No Good Eggs

I had a very hard time deciding if I wanted to attempt a VBAC or have a schedule c-section with Naomi. (I had a vaginal birth with the twins and an unplanned c-section after pushing with Malia). Then, once I settled on the c-section, I was nervous I would go into labor (but not have my water break) before the scheduled day, and would have to convince my doctor to perform the c-section. Ultimately, that did not happen. I went to bed on March 5^th and slept relatively well, considering there was a huge baby on my bladder, waking me up every 90 minutes to pee.  I set my alarm for 4:40 and my mom was coming over at 4:55am. Malia was thankfully still asleep, so I didn’t disturb her. I kissed Avani and Jeremiah goodbye. I got very teary because I was having a lot of anxiety about the surgery and was worried something would happen to me. My mom gave me some hugs and took a picture of Brian and I and we headed the hospital.

We got checked in and shown our room. I changed into a gown and they did my blood work, reviewed and signed all of my consents, took my vitals and started my IV (which took two attempts and blew my vein, leaving a giant bruise). We talked about my birth plan (keep me alive, keep baby alive, breastfeed) and I showed them the cord blood banking kit. They also prepped my surgical site, reviewed my previous deliveries, and started me on an antibiotic and a bag of fluids. I had to drink a nasty drink to prevent nausea, but just like last time, it gave me nausea. I didn’t throw up but I had to spit into a bag. I started having some contraction while I was laying there, probably from the positioning and my full bladder. I had to go to the bathroom once and take the whole IV pole with me.

Dr. Barr came in first to review what was going to happen. I had seen her the week before and was very teary the whole time, telling her about my anxiety for me and the baby and explaining that I had only every had babies that had to go straight to the NICU; I had never been able to hold a fresh wet baby before. She told me about the c-section plan, which included a clear drape so I could see the baby right when she came out, and being able to hold the baby right away before the nurses took her. It sounded wonderful but had to imagine. Would this baby come out breathing, unlike all my others? We reviewed this plan again and I reiterated my desire to hold her as soon as it was safe. Dr Barr is so very nice and warm and comforting, so that was wonderful.

Next the anesthesiologist came in. Apparently he is the nurses’ favorite to have in a c section and he was indeed very thorough and friendly and kind. He explained the spinal in detail. This must be what most people who give birth are most nervous about (having a needled put in their spine) but so me, I don’t really stress about it, as I know anesthesiologist do it all day every day and are some of the smartest people on earth (not that they aren’t human). In the OR he also explained every step in detail and the nurses were impressed I didn’t even flinch at the needle.

By 7:05 all my pre-op stuff was done, and both doctors had been in to see me, but we were not yet headed back to the OR. Then I was able to walk back, got onto the table, and got my spinal. Once that was in and I was laid on the table, then they started prepping my surgical site. There was a guard in place (like a very sticky sticker that worked like spanx to keep my tummy up near my chest) which I don’t remember from my previous c section. They did a very hard (supposedly) pinch on my skin which I did not feel at all, so they knew the spinal worked. They placed my catheter, which is so much less unpleasant when you are numb! Then finally they brought Brian in! It felt like forever waiting for him but it was probably only 15 minutes or less!

I felt a lot of tugging and pulling at they did the incision. It’s a weird sensation. Not painful but strangely uncomfortable. Like someone is rifling through a tote bag on your stomach, trying to feel for keys at the bottom. It felt like it took forever and I asked the anesthesiologist (who was by my head) if everything was OK. He said yes, this part takes time, and they would remove the drape so I could see her when it was time. A few moments later they took the blue drape down so it was just a clear drape and I could see her coming out of me! She was covered in the white vernix and she was crying!!! I have probably never been so happy in my life! I knew she was breathing and I was so thrilled and relieved! I remember saying “she’s crying! She’s breathing! Good girl! Good job!” They removed the clear drape and put her right on my chest and I finally got to hold a fresh wet baby!! (it was really more like my neck because of the surgical site area). It was 7:37am!

