Friday, August 31, 2012

The Past Two Weeks

Lydia was two weeks old yesterday! She has accomplished so much over the past two weeks.

She lost two ounces in the first few days and was down to 2 lbs. 8 oz. As of today, she is 3 lbs. 1 oz.

Her bilirubin levels were high, so she was under the phototherapy light for a few days after birth. Because the light is drying, she also received IV fluids. On August 23, at only a week old, she received her last phototherapy session and her last dose of IV fluids. Her IV was totally removed the next day.

Like many preemies, she had some apnea spells - when she would forget to breath for a few seconds - during her first few days. Starting on August 20, she received a dose of caffeine daily to stimulate her breathing. On August 27 she received her last dose of caffeine, and I am happy to report that she hasn't had an apnea spell since then!

On August 24, a week ago, she was moved from intensive care to intermediate care.

On August 28, her umbilical cord stump fell off. I noticed it was gone when I was changing her tiny little diaper.

She started eating breast milk through a feeding tube on August 18. She bottle feeds a few times a day now (I get to bottle feed her when I am there, which is every day) and gets the rest of her milk through the feeding tube. Because she is still so young (35 weeks gestational age), she gets tired while trying to eat from the bottle. Sucking, swallowing, and breathing all at once is hard work for a 3-pounder!

She's got a mess of blonde hair, blonde eyebrows, and blonde eye lashes!

Thursday, August 16

When Thursday arrived I discovered that my muscle control was seriously compromised. I had to have help walking to the shower and had to sit in a chair to shower. One of the nurses had to help me dry my hair because I couldn't hold the hair dryer. It was like I could decide to move my arm or leg, but once it started moving, I didn't have the control to stop it. I had trouble speaking clearly because my tongue felt so loose and fat, and my vision was blurry. Did I mention that mag was the devil's drug??? I felt like I was losing my mind.

I worked a little bit more that morning just wrapping up loose ends, but soon after 9 am I disabled my work email account on my phone. I haven't turned it back on since then.

Lydia received another BPP sonogram and got another 10/10. All through this she still seemed to be doing fine. When Dr. Patterson made her rounds that morning, she told me that my liver enzyme levels continued to rise and my health was declining quickly. She wanted to induce labor at around 10:30 am. After I was induced, they would be watching Lydia's heart rate (I still had an external fetal monitor on me) to make sure she was handling the contractions well.

I was reluctant to go ahead with the induction because Lydia was only 32 weeks 6 days, but it was obvious that it was just a matter of time before something serious happened to me or her. Chip called his parents to let them know I would be induced, and Brian called my mom. Corinne and Susan arrived at the hospital thinking that they'd hang out with me while I was on bed rest only to find out that I'd be having a baby that day.

At 10:30 when Dr. Patterson checked me, I was already 1cm dilated and 60% effaced. She gave me Cervadil to start the contractions, and I began to feel tightening contractions very soon after that. The contractions were easy and didn't feel like much compared to all I had experienced over the previous few weeks. The next few hours were surreal. I had wanted a natural, drug-free, vaginal birth, and here I was, getting all kinds of drugs through an IV that I didn't want. I was hooked up to a fetal monitor that I never wanted. How in the hell I was going to deliver a baby if I couldn't stand, walk, talk, or see?

By 2 pm when Dr. Patterson checked me again, I was still only 1cm dilated. The nurses had been watching Lydia's heart rate, and it was dropping every time I had a contraction, though I'm not sure by how much since it is normal for a baby's HR to drop a little bit during contractions. These were small contractions, and given that she was less than 3 pounds, it didn't appear that she would be able to handle the stress of larger, more powerful contractions as my labor progressed. Dr. Patterson decided that I would need a c-section, and I reluctantly agreed. It wasn't what I wanted, but I couldn't imagine delivering her vaginally in my physical state.

Things happened very quickly after that. I was prepped for surgery. Dr. Patterson said a prayer with us. I went to surgery and received an epidural to numb my lower body. Lydia Grace Burr was born at 3:13 pm. 2 pounds 10 ounces, 15 inches long. Her Apgars were 7 at 1 minute (-1 point each for color, reflex, and muscle tone) and 8 at 5 minutes (-1 point each for color and muscle tone).

