Thursday, November 19, 2009

We're home!

A lot of people have been asking me for Baxter updates (and more importantly, more Baxter pictures). I hope this post satisfies!

Baxter was able to come home from the hospital on Tuesday, November 10. He was 8 days old. On Monday, Michael and I spent the night at the hospital for a "room in". We basically went to a spare room with Baxter and took care of him all on our own, with the peace of mind of knowing that the NICU nurses were right around the corner if we needed them for anything. Before we took him from the NICU to our rooming in room, we gave him a bath under the watchful eye of Sandy, his nurse. Baxter hated his sponge bath. He screamed a strong, high-pitched scream we'd never heard before the entire time he was getting bathed. After the bath was over and he was sitting in the warmer, he silently glared at Michael and I for about five minutes, shooting invisible daggers from his eyes and secretly plotting evil schemes to keep us up at night as retaliation for the bath we just gave him.

[This picture was taken right after he had his NGT taken out. On top of that, he now has a bald patch on his furry back from the tegaderm dressing they removed. Oh, the injustices he's had to endure.]

During our room in night we discovered a couple things:
  • the labor and delivery floor is not a place to get a good night's sleep
  • the only palatable menu option for inpatients at the hospital is the breakfast burrito
  • Baxter likes to wake up every hour and a half to eat and make a mess of his diaper. We think we go through one bag of preemie diapers in 12 hours. Hello, reality check!

    We make it through the night and are discharged the next morning by the Neonatal Nurse Practitioner and are super-excited to go home, but we have to meet with the Lactation Consultant first (later dubbed by Michael as the "Lactation Nazi"). She chastises me on my lack of hardcore pumping dedication and tells me I need to pump every two hours and after each feed. Basically, I need to have this darned contraption strapped to my chest at all times. I get a mental flash of me looking like a woman in National Geographic by the time Baxter's three months old from all the pumping and pulling. After my verbal lashing, we strap Baxter into his carseat (which he is entirely too small for, even with the extra padding we have to center him better in it) and go home!

    Baxter's been home for a little over a week now. We've had a couple of long nights where he's been up a lot due to discomfort from gas, but most of the nights he's been able to sleep for three hour stretches at a time. He doesn't like sleeping in his bassinet and ends up fussing if we place him in it, so he's been sleeping on our chest, in our bed. It's not something that we really want to keep doing because I'm afraid he'll fall off and get squashed. He has a baby rocker chair that vibrates and plays music/nature sounds that he tolerates sleeping in (after we pile a bunch of blankets in it to prop him up), so the past few nights he's been sleeping in that for part of the night. I've also discovered that he doesn't like the dark -- I've tried turning the lights off in the room to sleep and as soon as I do, he starts wailing. I'm afraid of the dark too, so maybe that was passed on through DNA.

    Most of Baxter's day is spent doing sleeping, with the occasional hour of alertness to look around at us and wonder why we're so weird. He smiles and laughs, sucks on his hands, and attempts to pick his nose in his sleep. Today he is 17 days old and both of us have noticed that his cheeks, hands, and thighs have gotten bigger. He has another pediatrician appointment tomorrow and we're wondering if he's hit 5 lbs yet. It's so strange to think he's going to get even bigger than this. It feels like he's growing too fast!

    This last picture was taken this morning. Bax fell asleep on Michael and is wearing this Santa hat that my former coworker gave us.

    ...

    Gotta go, baby's awake!
  • Monday, November 9, 2009

    NICU: Day 6

    We didn't get to the NICU until around 3 pm today. We decided the night before to take it easy, as my BPs were insane (180/100ish) the night before and in the morning. They'd go down to the 120-140/70-80 range after about 15 minutes of resting and focused relaxing (if there is such a thing). My parents went to visit Baxter after church and were there when we arrived. My mom was able to feed him about 45 ml orally, which was great. He had the same nurse as the day before (we figured out her name was Sandy) and she said she was planning on removing his NGT today as he was taking all of the bottle feeds by mouth. The only time he uses the NGT is after breastfeeding to supplement volume he may not have gotten because of problems with latching or milk let-down. We brought his carseat in for the staff to do a breathing test on him while he's in it. Apparently if your baby is born less than 37 weeks gestational age or is less than 5 lbs 6 oz, they need to do this test as these smaller babies tend to drop their oxygen levels if they're in a semi-reclined position for an hour.