She was there for a few moments and crying on and off! I thought she looked a little purple and asked the baby nurses about her coloring. They said “we can take her and rub her and get her a little more pink” which I was happy to let them do, because of course I was nervous. They took her over to the warming bed and Brian went with (two nurses and him). They were rubbing her skin to kind of wake her up. At one point they puta pulse ox on her and I could see the numbers, going between 84 and low 90s. I asked if she was OK and everyone said yes and was calm. Brian got to trim the cord! They didn’t weigh her or do any APGARs, they brought her back over to me and placed her on my check/neck again. I got to hold her, with Brian’s help, like that while they sewed me up! It was awesome! When Dr Barr was almost done with me the nurses asked if they could take the baby to weigh her, and I said yes and Brian went with her. They did her eye drops and shot and weighed her. A nurse came back and asked if I wanted to know how much she weighed. I couldn’t believe it when she said 9lbs and 7oz! Even bigger than Malia, wow! 19 inches long! Dr Barr said “aren’t you glad you opted for the c-section!” and indeed I am because I think I otherwise would have ended up with a c-section after pushing, like I did with Malia.

They wheeled me back to the delivery room and she was all ready for me to hold her and nurse her! By 10:05 )(probably sooner), she had latched on to both side and ate while we were in the recovery room! Naomi was cooing and very content. We gave her the middle name Adele, after my mom’s mom. She was “thrilled and shocked” about the name! I felt good besides the uterine cramps from the post c-section Pitocin. By 10:36 she had already had her first pee and poop! She needed size 1 diapers, not newborn! At 11:05 I was moved to Mother-Baby and by 11:19 she had had her first check up with Dr Omar! (Our favorite of the pediatricians from our group!)All was well and we were happy to hear he would be her doctor for the next two days in the hospital too! At 12:05 my spinal was wearing off so I took one pain med. She was large for gestational age and had to have the blood sugar protocol (testing before she ate and having good numbers 4-5 times in a row). All her levels were good and she passed that on her first attempt. My mom says she looks like a mix of me and Brian!

At 12:15 she opened one eye and we got a picture! We ordered lunch and spent all our time looking at her and taking her picture. I could not get out of bed till that evening and still had my catheter all night. I got to talk to my maternal Grandma and Grandpa, she was very excited and had lots of questions and he said “she is over the moon to have her name on that baby!”

(here is a picture, a month later, of Naomi Adele with her great grandma Adele!)

One thing (the only thing?) all my deliveries have in common is that I am right in between sizes on the blood pressure cuff and thus both bruise my arm terribly. I have tons of long thin bruises on my arm, plus two huge bruises from the blood draw and the failed IV placement. Otherwise I felt pretty good. I was able to only take the one Norco and other took only the super strong IBP (torodol) in my IV, until getting switched to the regular IBP 800. I also had my vitamin, Zoloft, stool softener and had to start the daily Lovenox injections to prevent blood clot. At 6:02 I walked about 20 steps to the bathroom to clean off with a water bottle, and back!

My mom had a very hard day with the kids so Brian went home to try to help with bedtime. Jeremiah “Daddy text this to mommy; I have an idea for if Naomi and Malia both want ‘momo’ (our word for nursing) at the same time. One can go on one boob and one can go on the other boob – I think that’s a really good idea!”

The first night we sent Naomi with the nurse to the nursery twice in between feedings to try to get some sleep. It still didn’t really work because our schedules for her eating, my checks and her checks were all off. The second night we kept her in the room with us and told the nurse when she was awake to eat, so that her eating and our checks could get synced up, and that worked much better and we got more sleep.

The first night she lost a ton of weight, 5%, which is a lot for the first night (usually you see more the 2^nd night) and she was down to 8 lbs and 14 oz. However Brian and I weren’t worried because the same thing happened with Malia, and Naomi had also already pooped 5 times! I fed Naomi every 3 hours all night and she did well latching but I didn’t have my milk in yet (I could tell cause I tried to pump). When we talked to doctor Omar a few hours later he was also not concerned about her weight loss!

