three weeks…

So we have a date. And a plan.

Yesterday was the first appointment with my doctor in three weeks, since the incident. Though I had taken time off work to spend with family visiting from afar, I had to make three appointments back-to-back, so I spent much of a vacation day in the car and on a table. After another detailed ultrasound provided a better picture of what may be going on with the placenta, my doctor made some decisions.

She does not recommend pushing back delivery from 34 weeks to 35. This baby’s birth day is now scheduled for 34w2d, which is three weeks from yesterday(!). So no hospital bedrest unless there is further bleeding or signs of preterm labor. They plan to give another round of steroids to mature the baby’s lungs before delivery. She still anticipates 1-2 weeks in the NICU for breathing and feeding issues. Based on baby’s current size, we’re hoping to reach close to 5.5 lbs by delivery.

She will not attempt to save my uterus. Due to the evidence of accreta (embedding), she will proceed with a hysterectomy without wasting critical time and blood trying to deliver the placenta too. Already she anticipates that I will need 4-6 units of donated blood. She doesn’t want to place me at risk any more than necessary when my womb will be clearly damaged beyond repair. Even with detailed ultrasounds, she can’t know how bad it is until they go in. Yet she is relying on the expert opinion of two senior radiologists in making her decision. She will have a pelvic surgeon assist in case of further complications.

I can accept the hysterectomy as medically necessary — as I said before, if I can have a baby out of this, it’s a fair trade I can live with. No more periods, no more fibroids. But this changes the entire birth experience as well as my recovery and, more importantly, opportunities for bonding with our preemie baby.

When I realized I could actually deliver a real live baby, I started drafting a plan for cesarean birth. While I knew this would be a highly medicalized procedure — i.e., and the very opposite of Baby Jaye’s birth experience — I still believed there was room to make it our own. For instance, I planned to be awake during delivery with Mac present and the screen down so we could witness the birth of our baby. I wanted immediate skin contact on my chest, even if just for a moment or as soon as possible, and a few other measures to ensure the best possible chance at early bonding and nursing.

My birth “plan” is now just one more thing I need to let go. My doctor told me yesterday that I won’t even get to touch or hold our baby after birth. They will need to begin the hysterectomy immediately following delivery, as I will be losing a lot of blood. Once Mac is ushered out of the ER and our baby is whisked off to the NICU, they will administer a general anesthetic and put me out for as long as necessary, at least two hours with no other complications. My recovery will take longer now, and while most c-section patients can rest with their babies while in recovery, I won’t be able to. Whether I will be able to even pump is questionable as “pump and dump” for the first batch is recommended with general anesthesia. Does this include colostrum? I don’t know and plan to ask a few lactation consultants. According to my doctor, I “should” be able to meet our baby later that evening.

Finally due to the placement of the placenta, the incision will be high and vertical instead of low and transverse, which is more painful with a harder recovery. To be clear, I don’t care about the scars. But I am concerned about my recovery and ability to care for a newborn and toddler, even with help.

As I was expressing how I felt about hearing this definitive plan, Mac reminded me about the big picture. In other words, we’re having a baby. I know. And that is an incredible and unbelievable thing.

On one hand, nothing else matters. There is no “but.” The ultimate goal is a healthy baby and mama. That thought alone — i.e., that by some miraculous turn we are so blessed to welcome a new baby to our family — makes me want to burst into tears of joy.

On the other hand, there is so much about this that makes me want to cry for other reasons — i.e., so many fears and concerns about a premature newborn, establishing critical early bonds, questioning whether nursing will even be possible, leaving our baby at the hospital after I am discharged, my recovery, etc. It may seem unimportant in the long run, but the thought of not even holding our child after birth — not even for a few seconds before being taken away and tended to by others for an indefinite period of time — well, I can’t really describe how that makes me feel.

I learned to let go of control when it comes to family building a long time ago. This is not about control. It’s not even entirely about MY experience. I gave up on that a long time ago too. I’m far more concerned about our baby. And while I know the baby should be fine in the excellent care of the NICU staff, with Mac available every chance he gets, it doesn’t change the fact that I should be with our baby yet can not. It doesn’t change that what I had hoped to be able to do — e.g., welcome our child to the world and care for her in whatever way possible, through comfort, by nursing, whatever — I won’t be able to do.

