was 2cm dilated and despite Syntocinon for many hours, she never proceeded beyond 2cm to 3cm dilated. She began to have fetal heart rate abnormalities; however, overall the fetal heart continued to show good variability. We offered her an epidural and she accepted this offer. We then let her attempt to dilate her cervix with the epidural in place. This did not happen and her cervix remained 2 cm to 3 cm dilated. We, therefore, made the decision to go forward with a cesarean section. She was made aware of the risks and benefits and she consented for the surgery. 

Procedure (WARNING: GRAPHIC): The patient was brought into the operating room and received a top up of her epidural anesthesia by Dr. Scott Paterson. The patient was then placed in a supine position and draped in the usual manner. A foley catheter had been inserted into her bladder. 

A Pfannensteil skin incision was made in the anterior abdominal wall and taken down to the level of the fascia using sharp and blunt dissection. The fascia was incised transversely and the incision was extended using Mayo scissors. Cautery was used to achieve hemostasis.  The fascia was then dissected off the bellies of the rectus muscle. the rectus muscles were retracted laterally exposing peritoneum, which was entered without complication. 

There was a fair amount of ascites indicating obstructed labour (Dr. Google tells me this is a build-up of fluid). The lower end of the Balfour retractor was placed and the vesicouterine peritoneum was incised. The bladder was then dissected off the lower segment of the uterus. 

From a vertex position, a live female infant was delivered spontaneously with no complication. The NICU was in attendance. The infant was vigorous at birth (If she was so vigorous, why was she admitted to NICU?). Cord blood and gas were drawn and sent for further analysis. 

Lyra June Staples was born on October 2, 2009 at 5:22 a.m. She weighed 7 pounds, 9 ounces, was 20.5" long and her head circumference was 13.5". Her daddy was able to cut the cord.

The placenta was sent to pathology. The patient had received antibiotics preoperatively. The interior content of the uterus was swept with a clean sponge after the placenta had been delivered. The uterus was then externalized and Green-Armytage clamps were placed both medially and laterally. the uterine incision was then closed in a single-layer closure. The uterine incision was then inspected and hemostasis required two figure-of-eight sutures.

The subfascial space was inspected and hemostasis required cautery. The fascia was then closed in a nonlocking 0 Vicryl suture. Subcutaneous fat was inspected. Hemostasis required cautery. The skin was then closed using staples.

The patient returned to the recovery room in stable condition. The sponge and instrument counts were correct at the conclusion of the case (Oh good, they didn't leave anything inside me) Estimated blood loss was 700 mL. 

Lyra was brought up to the NICU while I was in recovery. As far as I remember, I was in recovery for quite some time before they moved me into postpartum. I think it wasn't until around lunchtime when i was finally allowed to be wheeled up into the NICU to properly meet her. I almost had to laugh a her being there. She was in a pod next to a set of micro-preemie twins and she was, by far, the biggest baby up there.

She stayed in NICU for about 36 hours, they paged me to come up to feed her. I had to hobble up there with my bum IV pole and my catheter hanging out to another wing on another floor. It was awful. They finally released her to me on Sunday evening. She slept with me that night, and Monday morning, Dr. Halleran said that I might be able to go home that evening. But of course, no one seemed to know who Lyra's pediatrician was, so they had no one to discharge her. I ruffled some feathers and ended p getting them to call in one of the peds to sign off on her case so we could finally go home. I think we officially signed out at around 8:00 pm. It was so wonderful to finally be home.

Now reading this report n retrospect, makes me so sad. It admits, 100% that my cesarean was unnecessary:

1. Why was I admitted? I wasn't in labor, and I was leaking, not completely ruptured. I imagine had I been able to go home, that leak would have sealed and I'd have continued to be pregnant for another week or two.

2. Her heart rate had spiked, but the report says that there was still good variability, which from what i understand is the important thing- not the rate itself, but how it changes in response to stimuli.

3. Failure to progress in the first stage. Of course. I WASN'T EVEN IN REAL LABOUR.

4. Why was Lyra sent to NICU? They said she was having oxygen desaturations, but as far as I remember from her monitor and the reports, her 02 was 98%. Her apgars were good- she was born screaming. Does this look like a sick baby?