    Sandy believes that Baxter is doing so well that she anticipates him being discharged on Tuesday as long as he keeps eating the way he has and that his bili levels don't rebound back up. The neonatal nurse practitioner comes by and confirms that this is the plan. Tomorrow we get to do a "room in" at the hospital, which is basically like an overnight trial run of taking care of Baxter by ourselves, but with the NICU staff nearby in case we think we need help. Mike and I are so excited to hear this, we give each other mental high fives and are all smiles. I can feel my blood pressure going down knowing that Baxter will be coming home soon. Sandy tells us to go out and enjoy the "last quiet dinner together the two of you will have for a long time". We decide to go to Chevy's, where a weird lady making balloon animals comes over to our table and takes 30 minutes to make a crappy looking balloon rose for me and talked about her birth experience the entire time. Thank you Weird Lady, you just made my beef chimichanga a little bit tastier.

    Sunday, November 8, 2009

    NICU Experiences

    I'll try to recount Baxter's days in the NICU so he can read about all the special care he received after he was born when he's older. I know that Michael and I never, ever imagined how exhausted we'd be following his birth. I guess we never accounted for how much time and energy breastfeeding would take, and when combined with driving out to Tacoma everyday, feeding schedules, things like eating and using the bathroom yourself take a backseat. It's something I'm struggling with now, especially since I've been told (several times) that I need to rest since I'm not quite out of the woods yet with pre-eclampsia. Last night in the NICU, we overheard the staff talking about possible admissions to their unit, one of them being a 26-year old mom with pre-eclampsia. She was 26 weeks pregnant and had a 20% chance of survival. Apparently she too had pre-eclampsia, but was found too late at her home after having seized and was currently intubated in the ICU and was probably going to have the baby taken out by c-section. As Mike and I heard this, all I kept thinking of was that could have been me. The whole time I was on bedrest I felt healthy enough that perhaps I wasn't taking it as seriously as I should, but now I see exactly how lucky I was that I came out okay and Baxter is healthy. I said a prayer for that mom and her baby as we left the hospital, hoping things would turn out okay. As hard as it is not to be at his bedside all the time, we're trying to figure out a new schedule that will promote more rest for me as well as visiting baby in the hospital so that my BPs are stable. As it is, they've been significantly higher than they were while I was on bedrest, but I'm chalking some of that up to sleep deprivation and the stress of having a baby in the NICU.

    Anyway, on with Baxter's NICU journal.

    Day 1: Mike went with Baxter to the NICU immediately following his birth. He was gone for about an hour and a half while I was in recovery, so he'll probably have to fill in the details of what went on that night. He was able to give Bax his first feeding with a bottle. When Mike initially put the bottle in his mouth, Baxter looked at him like, "What am I supposed to do with this?", then after some coaxing, figured it out and took the whole 15 ml like a champ. The night NICU nurse was pleased with how Baxter was doing and thought he'd stay about 12 hours in NICU and would be able to go home with us when I was discharged.

    After I was recovered from delivery, I was able to visit Bax in the NICU and cuddle with him. He was so tiny! His face was all swollen and the back of his head was cone-shaped from his journey down the birth canal, but I still thought he was perfect. Jackie (his nurse) gave him a bath and we all cooed over his super soft hair. We stayed with him until 2:30 am and then went to the post-partum unit, where I conked out from exhaustion.

    The next morning, we visited Baxter and found out that he didn't do as well after we left. He had a period of apnea and turned blue. He wasn't waking up despite vigorous stimulation and just as they were going to give him supplemental oxygen, he started to breathe again. He also started spitting up his feeds and had problems regulating his temperature. Dr. Kregenow, his pediatrician, met with us and said she expected at least a week's stay in NICU to help him with his issues. She said he was pretty healthy and was acting like a typical 35-weeker with the issues of temperature regulation and coordinating breathing/sucking/swallowing.

    That day he seemed to regurgitate every feeding through his mouth and nose. He was swaddled in so many blankets it was like he was in a cotton cocoon. I was concerned his nurse wasn't watching over him very well since I'd had to suction his nose a couple of times and she never came over to talk to us once, but luckily my friend Irina (whom I went to nursing school with) is one of the NICU nurses and kept an eye out for him the entire day. We were so grateful for Irina and felt he was in good hands with her there. We talked about his regurgitation issues and concerns about aspiration and not absorbing feeds and throwing off his blood sugars. I was hoping he wouldn't have to have IV nutrition like the other babies in the unit. We kept our fingers crossed.

    On my side of the hospital, my BPs were fairly elevated. I told my nurses (three of them) that I wasn't getting my scheduled antihypertensive medication and that I wasn't seen by an OB yet for follow up, but instead of looking into it they just passed it onto the next nurse. I was too tired and worried about Baxter to really get into it with them, but I was keeping tabs on what was going on. I was like a sinister Santa Claus, making a list and checking it twice.