There is much more I want to say, but can’t seem to find the words. I realize that my feelings about this birth and my recovery and the thought of a preemie who, by most estimates should be fine in the long run, may seem petty and unimportant. I get it. I might get annoyed reading my posts too. But that doesn’t change what I’m processing right now as I prepare for this.

Thank you all for your concern and well wishes. It means so much to both Mac and me. We are doing our best to line up our support network, and we appreciate every positive thought headed our way. Many thanks.

~ by luna on August 19, 2011.

36 Responses to “three weeks…”

  1. I’m so sorry that all of this is happening so differently from what you had hoped or imagined. I understand that it is difficult for you to process all of it. I hope that things all still go as well as possible and the healing is quick. One thing I’ve seen is that mom’s with babies in NICU seem to do really well as they are so determined to get up and see their babies. I know it will be a long recovery though and I hope you do well. Hugs to you.

  2. You know Kami still hasn’t been able to let go of the birth she had envisioned. Not that she wants mroe kids but she still wants that birth that she has dreamt about. I on the other hand got past that along time ago since I never got to the point where there would be a birth, but I will say my heart ached and hurt that Benjamin was born at 8am no one held him and I wasn;t allowed to see him or hold him for just a short while until the next afternoon. At least your husband can be there. Whatever it is they need to do to keep you and the baby helathy is whats important, and I know you know that of course but it is hard to let go of dreams, but at least you are able to do a little planning and prepping before hand.
    Do you think you would be able to take the don peradone (however it is spelled) and the herbs to help keep your milk and pump? I hope you can that is still the thing that hurts the most, I’m still embarassed to feed Benjamin a bottle in public, I feel like a bad mother and I’m also very judgemental at times, or goign thru all of this made me really jaded for a while, so no doubt others are judging me as well without knowing the story, I really try not to do that now.
    Sounds like you have a great team!

  3. Don’t worry about the initial pump and dump — there most likely wouldn’t be any output yet anyway so soon after a preemie birth. It’s a matter of sending the body the signals more than anything. Personally in your shoes, knowing what I know after my own accreta and BF problems, I’d insist that I get hooked up to a pump as soon as medically possible, even having the LC do it for me if I was too groggy to do it myself, just to start the process going.

    If your baby is allowed to be held the first day, Mac will do it. If not, the fact that you aren’t yet allowed won’t make a difference. I touched my Burrito’s forehead at delivery while DH held him and I held him a few hours later for a few minutes (wheeled in the hospital bed post-op that first time), but neither of us touched Tamale at all in the OR, and that day we could only barely touch her through the isolette window. Your little one will have a few precious days of gestation over my twins and will hopefully be a bit sturdier, but still, both on the baby’s end and on your end there are many factors conspiring to keep you from initial contact. Do I still feel a pang that I didn’t hold my daughter that first day? Absolutely. Did it affect her at all? Absolutely not.

    The first few days will feel like an eternity interspersed by brief periods of contact, but so soon, you will be able to hold the baby for long periods and you will more than make up for lost time with the bonding, in the NICU and then at home.

    Thinking of you, so much. Here if you need anything — sorry I’m not nearby to give Jaye some playdates, now and after she becomes a big sister!

  4. Mine wasn’t a preemie delivery, but I was under general anesthesia for about three hours with my c-section (they also had to do a hernia repair afterwards, hence the general). I wasn’t even awake for the delivery. While I was “sleeping” the baby was taken to the nursery for observation and some tests (he was fine in the end) and I didn’t get him until about 9 hours after he was born. I nursed him immediately as I got him. I didn’t pump and dump. I was groggy for days afterwards, I think it was because I was under for so long. It was a horrible experience and it took me a while to get over it (psychologically). I think that if I had been prepared for it to go that way it wouldn’t have been so bad, but I was expecting to be awake for the birth, and it was just before I was wheeled in that the anesthesiologist decided to put me out, which was devastating. The boy is now nearly two and he is still an avid nurser. In fact, I would like to wean him but I don’t know how. Just sharing how it went for me, maybe you can take something from it? At least that maybe you don’t HAVE to pump and dump?

