Little One

For the purpose of this blog, our newest addition will be nicknamed Little One.  Here is a record of her labor and delivery and her short stay in the NICU.  This has taken me several days to write and some details may be a bit fuzzy but I know I will appreciate having this in writing in a few years.

Labor and Delivery

My water broke at 12:45am.  World Traveler and I had gone to bed before 11:30.  I hadn't really slept when I realized I was getting wet.  Yup, my water broke.  I woke up my husband who was asleep and a bit groggy.  We got dressed, I called my mom to meet at the hospital and he went over and got his mom to stay with the big kids.  We didn't wake them.  They knew if they woke up in the morning and Bestemor was here and mom and dad weren't, we were probably at the hospital getting ready for Little One to be born.

My anxiety was pretty high.  I was definitely more nervous going into labor with this one than I was with the first two.  Contractions started within five minutes of my water breaking.  They were close together-about two minutes apart and pretty painful but bearable.  By the time we got checked into triage at the hospital, they were more painful and I had to breathe through them.

We got put into a room and I was checked-dilated at 3, almost fully effaced.  Contractions stayed close together and painful.  I was asked if I wanted an epidural and of course, I said yes.  By this time my mom was at the hospital too.  Once the anesthesiologist was in the room, I was ready.  I was also highly anxious and came very close to passing out.  The nurse was awesome and no one made me feel bad for not being able to cope very well with my anxiety.  Shortly after the epidural was in and the pain managed, I was able to control the anxiety better and felt better.  I was ready to push only 4 hours after being admitted to the hospital.  I was group B positive which meant I was getting antibiotics. The antibiotics needed to be in my system for 4 hours to be effective.  When I started pushing, it had been about 3.5.

I ended up pushing for over 1.5 hours and Little One had not made much progress.  The doctor checked me and said she was sunny side up so he attempted to turn her the right direction.  Soon after the next shift started and I got a new doctor and new nurse.  After another hour or so of pushing, baby was still higher than expected.  The doctor told me that he truly felt she should be coming out but she did have a big head and he thought she could use a little help.  After some discussion, I ok'd using a vacuum to help.  It took about 4 more contractions and out she was!  She was beautiful and BIG!  I am so thankful to God for all He did to get me through everything-including the fact that I did not end up in a C-section.

Our beauty was over 9 lbs and over 20 inches long.  Her head was 14 inches.  No wonder she needed some help.

NICU

Things were going well for the first part of the day.  It's routine to check big babies for low blood sugar problems.  Her blood sugar was low.  Now, my first, Precise Prince has low blood sugar at birth.  I was a first time mom and didn't know a lot.  I was told he had to have formula to get his blood sugar up so I would nurse him a little and then give him a bottle of formula.  He stayed in the hospital an extra night, did get his blood sugar up quickly and did not go the NICU.  I was truly blessed that he took just fine to nursing and the bottles he had in the first week or two did not cause problems.  Actually he did quite well going from bottle to breast and back again.

Now, I know that this is not always the case.  Often babies who are given bottles in the early days end up preferring the bottle and have trouble learning the proper way to breastfeed.  Bottles are easier to get their food from.  With the breast, they have to wait a bit longer for the food to show up.  In addition, both methods require a bit of a different suck to work.  Bottles are easier.

I really do not want to fight my baby to nurse.  Although I plan to introduce a bottle at about 6 weeks (for expressed breast milk), I didn't want to start off having problems.

The new protocol in my hospital was not to start with formula but rather to have baby nurse often.  Unfortunately, Little One was not keeping up her blood sugar levels with this.  (In addition we were doing kangaroo care-skin to skin contact with her laying on my chest or my husband's.  Super cuddly bonus!)  The next step was to try formula.  (We had several low sugar levels by this time.  They weren't trying to hurry the formula at this point.)  I had an awesome nurse at this point who, when I explained that I would do formula (I believe I may have cried because I really prefer not to do formula at all) but that I would not do bottles, helped me set up a supplemental nursing system (known as SNS) so Little One could nurse and get formula at the same time.  No bottles involved.

Unfortunately, even the formula did not get her blood sugar up enough.  At this point I'm a little lost on the exact timeline of everything but I do know that at early morning on day 2 (so Sunday morning, she was born on Saturday morning) the pediatrician wanted her in NICU to get this under control.  So off my baby went (with dad going too, of course) while my nurse worked to get me discharged quickly so I could go too without having to keep going back to my own room and getting checked.  There was a distinct possibility she would need to get an IV. 