At 5:35am my catheter came out, and despite all my concerns, I peed on my first try, about a half an hour later! (After I delivered Malia my brain did not reconnect with my bladder for 3 days and I have to be re-cathed multiple times and ended up staying in the hospital for 3 days trying to pee). What a huge relief after the 2 day catheter debacle from my last delivery! I also made a few solo walking laps in the hallway. I could tell this recovery was going to be so much easier than my last c-section!

Naomi lost more weight overnight, but again Dr Omar was not concerned about the amount. I met with two different lactation RNs and they assured me the loss was normal, especially for a c section when they put on fLuid from my pre-surgical IV.

I got to take a shower! We had Bella Baby do her newborn hospital pictures! We ate and nursed and napped and had an all around busy but quiet day! I am happy with our decision to not have our family come to the hospital this time! It was so nice to have some time with just me, Brian, and baby. He helped my mom out around dinner time again the second night. Malia had a better night but my mom still did not get much sleep at our house.

We slept much better night two. We had breakfast, I saw Dr Barr and got the OK to go home, and Naomi saw Dr Omar and got the OK to go home. Brian drove through the pharmacy to get my meds and installed the car seat base (yes, baby #4 doesnt get a car seat installed till she was 2 days old!). When he got back I took another shower and we were just about to order lunch, because the unit seemed very very busy, but our nurse surprised us and had our paperwork ready!

Just over 48 hours after her birth we got to come home! I was so ready to see our big kids!

This birth could not have gone much better. I have s full term baby and my bladder had no problem working after this c section! My milk is in! We got to come home after about 50 hours in the hospital! Twins are thrilled and Malia…. she has a big adjustment to make! My pain is OK, gas pain is worse than incision pain at the moment. Let the chaos begin!

Naomi Adele Kim

7:37am

9lbs 7oz

19 inches

Baby girl will be here in 29 days or less! I still feel good; tired and some hip pain at night. But I don’t feel too huge or uncomfortable yet. It’s not easy to pick things up off the floor, but that’s what I have 3 kids for! (To drop all the stuff first, then pick it up). The crib is assembled. I asked my friend for the pack in play back. I bought some tiny diapers and organized and washed all the girl clothes, plus swaddles. I’d like to make and freeze some lactation cookies. There are a couple rooms I’d like to get more orderly before she comes. We have our weekends wide open this month, which is heaven as I bounce back and forth between manic nesting and total exhaustion.

I only have one Makenna progesterone shot left and am so grateful to have made it this close to term! If I deliver now it would be at my local hospital! Just don’t ask me if I’m going for the VBAC or the scheduled C, I haven’t decided! Growth ultrasound on the 19th to help guess if this baby is going to be as large as Malia.

In other news that I never ever thought would happen, B is getting a vasectomy in July. We always said that avoiding that was one of the pros of my extreme infertility. Oops.

Here are some of my favorite maternity pictures!

I’ve been way too busy and tired to post, but we are well! Currently getting ready for Christmas and hoping to stay healthy! I hit the third trimester yesterday and baby #4 is growing well! I turned 32 last week and feel so fortunate for my life and my family! I hope you have healthy and happy holidays!

(Please note before you start this that Jeremiah is fine. This was a very scary ordeal and it took me a long time to finally write it all down. I would like to share it with you because writing is cathartic for me.)

On Sunday August 19th at about 9pm (after he had been sleeping for a couple hours), Jeremiah woke up coughing and unable to fully breathe. Brian and I did not know what was wrong at the time, but we later found out that it was a sudden onset of croup with stridor (closing of the airway). Jeremiah had not been sick at all – no temperature or cough or runny nose or anything. So, when he woke up upset we thought he was scared of coughing or having a bad dream and having a panic attack. We tried to take him to different rooms of the house, cuddled him, tried to get him to drink water and told him to take deep breaths. He would calm down a little bit on and off and even almost fell back asleep. But he was still making weird noises when he breathed. It sounded like a loud whistle. He didn’t have a fever but he was saying weird things. We tried to calm him for over 20 minutes and only finally decided to call 911 because he was talking about a train coming and we were afraid he was hallucinating.