  5. I was under general when our oldest was born. I also have a vertical incision. I did not get to hold him for a day or two (he was 31 weeks). My milk never came in (not for lack of pumping for 12 weeks) so nursing was out. What did help us bond during his 7 week NICU stay was lots of kangaroo care. Although his birth experience was not what I had dreamt it would be it is our experience and he likes to hear stories about how small he was, etc. 8 years later.

    I had hoped for better when our youngest was born but the hospital was not adoption friendly and I did not get to hold him until we left the hospital. I feel like I have bonded really well with both boys even though neither experience was ideal.

  6. I loved reading your thoughtful post–I think you have a wonderful perspective on everything. It sounds like you have a great medical team, and I’m so glad you guys are gathering your support system. Baby Jaye and her little sister have an awesome mom and dad and some great extended family, too.

    I’ll definitely be keeping you in my thoughts and prayers. In my mind I’m already looking forward to reading your next winter solstice post: early setting sun, beloved daughters at your side, glowing candles.

  7. Luna, this post left me so overwhelmed. I can imagine the emotional roller coaster you are in right now! Hugs…and yes, I know and feel for every single fear you have on bonding and nursing with the little one. I wish him/her a quick speedy discharge from the NICU and hope your surgeries – C and the hysterectomy go well.

  8. What an intense post. I felt like I needed to give you a hug and tell you that everything is going to be okay. I wish I lived closer to you, I would definitely be there to help out. It all sounds so scary, but I think you’re going to be in good hands and your doctor seems to have a very good plan in place. I know that doesn’t take any of the fear away, but you are so surrounded by such love and positive vibes, that I know everything is going to work out and be alright. I’m keeping you and your little one in my thoughts and prayers for speedy recoveries for both of you. ♥

  9. I don’t mean to take my experiences for granted, but there was just so much more that “bonded” me to my children than touching and nursing — including Maddy, who I hardly touched, and pumped for but never fed. I just know the same will be for you as well.

    As for the rest — I’m hoping dear Luna that you have friends and family in place to feed and care for you all for a spell! I’ll do anything I possibly can from the opposite coast. Including donate blood, in your honor. I’m just biting my nails for this resolution. sending you all my love.

  10. As a last resort (if you’re averse to drugs, that is), Domperidone works wonders. More Milk Plus (the foul tasting liquid) is also great, but the former increased my supply ten fold, and very quickly. I did have to order it online, I’m pretty sure it’s actually illegal for a doc to prescribe it for milk production in CA (I couldn’t find one who would) — but I used a pharmacy I found through recommendations from friends, and it worked well.

  11. I’m hoping everything goes well and there are no surprises. Best of luck to you in the next three weeks and beyond. Positive vibes and a big hug to you.

  12. My goodness. That’s a lot to take in during a doctor’s appointment.

    I definitely understand why you wanted to make the c-section your own experience. I did too. I am hoping and wishing for the best for you. Can I volunteer to make your family a dinner one night? When I had my twins, a few friends did this for me and it was super helpful. And there were leftovers, too. :)

  13. It does sound scary — a hysterectomy is no picnic, never mind in connection with a C-section –, but it also sounds like you are in very good hands & they are not leaving anything to chance. I have been thinking of you, dear Luna, & you will be in my thoughts & prayers as the big day approaches! (Any chance Mac, or someone, can provide us with a soon-after update??)

  14. This sounds like an intense appointment. I am so glad that you have a clear plan now, and can work through some of your feelings about it in advance. Have you thought about ways to make this birth plan yours? Would it help to have someone with your husband to take photos so you can quickly catch up on what’s happened when you wake up? Can you bring a friend along to help care for you so that your husband can focus on the baby (or vice versa) later in the day? Do you want to plan something the night before to celebrate now that you have a fixed date?

    I would absolutely talk to a lactation consultant now (and find a really good one). I’m pretty sure that colostrum picks up a lot less of the “pollutants” than milk, so it should be much easier to use expressed colostrum than breastmilk after anaesthesia. Would your NICU allow you to use a friend’s donated milk for your baby? Would it make you feel better to know where the baby’s first milk came from? Will they allow another woman to actually nurse your baby for you (to help with the latch for when you are able, if that’s even a reasonable expectation at 34 weeks)? (This is the one thing I do know about a bit having been at a friend’s delivery in part so that I could nurse her baby instead of sugar water post-delivery given her gestational diabetes, although in the end the hospital refused to allow it. We also brought a friend’s pumped milk to our first delivery should our daughter have needed immediate supplementation).