She was a tiny but healthy baby who was screaming and crying after she was born. She breathed room air from the beginning with no ventilator and no oxygen. 

Wednesday, August 15

We got up early on Wednesday morning so that we could finish packing for the hospital. I had gotten about three hours of sleep. As luck would have it, one of the work projects that I had been working on for months was scheduled to go live on Wednesday night. Since I thought that I might be on bed rest in the hospital for a few days or even a few weeks, we stopped by my office on the way to the hospital so that I could pick up my laptop and a few other things. When Chip tried to crank my car to leave the office, it wouldn't start! The battery had died! It was about 7:45 am, and lots of folks were showing up for work. A couple of my co-workers, Tim and Milton, helped in giving us a jump start.

After I checked into the Women's Hospital in Tupelo, I was taken to Labor and Delivery Room 107. The nurses asked me to change into a gown. I had Chip take a few last preggo photos of me since I figured I would not be back in my normal clothes until after she was born. I was right.

The nurses took my blood pressure (144/70), took more blood samples, and put an external fetal monitor on my belly to monitor Lydia's heart rate. Lydia got another BPP sonogram and scored 10/10. When my blood work came back from the lab, it showed that my liver enzyme levels had doubled from the previous night. I did not have any symptoms yet - no headaches or abdominal pain - but from looking at my health stats my doctor could see that those symptoms weren't far behind.

Preeclampsia and and HELLP syndrome have a laundry list of complications from liver and kidney damage to seizures. To prevent seizures I was hooked up to an IV of magnesium sulfate at around 11 am.  Magnesium sulfate (called "mag" by the nurses) is the devil's drug!! Just look at this list of side effects:
 - hot flashes
 - muscle weakness and lack of control
 - nausea and vomiting - blurry vision
 - slurred speech (well, because it is a muscle relaxer and the tongue is a muscle)

And I experienced them all. The first dose was very concentrated and burned like fire going through my IV and made me super hot. After that initial dose the following doses were more diluted. Sadly though, because the drug is a potent muscle relaxer, I was bed bound... which meant bed pan. Because of the nausea and vomiting, I was put on a liquid diet of Sprite (which I didn't drink because it is disgusting), Jell-o, pudding, and cream of chicken soup (also disgusting but manageable). Being bed bound was awful... Chip was such a trooper for being my personal servant for a few days. The liquid diet just made the whole experience more of a nightmare.

The nurses monitored my blood pressure, temperature, and heart rate every hour, even during the night while I was trying to sleep. Blood samples were taken every eight hours. It continued like that for three days.

That afternoon I arranged for my brother, Brian, to come to the hospital the next morning. Chip needed someone to lean on and relieve him a bit, and Brian was eager to see me and see how I was doing. Corinne also volunteered to come over to see me. On Wednesday afternoon and evening, I worked some to monitor how things were going with the project release. All was good.

Thursday, August 30, 2012

Week 32

At the appointment on Friday, August 10, I had a BPP sonogram, and baby Lydia scored a 10/10. The sonogram tech measured her at 2 lbs 11 oz, HR 144, 136, and 128. Her abdomen and femur were still 2-3 weeks behind her head, but other than that she was doing great. My prognosis, however, got worse. My blood pressure was 135/92. This was now the third high blood pressure reading in ten days. I still had major swelling that had started on Monday and had not gone down. And, I had gained five pounds since Monday due to the swelling. All were signs of preeclampsiaI was seeing one of the other doctors in Dr. Patterson's practice that day, Dr. Garner, and she had me do a 24-hour urine capture to test for proteins, which is the best way to diagnose preeclampsia

When I woke up on Saturday morning, most if not all swelling was gone, and I was feeling much better after such a bad week. I went to work on Saturday morning, then I rested on the couch laying on my left side almost all weekend trying to get my blood pressure to lower. The swelling would not return, which got my hopes up again that my health was improving. I was hoping that the previous week's episode was stress related because of all the driving, appointments, and the fact that it was a stressful week at work because I was missing so much work. I made a vow to stay home at the first sign of any new swelling. 

On Sunday I had to drive to the Women's Hospital in Tupelo to turn in my urine sample. My doctors had ordered the lab to take a blood sample to test for HELLP syndrome.  