When the EMS got there they checked his oxygen (99) and didn’t know what was wrong (in hindsight they had probably never heard stridor). He was transported via ambulance to Trinity ER. Brian rode along and my dad drove me (my mom stayed with the girls). They gave him a breathing treatment in the ambulance, I think, but could not get his IV in. When we got to the ER he got a breathing treatment and responded well right away (hence the picture here) so they decided not to start an IV and just give him an oral steroid. They told us it was stridor and he would probably stay overnight for observation. About 40 minutes later he had to pee, and when he stood up to pee in the hospital jar thingy the stridor came back. At this point we had totally calmed down and all of the sudden the staff seemed panicked again. They told us that he needed to be sedated, intubated, and go to Iowa City via helicopter. I was totally stunned and in disbelief, as he had been fine 5 minutes before. I asked why they had to do something so extreme ad they said that if they didnt they could have to do an emergency trach if his airway closed more. OOOOOOOH K. Wow, I had no clue how serious this was until she said that.

From then on it got a little chaotic at Trinity. We told JD that they were going to give him some medicine to help him go to sleep but we would stay with him the whole time. He was so brave and did so well. I was so nervous for him to go under anesthesia for the first time. Thankfully a nurse warned me that his eyes were going to dart back and forth and that was a normal side effect. Once he was under the ER doc and Respiratory Therapist really struggled to get the tube in – I don’t think they had probably ever intubated a four year old and his airway was so small -they never even got the “right” size in and had to go with a tube a size smaller than his correct size. Then, the tube was not as far down as it needed to be (X ray) and they had to do it again. They told us the x ray showed he had pneumonia but later at UIHC they said it was just a bad x ray and he may have actually had a partially collapsed lung, he did not have pneumonia. The Respiratory therapist was trying to suction the spit and liquid out of him but that was really irritating him and making him “mad” and then his stats would fall. This was majorly freaking me out – it was not a calm environment at all. Meanwhile the helicopter team arrived and was doing paper work and changing his machines over to the transportable one. Thankfully their lead NP seemed very calm and together. I was very ready to get out of Trinity but very nervous for my son to stay stable and be in a helicopter. (He had one of our old IVF nurses and Emma Crino, she was the only one who explained anything well to us). JD kept having his stats get worse and the respiratory therapist and nurses wanted to get him stable and the doctor said “this is why he needs to get to Iowa City” so they got him ready for the helicopter. He kept needing more medicine to keep him sedated and still – more Ativan and Phentanyl – which scared me even more! Thank god Brian weighed less than 140 and got to go with! I was so scared watching my two boys take off together!

I watched the helicopter take off, then my dad drove me home. My mom went home to pack her overnight bag and I nursed Malia and packed Brian and my bag. At this point I had no clue if this was a short stay for an acute issues or a long stay for an diagnosed chronic issue. It;s impossible to put into words how scared I was but i am sure I will always remember the feeling. I was so relieved when Brian texted that they landed. When I got up to his PICU room it was the picture of calm – I instantly felt relief knowing we were at the right place. JD was still sedated and intubated. His stats were good. They had an IV going with steroids for his airway. They had drawn blood to try to find a cause. Brian and I gave him lots of hugs and kisses – he looked to be resting peacefully and we even went to sleep for two hours!