    I know that everyone’s experience is different, but I found the bonding process with a newborn took weeks. While it was incredible to hold a baby for their first minutes (as you well know), it was not those first minutes but the daily care over weeks and months which established our bond. I am sure given how incredibly well you have bonded with your daughter that you will find your own way to bond with this baby, even if your relationship does not include breastfeeding in the end.

  15. I am a breastfeeding mother of a 9-month old in SF and O+ – universal donor. Happy to offer up my blood for you. Weird comment, I know. I wrote earlier about my sister having her baby boy month early with zero long-term complications. I had my babies at CPMC, they are familiar with me. I have two babies via c-section and would love to make you lasagna because having the basics taken care of mean you get to focus on your daughter and new baby girl. Email me if you want blood or lasagna, I doubt I will ever write that again. But happy to offer it.

  16. In my opinion there is no reason to apologize for any of your feelings. They are all well within reason. Sending light and love.

  17. Both sides of this equation are so BIG — I’m sending a lot of energy to the potential + side in hopes that everything goes as well as it possibly can, even exceeding your expectations.

    XOXO, Luna.

  18. Wow that’s so huge. I had no idea. But ultimately, you need to be healthy and if that’s what it takes, that my friends is JOB 1, ok, as well as having a baby. I’m sure the little person will be super fine without the initial contact. I have a friend whose twins were in incubators for 6-weeks before they were released into the world, and they are all thriving, bonded, crazy little maniac now ;)

  19. Sounds like a great plan that you’ve got in place. I’m sorry you won’t get your dreamed-of birth, but I’d expect things to go reasonably smoothly with the surgical plan you have at that gestational age.
    I don’t think there should be any need to pump and dump. I don’t know if I made much colostrum the first few feedings, and I wouldn’t say much of the anesthetic meds will make it into your breastmilk. The pain meds, sure, but they’ll pass through in pretty low amounts. At our hospital, if you’re awake enough to hold a baby and attempt to breastfeed (or awake enough to hold a pump on), the milk or colostrum should be fine. If they don’t have to cut through the placenta to get the baby out, I’d think you’d have a moment to see your baby and give her a kiss before they put you under GA for the hysterectomy. I certainly hope that will be the case!
    Good luck with all of it!

  20. I just want you to know that I’m listening and you are going through SO MUCH and you shouldn’t feel guilty or petty for wanting to discuss it. I am so excited to meet your second child!!!!! And finally (for what it’s worth, I hope this isn’t annoying unwanted advice) like other commenters, I had a horrible, emergency placenta detachment problem after my second very calm, unmedicated, vaginal birth. I had to be put completely under and endured an hour of surgery & recovery. I nursed my baby the minute I got my hands on him (about two hours after surgery) with no pump and dump and no concerns from doctors. Matt helped me hold him in the right place. So, I hope it works for you, but if it doesn’t, given the preemie thing and any number of other unknowables, you’ll bond all the same and it will be beautiful. xoxo.

  21. I’m sorry that your birth experience won’t be as you’d hoped for, Luna. I know that you know the most important thing is that both you and the baby are safe, but it is difficult to let go of your hopes for the birthing experience. I finished up having to have an emergency c-section, and my daughter had difficulties in breathing immediately after she was born. She had to be rushed off for resucitation, so I didn’t get to hold her straight away. Although I don’t dwell on it very often, it is something I regret very much. But it has in no way affected my bond with her: that was something that was forged in the first few weeks of bringing her home from the hospital. As many other commenters have said, you will bond with your baby, whether or not you get to hold him/her after she is born, or indeed whether you breastfeed him/her or not. But I do appreciate the enormity of the situation you’re facing, and hoping as hard as I can that it can be as positive an experience as possible.
    (longtime friend and reader, recently moved to new digs)