    Day 2: Baxter's nurse this day was Ashley, and she was awesome. She actually has 5-month old twins who were preemies and so she knew what kinds of feelings we were having and helped us feel better about the whole situation. She let us have a more active role in Baxter's care, letting us do kangaroo care, change his diaper, and was very good about educating us on various aspects of the NICU, Bax's situation, and baby care in general. Later in the day, Baxter got an NGT (nasogastric tube) to ensure he'd get nutrition since he didn't seem to be cueing for feeds. The plan would be to first offer a bottle or the breat, see if he'd take anything orally, and whatever he didn't eat on his own would be put down his NGT. I was pleased that he would have tube feeds over IV nutrition and hoped the light would click on for him soon.

    I also had a better day with my nursing care this day. My nurse was Terry, and I told her about what was going on with my BP medication and everything. She actually listened to me (and assessed me properly) and by 9 am, I had seen the OB and all of my issues were addressed. She was fabulous.

    Day 3: Baxter had Ashley again as his nurse. I worked with the lactation consultant with breastfeeding and pumping. We found out that Baxter has an attached frenulum (just like his daddy had as a baby), making him "tongue tied". She manhandled my boobs and said my nipples retracted, and apparently this combination of attached frenulum + retracting nipples = frustrating, usually unsuccessful breastfeeding sessions. I was fitted for a nipple shield which seems to work him latch better -- that is, when he's not trying to pull it off of me. We discover this day that Baxter likes to grab and pull at things, especially his binky pacifier and NGT. Since his NGT was placed, he hasn't spit anything up and has been absorbing all this feeds. Hooray!

    Mike also changed his first diaper this day, and it was a nice poopy one. I video taped some of it because I was cracking up at his reaction. Baxter was completely calm, holding out both of his legs for his daddy. Mike was almost in a panic trying to get to get it done without choking on the smell or getting anything on his hands. The wet wipes were flying and Mike was sweaty when he was done. Hilarious.



    I was finally discharged from the hospital. I almost thought I wasn't going to be, with Terry and Ellen (the care assistant) having to track me down in the nursery for BP checks and medication. Hee hee.

    By the afternoon we noticed that Baxter was turning yellow. His night nurse, Sarah, expected his bilirubin levels to be up and him needing to be placed under phototherapy lights soon. If he needed phototherapy, he'd have to be placed in an isolette to help his temperature regulation as babies need to be wearing only a diaper for maximum exposure. We were in the smallest corner of the NICU (Mike referred to it as "the chokey") and hoped we'd get moved to a larger space if he'd need the isolette.

    Day 4: Molly was Baxter's nurse this day. He was in the isolette when we came to see him and it looked like a he was getting a suntan, all stretched out with little sunglasses on. I discovered what engorgement is as my milk comes in and I have a terrible night of pain. My boobs feel like rocks and look like I just had plastic surgery. Even the feeling of air blowing on them is painful. No one ever warned me about this, I grumble. I work with the lactation consultant again and she puts me on a military-style pumping regimen. There goes what little free time I had left! The good news is Baxter seems to have figured out how to latch and breastfeed a little better today. He also seems genuinely interested in these high-contrast flashcards of sea creatures a co-worker of mine gave us. His little mind is amazing!





    Day 5: We didn't catch the name of Bax's nurse today, but she was cool. We're moved out of the chokey into a more spacious area. His nurse tells us that when Baxter wants something, he wants it now. We find that out when he fusses for his binky, and later when we try to breastfeed and he's not getting instant gratification. He's discovered he can kick his legs against the rolled blanket at the isolette and scoot himself up, causing his eye protection to loosen, which he then attempts to rip off. We think he's playing mind games with us regarding feeding. We go home a little frustrated.

    Saturday, November 7, 2009

    Introducing Baxter!



    On Sunday, I woke up at 5:45 am and called the L&D floor at SJMC to see about my induction. Mike and I were secretly hoping they were super busy so I wouldn't have to come in until later, but lo and behold, they wanted me in at 7 am. Joyous. After our initial panic we managed to get ready and drive to the hospital, thinking the entire time that when we came back home, we'd be a family of three. The little carseat in the backseat of the car would be filled with our bundle of happiness soon.