I was simply waiting on the paperwork so I could head to NICU when the nurse practitioner came to my room to explain some options.  My wonderful husband wanted her to talk to me before making the decision.  In short, an IV was a possibility but was more invasive and actually carried more risks (although all were very low) than formula.  I was fine with the formula but again reiterated that I didn't want her to get a bottle.  So they tube fed her the formula since I couldn't get there fast enough to try nursing with an SNS.

Our first nurse in the NICU was training a new nurse.  Both were nice enough but they were more business than the other nurses I had.  At the next feeding, the nurse asked if I was sure I didn't want to do a bottle.  I explained why (that I didn't want to deal with nipple confusion and I wanted to get a good nursing relationship established) and she set up as SNS system.  She set it up different than the nurse from my regular room did.  Essentially, the way it was set up, Little One wasn't getting as much formula in her-it was dripping out the side of her mouth.  The nurse mentioned a bottle each time I had to feed her.

After a couple more feedings with the SNS and her blood sugar still being too low, the nurse really pushed the bottle.  I asked why and she said that the baby would be able to drink it more slowly and get more formula because the SNS system was working on gravity.  I cried and explained this didn't make sense.  (There is more to it, but this is already a book.)  I gave in (in tears the whole time) and said "I know one bottle will be ok, but I will not be giving her bottles for every feeding."  I was quite distraught. The nurse also said at one point "we just want what is best for the baby."  Let me say that statement really upset me.  I was dealing with very little sleep, a postpartum body and a baby in NICU.  Of course I wanted what was best for my baby.  That was the whole reason she was getting any formula at all when I am such an advocate for nursing.  I ended up only nursing her on one side before World Traveler gave her the bottle.

I went and pumped and took a short nap after calming myself down a bit.  Little One slept and World Traveler ran errands.  When I returned to the NICU (we were given a sleep room so I was napping in there) there was a new nurse for the night.  I started talking to her and spent about 10 minutes sobbing over everything.  I did mention that I felt the previous nurse pushed the bottle fast, that it didn't make sense to me and I especially mentioned that I didn't like being told "we just want what is best for the baby."  I found her to be more compassionate than the first nurse.  Honestly, I wanted Little One's numbers to be good, but I was also not sure what to do if they were.  I knew a bottle wasn't the only answer-it was just easier for everyone else.  It would have been easier for me too-but only temporarily and could have caused more problems in the long run.   (Side note: Precise Prince has blood sugar issues at birth as well.  I had done a bit of research afterwards.  This is a common problem that tends to resolve quickly so I knew that she wouldn't be needing the formula for very long so we were looking at a temporary problem.  Just how temporary wasn't known-a few days or weeks.)  The nurse was supportive and she said that if the bottle worked to go ahead and try the SNS again but work on doing it better/different.  I had told her that the last time we used the SNS I know we didn't do well.  Also, I had an idea of a better system based on what we had done before moving to NICU.

Her next blood sugar numbers were good.  I felt like I was failing her-my body wasn't doing what it should-but I also knew that this feeling was not right.  That this wasn't my fault.  Using the first system, World Traveler helped me with SNS and I nursed Little One again.  How happy I was when her next blood sugar levels were still good!  This time there were a few tears of joy.  My baby was doing well.  I was able to do this SNS system on my own so through the night, I got up every three hours to nurse with it and I let my husband sleep.  Her numbers stayed up.

Through all of this, I prayed.  I prayed for God's will and asked that my pride not get in the way for what was best for Little One.

After that night, I knew we would get to go home after the doctor's rounds.  We had a new nurse in the morning who was also training another nurse.  I was thankful not to have the same nurse as the day before.  The pediatrician came in and looked at Little One and asked we were doing.  I said well and somehow in this conversation mentioned that the SNS was working well.  He mentioned something about bottles as well-I was not offended by the comment, but it showed how little many doctors and nurses really know about the problems bottle feeding can cause in a nursing baby.  At rounds, we were given the ok to go home, continuing with the SNS and seeing our pediatrician the next day.

We did see a pediatrician the next day (our doctor was full up and so we saw one of her partners).  My milk had come in, Little One's number was good and I was given the ok to stop supplementing.  Yay!

This whole ordeal was very emotional.  I questioned myself on a few issues. Looking back, I think I needed to not question myself so much.  But at the same time, I am glad that I didn't take a stand simply on principal without even considering other options.