On Tuesday, August 14, I went for another BPP sonogram. Lydia scored another 10/10. The sonogram tech measured her at 2 lbs 12 oz, HR 149 and 127. Her abdomen and femur were showing 4 weeks behind her head. Sonograms are an imperfect science, and each tech measures a bit differently, so these measurement variations were typical. In general what the sonogram was showing was that Lydia still showed asymmetrical growth, but she was a healthy baby otherwise. Each time she was "practicing her breathing" taking fluid in and out of her lungs. 

My blood pressure was still high, 138/95. Dr. Patterson had bad news for me. My urine sample did contain protein, which is a sign of kidney damage. My blood work still looked normal. On Sunday evening, as soon as my urine results came back, the doctors diagnosed me with mild preeclampsia. Going forward, in addition to BPP sonograms, blood pressure, and urine tests, I would have blood taken and labs done. She started the blood tests immediately. 

On Tuesday night, Dr. Patterson called me at 9:45 pm, right after my blood work came back from the lab. I was now showing elevated liver enzymes in my blood which is one of the symptoms of HELLP syndrome. My health was worsening, but the crazy thing is that I FELT fine! 

She said that she wanted to admit me to the hospital first thing the next morning where they could monitor me more closely. I would be on bedrest in the hospital until baby Lydia came. She said that could be ten hours or 48 hours or two weeks depending on my health and Lydia's. I was in shock. I couldn't believe that I could be delivering my baby at 32 or 33 weeks. I cried some, and I'm not really a boo-hooer. I started packing my bags hoping for a long stay in the hospital. I didn't fall asleep until after 2 am. 

Monday, August 27, 2012

Week 31

Week 31 began a wild ride that still has not slowed down. I went for another sonogram in Tupelo on Monday, August 6. At this appointment my blood pressure had shot up to 143/97, but I had been talking to the nurse during the reading. She said she would get another measurement before I left the office, but we didn't end up doing that. We really should have. 

On August 6 Lydia was measuring 2 lbs 6 oz. Her heart rate was 140. Her head was measuring 30 weeks, abdomen 26 weeks, and femur 27 weeks. She scored a 10 out of 10 on her biophysical profile (BPP) sonogram. Dr. Patterson decided not to give me the betamethasone shot at this appointment because she didn't want the steroid to affect the outcome of my sonogram with Dr. BK the next day.

That evening we drove up to Memphis because our appointment with Dr. BK was at 7:30 am. It was this evening at the hotel that I noticed how swollen my feet and ankles had become over the course of the day. I blamed it on stress and a normal reaction to being pregnant during the heat of August.

On Tuesday, August 7 at my appointment with Dr. BK, we found out that she was actually in the less than 5 percentile for her due date. They measured her at 2 lbs 4 oz, with her head measuring right on time at 31 weeks. Abdomen and femur measurements were about the same, about 4/5 weeks behind. Her heart rate was 129, and she scored at 10/10 on her BPP. My blood pressure at this appointment was back to normal - 118/70. I forgot to mention the swelling in my feet and ankles, which hadn't gone away overnight.

Dr. BK explained that she had asymmetrical growth -- she was directing her energy into maintaining the growth of her brain and heart at the expense of her other organs, muscle, and fat. Generally that points to some sort of physical deficiency in the placenta or a lack of sufficient blood/nutrient flow through the cord. However, they still did not see any evidence of that on the sonogram and didn't find anything physically wrong with me or with baby Lydia. Blood flow through the cord was good, everything in my womb looked normal, and other than her small size she was a very healthy baby. He explained that the only thing that pointed to a growth restriction was the asymmetrical growth. Because my health was still really good and she was still really healthy other than her small size, everything else pointed to me having just a small baby. 

Dr. BK's plan of action was that me and Lydia would be monitored very closely to make sure that blood flow through the cord continued to look good and that she was growing. I would have biophysical profile sonograms twice a week - one in Tupelo and one in Memphis. He said that his goal was to get me to 34 weeks. That really freaked me out. Dr. BK told me to drive straight to Tupelo to get my first round of steroid shots, and we did. I drove back to Tupelo the next day, Wednesday, August 8, on my lunch break to get the second shot. I was scheduled to have a BPP and to see one of the other doctors in Dr. Patterson's practice on Friday, August 10. I would have another BPP and see Dr. Patterson on Tuesday, August 14. Dr. BK would see me on Friday, August 17.  