The blood word came back and was positive for the common and cold and croup. We were anxious for Rounds to find out if that was enough of a cause or if they were looking for a bigger problem. Meanwhile JD needed 3 boluses of sedatives that morning because he was sort of waking up and moving around. When rounds came they assured us that he had an unusual reaction to those viruses but they were likely the cause of the stridor. They said its rare but they see it and we only need to be concerned about another cause/issue if it happens again in the next couple weeks. I was so relieved we weren’t searching for a chronic lung problem! They said once he was extubated he would stay for 26 more hours (24 in NICU and then another overnight on the pediatric respiratory floor. So I started making plans to go home that night and also to pump in the PICU. They decided to check in ASAP for a “leak” to see if he could be extubated that day.

(If no leak he would have to stay intubated and they would have to review his sedative plan because he had needed 3 blosues and they have to be very careful how much fentanyl they give him, so they may have to change to a longer acting drug, but they prefer Fentanyl because its shorts acting and quits working rigth when you stop it…)

They noted that the stridor was really bad because he didn’t have a “leak” between his tub and his airway when he arrived last night even though it was a too small tube. Almost immediately the Respiratory Therapist came in to check him and he DID have a leak! Hooray! They said he could be extubated that afternoon as long as the floor didn’t get too busy with new cases!

Feeling some relief, I went to pump and Brian got on the phone in the back of the room to call Disney to cancel our trip for the next weekend. When I cam back from pumping Jeremiah was moving around a lot and his hand was trying to grab at his breathing tubes. I tried to hold his hand down but he was moving more and more and trying to pull them. I ran into the hallway to call for help and thankfully the rounds team was only a few rooms away. By the time I stepped back into the room Jeremiah had extubated himself!!! The team yelled instructions to each other “hes extubated! stop the fentanyl” Another extremely scary moment because I didn’t know if he was ready to breathe on his own, it was no supposed to happen like this, and he was on all these drugs to keep him asleep! Would his body wake up enough to be able to breathe?

Well he basically immediately started the breathe! (The respiratory therapist was there, ready to re intubate him if needed). He would start waking up soon so Brian and I stood next to him and talked to him. Over the next 10 minutes or so, he totally woke up. He didn’t even complain about his throat being scratchy from the tubes. He was exhausted but fine. He was a little bit scared of course, and hated having the IV in his hand, but overall was incredibly brave and calm!

So, we got to start the clock to going home. He developed a very small fever which they attributed to his viruses. He was able to drink clear liquids and eventually try real food. He got out of bed with the PT and walked to the couch and back. They determined he didnt need his 3rd round of steroids. His stats were good, though we occasionally had to put the oxygen up around his mouth to get him to 99. Brian and I took turns getting something to eat and I went to get him a teddy bear (wearing a Hawkeye shirt, which he named Pillow) JD spent the whole day watching videos on his personal YouTube TV screen over his bed. I went home to feed Malia and be with Avani, Brian stayed overnight. The next morning they determined he could go home and did not need to stay a night on the respiratory floor! My sister came to visit and brought him new race cars and a drawing from my BIL! Before I even got back to Iowa City at 11am he was released for home!

He does not remember anything from when he was sedated. He does not remember the helicopter ride, which at first was upsetting to him, but now he thinks is cool! He of course has not clue how scary the whole ordeal was!

Since then, he has been fine. I mean he had had multiple viruses and a double ear infection, but no more stridor. Last Tuesday night when he coughed I couldn’t sleep for over two hours just panicking and listening to him breathe, but he’s fine. We still have no clue why this happened other than the doctors said that kids body’s have weird reactions to viruses sometimes. We are so so so grateful, now more than ever, for our children adn their health!

If all continues to go smoothly, yesterday was my last appointment with UIHC Maternal Fetal Medicine. My cervix is still extremely long (over 4) and they have no other concerns. I got a quick peak at baby. She was head down, with her legs up by her head and her spin on my left side. She’s so cute!