  22. Luna, I continue to keep you and your family in my daily thoughts. I am very glad that your medical team is keeping you completely informed about everything. I am sorry that your birth plan has needed to be changed, I know the feeling of not being able to control something about your experience that day.
    I am not sure how it will be in your hospital, but the one that I worked for gives Dad/Mac a choice- being that you will be placed under general anesthesia almost immediately following delivery he will be removed from the OR anyway- the c-section deliveries that I have been involved with (wish I had kept track, but I didn’t) the NICU team will have Mac accompany them into the NICU and he will be nearby as they stabilize your little one. We would have our charge nurse, a ‘free’ nurse or an aide be with Mac the entire time explaining what is being done, what the particular leads (resp, cardiac, temp, etc) are all for, explain the monitors and anything else that is going on, sometimes depending on a lot of factors, room being one of them, Mac will actually be at the bedside (warmer or isolette) of your little holding a hand, foot, head. And as someone else posted it is not uncommon for Mom to be brought into the NICU in her hospital bed. From what you have told me you will be in an amazing hospital- they have done so much in the way of research and development in many areas, but especially so when it comes to the NICU. I am not in anyway saying that you shouldn’t be scared- it is a Mother’s nature to want to be close to their child and when that isn’t possible it is difficult.
    I wish that I was there to give you a big hug, hold your hand, help with Jaye- but I know you and Mac have an amazing family and circle of friends that will be there for love, support and to help care for you and your family. I know that you also have a large circle of friends here on the net that are thinking of you and are sending you warm, loving, healing thoughts for the amazing outcome that I know you never thought you would be experiencing- I am an happy beyond words for you, Mac and Jaye- the gift that you all are receiving, this blessing that has fought so hard to be here, a rainbow baby- a gift being watched over by her big brother- I cry tears of joy with every post. I know you know you are not alone- there are so many of us with you on this journey, and I can’t wait for the next chapter and beautiful photos of big sister Jaye and her sweet baby. As always, you are in my thoughts, and I along with everyone else will be waiting as the next few weeks and days pass for your post welcoming the newest member of your precious family home. Big hugs to you all! Keeping you in my thoughts and close to my heart. <3

  23. I’m so sorry to hear that you have so much ahead of you. I really feel for you and hope everything will turn out to be ok in the end. More than ok, in fact. As you stated, caring for a premie is one thing, but when you have to recover from serious surgery yourself, well, that’s quite another. I hope you will be surrounded by helpful and supportive people (sounds like you will be). In the end, we all have plans and expectations on how things should turn out and yet they never do turn out exactly as we’d envisioned. In the end, you can only hope that it will all fall into place — which I sincerely hope it will. Thinking of you.

  24. We’re sending lots and lots of positive thoughts and love your way. I wish we could do much more than that but it appears we’ll be gone for the birth and early part of your recovery. You have so much to process and think about and you couldn’t be annoying about any of this if you tried.

    I really hope to see you before we leave and tell you this and so much more in person. I hope it all goes as well as it possibly can and you and Mac get as much of what you’re hoping for as possible, during the birth and recovery and after that.

    And soon, so soon, our girls will likely both be incredible big sisters and we’ll be meeting each other’s new additions. What an incredible day that will be.

  25. Luna, your feelings are NOT “petty and unimportant.” They are completely reasonable and predictable in this very difficult situation. From all you’ve written, you seem to be doing a great job planning for all contingencies, advocating for yourself and your family, and processing the enormity of it all.

    The birth experience your are anticipating is not one anyone would hope for herself or her child. But, I have great confidence that you – being who you are – will find great sacred moments and even joy in it.

    I am so looking forward to getting all happy-misty-eyed reading one of your posts about looking into this new baby’s eyes and kissing little feet. I continue to send very best wishes your way!

  26. I can’t even imagine how many swirling emotions you’re feeling these days. I can only offer support and let you know I’m thinking of you and sending positive vibes your way!

  27. Hugs to you. What you are feeling is perfectly normal.
    Praying for an uneventful three weeks=)

    I cant wait to hear if you are having a boy or girl.

  28. I don’t think anyone will get annoyed reading your posts and I can absolutely understand your feelings and emotions. I do hope the medical specialists will do everything to ensure the safe arrival of your little miracle and your own continued health and that you can hold him/her really really soon. You’re in my thoughts.

  29. You are not being petty at all. I understand where you are coming from and your desires to be there for your baby.

    I think early bonding is very important, a peaceful birth and all of that. Personally, I would be pushing for every little concession I could get – a bikini cut if things don’t go as dire as they expect, have DH hold the baby against my face while you are under, I don’t know what else. Maybe you are doing that, maybe it isn’t your nature.