At this point, I was really frustrated to have to drive back and forth to Memphis and Tupelo so much. I was missing a ton of work and was having to catch up in the evenings. But, I was reassured knowing that I had two doctors monitoring Lydia’s health and mine. I was still optimistic that everything was fine, that Lydia would make it to her due date. Little did I know that I would be admitted to the hospital in a week.

Week 30

I was super excited about my 30 week appointment on Tuesday, July 30 because of course it meant that I would get to see my baby girl in 4D with the 4D sonogram. She was ADORABLE on the 4D sono. Her eyes were open, and she kept opening her mouth and sticking her tongue out. We were in love! Chip said she looked like she had Claudia Schiffer lips, but he didn't recognize the nose at all. I did, though! She has Lukas's nose! 

30 week sonogram
But then I got a curve ball thrown at me. Lydia was measuring small, in the less than 10 percentile for her due date. She was only 2lbs 1oz. Average weight for the 30 week mark is a little less than 3 pounds. Her head circumference was measuring right on time (so my due date, October 5, was not wrong which would be the simplest explanation for her small size), but her abdomen and legs were about 5/6 weeks behind. 

My doctor, Dr. Brandy Patterson in Tupelo, thought that I could be simply growing a small baby since I was a small baby myself. Or, it could be more serious - that she was not getting the proper nutrients because of a physical problem with my placenta or cord, although in the sonogram that day blood flow through my placenta and cord looked normal. She scheduled me to see a specialist, Dr. Roy Bors-Koefoed (aka Dr. BK), in Memphis the following week. 

My blood pressure at this appointment was higher than normal - 131/89. It had hovered in the 117/77 range my entire pregnancy with one exception. On June 4 it had been 128/85.

At that appointment on July 30, Dr. Patterson started to prepare me for an early delivery. She said that if Lydia was just small, then I should be able to go into labor naturally. But, if there were complications that were preventing her from growing, then she would want to deliver her no later than 37 weeks. Dr. Patterson decided to see me again the following week to do another sonogram to check Lydia's growth progress. She mentioned that at my next appointment on August 6 that I would get my first round (out of two) of betamethsone steroid shots to jump start Lydia's lung development. I was diagnosed with intrauterine growth restriction (IUGR).

At this point I started to get really bummed. I was frustrated by the possibility that my body was not providing sufficiently for my baby. And, I was frustrated about what it meant for labor and delivery. I wanted and had been preparing for a natural labor and vaginal delivery with no drugs. With this complication I knew my chances of being able to go into labor naturally were quickly diminishing. I'd likely be induced at 37 weeks which would be an intervention. 

I tried my best to stay optimistic. Dr. Patterson is super energetic and peppy, so while she gave me all the facts about what might happen, her positive tone and energy really helped me keep a positive outlook on everything. Looking back I wonder if maybe I was overly optimistic and didn't really understand how serious things were about to get. 

Sunday, August 26, 2012

Introducing Lydia Grace

I have good news! My daughter, Lydia Grace, is here!

Born August 16, 2012 at 3:13 pm
2 pounds 10 ounces
15 inches long

She was born at 32 weeks 6 days, just hours short of 33 weeks. I am so thankful to say that Lydia's health is excellent given how early she arrived. She is in an incubator to help maintain her body heat because she's so tiny, but she's not on a ventilator, no IV, no oxygen. She is small, but she's growing every day.

Daddy holding Lydia moments after her birth.

Sleeping beauty.

Little cutie pie.

Waving "good morning" to daddy.
Over the next few days, I am hoping to gather my thoughts concerning the weeks that led up to her birth. I have notes on my phone, jotted in notepads, and written in emails (sent to many of my readers), but I want to capture the story here.

Saturday, August 25, 2012

It's a Celebration

Tonight we are celebrating the birth of our daughter. Chip is making dinner. The starter is a watermelon salad with roasted figs, feta, manchego, and balsamic dressing. Then for dinner, filets and rosemary roasted potatoes.

We opened a 2005 Bond Matriarch from our Napa collection from our visit a few years ago. Wine, I sure have missed you!

I'll update the blog tomorrow with all the details about the birth of my beautiful daughter, Lydia Grace.

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