I asked the high risk doc to weight in on whether I should have a v back or planned c section. He said both are very low risk and it’s definitely my choice. Since I don’t want to have any more kids (for real this time) he said he would lean c section. The surgical risks of a planned c section are sightly lowers than the risks of a v back gone wrong. I was happy that he was comfortable with both options and also happy to hear an opinion cause I have no f-ing clue. He did emphasize that if my cervix is closed he would not recommend an induction for a v back and I should DEFINITELY not have anything like cervidil go open my cervix. (Augmenting labor or a foley ball or pitocin would be OK if my body had already started labor on its own).

I can feel her every day! This is certainly my favorite part: Im not so big to be uncomfortable and I can feel her squirming every day!

Finally had my scan after the reschedule from two weeks ago and it overall went well. Of course it couldn’t go perfect, I need something to worry about.

So, the baby has a cyst on her brain. Apparently that sounds a lot worse that it is. They are sure it will go away and have no impact on her whatsoever (this is from my high risk doc, not regular OB). It’s called a CPC and is a “normal variant.” They will not recheck it or do anymore testing. A cyst on the brain coupled with other brain and hand issues as well as other things can be a sign of Trisomy 18. However, everything else on baby looks “fabulous” and I had a screen for T18 already. So he said “it’s nothing to worry about and I wish I didn’t even have to tell you about it but I had to”. I trust this guy, it’s his job to find and worry about and examine and evaluate every little thing and he has no concerns, so I’m going with that. I am lucky to already be in the maternal/fetal/high risk program since they really know what they are doing.

Other than that, she looks great: chord, placenta, brain, heart, kidneys, bladder, stomach, hands, feet, bones, they saw everything they needed to see for a Level 2 today. And my cervix is still nice and long. I will have one more cervix check in two weeks and if that goes well then I’ll be done.

My placenta is in the back! For the ultrasound she was head up (under my belly button) and butt down. Her feet started up by her forehead, but then moved down low. Her hands were us exploring her face most of the time! She got a cute profile shot!

I am supposedly 20+2 and she measured 19+3. He said that’s perfectly fine because of course ultrasound is not perfect and they say it can be give or take 10-14 days at this point. I’ve only had large babies, but those were with a 5″9 egg donor. I am only 5″2 on a very good day, so maybe this baby won’t be 9 and a half pounds like Malia.

Overall I’m feeling good about today. Of course I wish they found absolutely nothing. But then if that was the case I’d just be worrying they missed something. I will probably have anxiety till she is born and then, as I know from my other kids, you just find more things to worry about. Worrying is the name of the game in motherhood. I’m going to try to trust my doc when he says it’s nothing to worry about and embrace my excitement.

I can feel her move every day now which is wonderful!

Brian’s dad’s family planned and hosted a beautiful dol for Malia! She picked the gavel (future lawyer or judge!) and the soccer ball (suture athlete!). We had a crazy, busy, long, exhausting, joyful Dol day and trip to SF! We just boarded to fly home. All went smoothly except the insane SF traffic (insane!!!) and Avani came down with a high fever on our last night, so we just packed and ate sushi in our room (yes my OBs are AOK with raw fish from reliable sources. Here are some highlights!

Sorry for the lack of post on Wednesday…unbeknownst to me my anatomy scan was rescheduled from my 18.5 weeks cervical length ultrasound (which Brian had taken the afternoon off of work for!) to my 20.5 weeks length ultrasound. I was upset by the change, mostly because no one told me and now Brian won’t be there. But I had also been looking forward to this day as a “maybe I can get excited after a good scan!” so I took it pretty hard.

(They did their best to look and everything they saw looked AOK, no concerns. But they said the image quality (because the baby is still small and I have body fat and c section scar tissue) was more of a 1.5 and I need a level 2 scan with level 2 image quality).

I tried to do some self reflection (while crying in the car). Was I sad because I’m worried something is wrong? Was I disappointed cause I’m ready to be excited and I feel like his is delaying my permission to be excited? Bingo. So I decided to just try to “let” myself be as excited as I can for the next two weeks while I wait!

Now it’s a week from tomorrow. I have felt her move at least once a day. And I felt her hiccup for the first time!