    But will any of that matter a year from now (heck 5 weeks from now)? To you, most likely, but to your baby? I just don’t know. I look at our youngest and still sometimes apologize to her for her violent birth (vacuum extraction, whisked away, her TUMMY suctioned so that she wouldn’t open her mouth to nurse for hours afterward – all completely unnecessary. It still disgusts and sickens me.) So it is clear 17 months later I still am emotional about it. And yet I wonder about the lasting impact. Kids and babies are so resilient. The months of her sister one minute treating her lovingly and the next pushing her over probably have a greater impact and I don’t worry about it – that is just part of growing up.

    Logically, I can’t see how the birth has any impact at all to her. Being a loving mom is so important to a baby and you are a loving mom and part of loving your child is making the best decisions for him/her even if that means not being there right after birth. I believe you will find a way to make nursing happen long term for you. I believe within a day the times you are there for your baby will already out number the times when you weren’t.

    If that doesn’t seem like enough . . . envision when your child is a rebellious teenager and you are in the middle of an argument when you throw your hands up in the air and say, “This is all because I couldn’t hold you right after you were born!” and see what kind of dismissive response you get.

    Wow, that was really long winded! I hope my point wasn’t lost. I really just meant to say, “It will be ok and it is ok to grieve the loss of the ideal birth.”

  30. Luna,
    I am so floored by your strength through all of this. I am so sorry that this experience is so complicated and so TOTALLY not the way you would want it to go. In a small way I can imagine *some* of what you’re feeling, having had to succumb to an unwanted c-section due to a breach position. But of course, what you are facing is so so so so much more than that. Oh Luna, how unfair that the early bonding time is being taken away from you, that just positively sucks and you have every right to feel all the various feelings you’re having about that! But again, Mac is right: Big picture. Healthy Baby, Healthy Mama. I am sending you all my positive thoughts right now. Hoping you are going to be surrounded by the best support possible at home and in the hospital to help with everything. xoxoxo

  31. luna, I love you and your strength. I know that you might feel anything but, but I think it takes a lot of strength to be able to recognize, clarify, and attempt to deal with your fears with such directness and presence of mind. As much as I can from across the country, I am sending my heart, peace, and love to you and your family.

  32. Great post. Hang in there!

  33. Visiting from the Lushary to say that I admire the strength you are exhibiting in facing all of this upheaval.

    As Mama to a 33.5 week preemie (I actually had a couple of dreams that she would arrive early, but never believed she would) who spent 9 days in the NICU and is now at 13.5 months close to the top of the height and weight percentiles thanks to a combo of formula and as much breast milk as I could pump and nursing, I can tell you walking out that first time is awful. Not going to sugar coat it. But it also does get easier. And now she takes me for granted, so I don’t really think there was much notice on her part that I wasn’t there right away or there for more than a few hours a day (45+ min one way if we didn’t hit rush-hour traffic) until we were able to bring her home.

    Something to ask about: the hospital where I gave birth allowed NICU parents to stay a couple of nights in an available room after the mother was released if needed.

    Keep strong.

  34. Hey girl:

    I was away, but now I’m back and I’ve read your post. All that processing of what might have been, what should have been…it’s all normal and very understandable. Somehow, someway, you conceived this life and still you feel a little sad that the delivery can’t be this calm, predictable, “normal” plan that you’ve always dreamed of. There’s something difficult and painful about the notion of giving up control over the most intimate parts of our lives. But I know that YOU know that you will move past this, go through this…til you get the moment when you can finally exhale….

  35. Dear Luna, I found your website via the skeins of IVF blogs, and I wanted to wish you peace over the next few weeks as you process the changes to your birth plan. I also wanted to share with you some advice that brought me peace when my baby was unexpectedly placed in NICU just a few days after birth and could not be held or nursed. I was beside myself because I couldn’t hold him, and my sister suggested I ask the nurses if I could put a breast pad in the isolette with him (I was trying to aggressively pump to supply his feeding tube). They allowed me to do this, and it made me feel that at least he was surrounded by my smell, if nothing else. Another mother brought with her a blanket with which she had been sleeping. Anyway, it made a big difference to me, and it might make a difference to you, too. Good luck in the coming weeks.

  36. [...] I had drafted a birth plan, it all went out the window with the preterm delivery. This baby’s birth would be yet one more [...]

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