    Once at the hospital, I was shuffled onto the L&D floor and met one of the midwives on call. She told me the plan: I was going to start on cytotec to ripen my cervix and induce labor with a low-dose pitocin throughout the night, but she didn't think I was going to give birth that day and said if I was still pregnant by Monday, I'd have a c-section. I didn't think I was sick enough to warrant a c-section, but I went along with the plan anyway hoping for the best. What ended up happening was hourly BP checks, cytotec every four hours, and the low dose pitocin. Things only got interesting in the middle of the night as I started to feel the contractions from the pitocin. I finally asked for some pain medication and was given the choice between nubain and fentanyl. I went with nubain under the advice of my nurse. Immediately after it was injected into me at 0300, I felt the room spinning. I closed my eyes, mumbled stuff, and was immediately knocked out. Apparently I was acting pretty drugged for the rest of that night and even through the morning, talking nonsense and trying to climb a ladder while lying supine in bed. Mike got a kick out of listening to me babble. I felt out of it until about 11 am, and I'd only received a half dose. Mental note: Don't take nubain again.

    The next morning I was only about 3 cm dilated and the new midwife (Heather) wanted things to clip along so that I could deliver vaginally. She talked me into using a foley-type device to manually dilate my cervix so that I wouldn't have to take more drugs. It was sooo uncomfortable, it had me on all fours just to deal with the pain. The foley thing was put in around 11 am, and while it didn't do anything to dilate me, my water managed to break around 1:30 pm. I was happy to see it was clear, but was really surprised at how much fluid comes out! After my water broke I was moved to a labor room and assigned private nurses, the awesome duo of Sonia and Kim, who stayed with me the entire time until Baxter was born.

    Within the first couple hours in the delivery room my contractions were getting more and more powerful (I was still on pitocin). It finally got to the point that I couldn't stand it any longer and asked for an epidural. The epidural went in smoothly and I immediately felt relief. I was able to sleep through the contractions for a few hours and didn't even feel it when I was straight cath'd. Around 6 pm I was 5 cm dilated and 80% effaced. Heather felt I would labor a little longer and ordered an indwelling foley placed. I was okay with that, after all, I had an epidural and wouldn't feel anything. I was wrong, I could feel everything in my lower abdomen and groin area, but my legs were totally numb. The foley was horrible and I screamed and writhed in pain everytime I had a contraction. I got a couple doses of labetalol every 10 minutes due to my SBPs going over 200. Anesthesia was called in to bolus me and he assured me that he was giving me the amount of medication they give people who have c-sections, but 10 minutes later, I could still feel those areas. My nurse checked my epidural area and noticed that the area around it was puffy, so probably the catheter migrated. She also did a cervical check and found that I was completely dilated and ready to go. (I'd gone from 5 cm to 10 cm in an hour!) Great. I was given the option of waiting for anesthesia to come back and re-insert another epidural or just go for it. I didn't think I could wait or sit still for another epidural, so I decided to push the baby out on my own, dead legs and all. I started pushing around 9 pm, and at 10:47 pm, Baxter Kai Lugod Balogh was born. He was 4 lbs. 12 oz and 17.25 inches long.



    I could hear him crying shortly after he came out, and saw he had a full head of dark hair when he was placed on my chest. Since he was a preemie, there were NICU nurses attending to him and he got whisked away as he had some issues with work of breathing. Mike went with him to the NICU and my mom stayed with me during the recovery phase. Luckily I had only one very superficial tear that didn't require stitching, so I was good to go. I was so happy and so exhausted at the same time. Having a baby is hard work! I remember falling asleep in between pushes during labor. The whole thing was a learning experience that I will cherish, and I'm thankful for the staff who looked after me during my hospital stay. (I kept a list of the good ones. :) )



    Baxter is still in the NICU but is doing well. His only issues are those of prematurity, meaning he has issues with figuring out the whole breathing/sucking/swallowing thing, temperature regulation due to him being so small and having no fat, and as of yesterday, being jaundiced. He's such a sweet, sweet baby. He's been pretty sleepy most of the time, but smiles and makes a lot of facial expressions. He loves being held by me or Michael, especially doing kangaroo care, which is skin-to-skin contact. He always cries after we put him down after kangaroo care, but otherwise a lot of the NICU staff comment on how mellow he is.



    I was discharged from the hospital on Thursday and have been trying to take it easy, but it's hard when Bax is still in NICU. We stayed in NICU for the rest of the day after I got discharged on Thursday and most of the day on Friday. We plan on staying with him daily so we can feed him and hold him as much as we can. He's been doing great and improving all the time. We hope he'll be out early next week so we can take him home. I'll have to save the details of Baxter's NICU stay for another post, as I have to go pump now (another adventure -- or misadventure -- in itself).

    A big thank you to all our friends and relatives who have come to visit us and sent us prayers, love, and support throughout this entire pregnancy. We have been touched by your kindness to us, and we can't wait until you can meet our son in person!