At least now I know there is nothing wrong with me. I wasn't in labour, and they decided to try and force it. I'm a little concerned that my incision was closed in a single layer suture, which is associated with a slightly elevated risk of uterine rupture (up to 3% as opposed to <1%), but other studies I've looked at imply that that the risk is associated more with the type of suture used- vicryl being favourable over gut.

My midwife is not concerned, so I shouldn't be either. She did have a nice little chat with me about worrying. She very frankly told me that worrying will not get me anywhere and that worry does nothing to empower me. I need to trust my body, to trust birth and to trust her as my midwife. And she's right. 

Monday, April 25, 2011


I have my first appointment with Noreen on Wednesday and I need help coming up with a list of questions I should ask her.

On the top of my mind are the following:
1) Issues with my uterus- how we can deal with a possible slow to start labour, and what I can do ahead of time to prepare

2)What could have caused the spotting I had on the weekend.

3)If she would be willing to go over my hospital records with me and help me to make sense of them and help me to recreate a timeline of what actually happened.

Any other suggestions about what I should bring to the Q&A would be great.

In other news, I had quite a fright this morning when an ER doc from the hospital called to tell me my swab came back positive. Of course I panicked, and he went on to tell me I tested 'inconclusive' for yeast. So I may or may not have an asymptomatic yeast infection. Ridiculous.

Friday, April 22, 2011

What a terrible day

I had some brown spotting today. I knew I probably didn't have anything to worry about, but of course me being me, I flew into panic mode, left work at 3:00 and headed to the emergency room.

The ER was deserted when we got there, so I assumed we'd be able to get to the bottom of things pretty quickly. I got moved to the gyne corridor right away and a phlebotomist came right in to do my blood draws.

And then we waited. For three hours, completely forgotten about. I walked into the corridor in my little gown and bare feet and got a bit shitty with a nurse.

Lo and behold, 5 minutes later my bloodwork magically appeared and the doctor shuffled in with a speculum and a portable ultrasound unit. My betas and progesterone were both good, cervix closed and we saw baby- heart beating away.

I'm not sure why they didn't do the ultrasound initially. It would have eased my fears immensely and brought my blood pressure down a little. At triage, it had spiked to 30/40 points above baseline for me. (130/85, whereas I'm normally around 90/55). I'm pretty irked that I had to ASK for the results and that no one seemed to give two shits about me, but this is my experience with hospitals and doctors. (After my miscarriage, I had a radiologist tell me that it was "god's way")

At least I can sleep well knowing that everything is okay.

Friday, April 15, 2011

Ultrasound Follow-Up

I just got home from visiting my G.P. who ordered my scan. Apparently that tech wasn't the greatest at her job. I suspected such. The radiologist who checked the measurements afterwards said baby measured 6 weeks, 6 days (I was 7 weeks by LMP on that day), which clears up all the WTF-ery I had going on in my head. It just wasn't possible to be six weeks.

The report says everything is normal, heartbeat still on target for that gestational age. The only anomaly noted was my uterus, but baby didn't implant in the septum, so I'm not worried about it. 

BUT one thing came up in my visit, that I thought was rather significant and I'm wondering why nobody told me this: Apparently, having a bicornuate uterus can make your contractions less coordinated and weaker, which would totally explain my slow moving labour.  You would think at some point that would have come up either DURING my labour or afterwards. I had a c-section- my uterus was at one point outside of my body, and nobody seemed to notice that little anomaly?

So glad to have a midwife this time around.

On the topic of which, I had the WORST dream last night. I was at my initial visit, and filling out a bunch of intake forms, and she looked them over, and told all the other girls "Congratulations, welcome to my practice:, and then she turned to me and said "I'm sorry Vyky. but you just have too many risk factors, I'm afraid I have to transfer your care". Worst. Worst ever.  That doesn't happen in real life, right?

I feel good. All of the things that had been eating at me have been all cleared up.