Friday, July 22, 2011

Who knows what to expect? AKA Birth Story - part 1

Sunday was a day of waiting and anticipation. It was two days past my due date, and I was hoping that it would end up being The Day. My doctor was on call during the weekend, but was going to be off most of Monday, and I was afraid I'd end up delivering during the one day he wouldn't be available. Bob had been predicting a birth date of the 18th, which would be Monday, for some time, so that just encouraged me to hope for baby on Sunday. Saturday evening I'd had a good string of contractions about eight minutes apart, but they stopped once I went to bed.

I was encouraged Sunday morning by a couple episodes of bloody show. That meant labor couldn't be too far away, but it certainly didn't promise that it would happen the same day. Unfortunately, the rest of Sunday was disappointing. Despite walking around at Target to encourage things, overall the day was quiet. I seemed to be having less frequent pre-labor contractions than I'd been having. Around four in the afternoon, I noted to Bob that the baby had seemed quiet all day. He hadn't been active during my nap like he usually was. I just assumed that I'd been focusing so much on the absence or presence of contractions that I hadn't noticed his movements as much as usual. I figured I'd lie down later and he'd be moving just fine, but right then I had things to take care of. In retrospect, I wish I'd taken the time right then to lie down, drink a cold sweet drink and count his movements. Instead, I fixed dinner, did household chores, and stayed busy until bedtime. At that point, I remembered that baby had been quiet, and after thinking about it, I actually couldn't recall when I had last felt a distinct, strong kick from him.

I was a bit worried, but not too much. I lay down, and tried to stir him up a bit. Usually, if you would push on him a bit, he'd poke back, or move away, but definitely be responsive in some way. Both Bob and I had enjoyed "playing with him" this way in the past, and it was pretty reliable. Sunday night I couldn't wake him up. When I pushed on him, there was no pushing back, no moving away, no resistance. It just didn't feel right to me at all, especially combined with the thought that he'd been quieter all day. I desperately tried to remember when I'd last felt him move, and all I could come up with for sure is that he'd been very active after I'd gone to bed the night before. I thought that he had made some small movements throughout the day, but I couldn't be sure, and that terrified me. I went and drank a Dr. Pepper to hopefully wake him up, and I called the doctor's office nurse helpline, but I was pretty panicky at that point. I went ahead and called my mom to come up and watch the other kids so we could go get checked out. I was supposed to wait 30 minutes after drinking the cold, sweet drink to go in, but I knew I needed to go in for my peace of mind, regardless. I wasn't sure whether I was being reasonable, or was being unnecessarily paranoid, or if I'd already messed up by not going in earlier.

On the way to the hospital, I felt one soft movement that I was pretty sure was Julian. After we checked in, I felt one more brief movement. At that point, I figured that I just hadn't waited long enough for the soda to kick in, and we'd find out that he was fine. Still, I think the sound of his heartbeat when the nurse first found it was an amazing relief. They wanted more than a brief listen, so I assumed we'd be monitored for an hour or so, find out he was fine, then get to go home. It didn't turn out that way.

It wasn't long before I noticed the first deceleration -- or slowing down -- of his heart beat. It was noticeable just from listening, I couldn't see the EFM strip from where I was. The pressure sensor for the monitor wasn't in a good position, after a while they moved it so that it would pick up the small, prelabor contractions I was having. It became clear to them (I could already tell) that the decels were definitely related in time to the contractions. While I heard the decels, I wasn't aware of something that is actually more significant: he wasn't having any accelerations in his heart beat. This lack of reactivity is a significant sign that baby may not be tolerating the uterine environment. The doctor ordered a biophysical profile, which is an ultrasound that looks at particular measures of baby's well being, to find out what was going on.

When the ultrasound tech arrived to do the biophysical profile, I was well aware of what to expect. I'd already had a couple BPPs this pregnancy, because the doctor had wanted extra monitoring of the baby due to my exposure to fifths disease, which can rarely cause problems with the baby. In those BPPs, the whole thing was over fairly quickly, as the necessary movements were noted quickly. The BPP Sunday night was different. The ultrasound tech took the measurements to estimate baby's size, and measured the amniotic fluid index, then tried to meet the other criteria. She was looking for body movements, extension and flexion indicating good muscle tone and practice breathing motions. She had to note the presence or absence of these movements over a thirty minute time period. As I noted before, with my previous BPPs, all the movements were noted quickly, and the whole procedure took 15 minutes or less. This time, we spent most of the thirty minutes watching a perfectly still baby on the monitor. Poking, prodding, shaking, speaking to him, etc. did not elicit any kind of response whatsoever. The tech kept asking if I was feeling any movements, she didn't want to miss recording something. I wasn't feeling anything. She'd periodically check his heart rate again, which did provide some reassurance. Still, the ultrasound made it clear that something was very wrong with the baby. It was not easy to watch.

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