Pieces from The Mighty

Friday, October 28, 2016

Welcome to the World Alice Ruth

On Monday, October 10, I went in to my doctor’s office to have what I imagined would be my last sonogram of Alice Ruth since I had a scheduled c-section date of October 19th set. Based on previous sonograms, Alice Ruth should have been measuring well over the 5 pound mark by now. The sonogram measured her at 4 pounds 4 ounces, but my doctor was not concerned, which took away any anxiety I was feeling about her measurement.

On Wednesday, October 12, I went back in for my last doctor appointment! All of the "lasts" were so very exciting to me since I have never made it to the "end" of a pregnancy before this pregnancy! At this appointment and much to our surprise, my blood pressure was elevated enough for concern, and there was protein in my urine. The doctor also had difficulty getting Alice Ruth’s heartbeat on the doppler (which was extremely scary for me), so they sent me in for a biophysical profile to check on Alice Ruth. She passed the 30 minute test within the first 10 minutes, so she was doing fine! They sent me home with a 24 hour collection to monitor the protein. At this point my doctor was still hopeful that I could make it through the weekend and hopefully to my scheduled date.

On Thursday, October 13, I went back to the doctor's office for my very last p17 shot and to drop off the 24 hour collection to be sent to the lab. I was feeling pretty good, even with the turn of events. On Friday late afternoon, October 14, I received a call from the doctor's office saying that my 24 hour collection came back and that I needed to go immediately to labor and delivery. The test results came back with elevated protein, so they wanted me to get checked out by the hospital and then we would decide what to do next. My dad came home to watch Ellie....on her birthday eve, and my mom drove me into the hospital where I met up with Tanner, who was already there waiting for me.

The week of October 9th had been an option for a scheduled c-section, but we chose to push it on out to the following week with the hope that I would be home for Ellie's 4th birthday on the 15th. So, this is not what we were hoping for, but at the same time, how could we not be thankful to have made it so far in the pregnancy! And....we had Ellie's actual birthday party back in August since my pregnancy was so full of unknowns: there was really no way to know how long I would be pregnant and "just in case" we were in the middle of a NICU or hospital  stay for her birthday.

They got me all checked in and hooked up to the monitors. After several hours of monitoring and a chat with the doctor on call for my doctor (my doctor was now out of town for the weekend), they decided to let me go home with the understanding that if I got a headache or had any change in vision, that I was to immediately come back. I was also told that if I was careful, there wasn't any reason why I couldn't take Ellie to Target to buy some toys for her birthday and then onto a restaurant for her birthday lunch. I was home just in time to tuck my 3 year old in for the last time before she turned 4 the next morning.

Saturday morning, October 15, and my precious Ellie's birthday was a happy morning! Ellie was excited to have a shopping trip planned as well as lunch at a restaurant! Mi Mi , my mom, had also suggested that after lunch she could take Ellie into the party store for a bouquet of balloons....which Ellie was thrilled about!  Our first stop was Target and we were there about 3 minutes when I had the overwhelming feeling that something was wrong. I was cramping and having back pain. We went and picked up a few toys for Ellie and checked out and we headed home. I took benadryl and tylenol and rested for a bit to see if the feeling would pass, but it did not. Off we went to the hospital for the second time in 2 days!

Once again, my dad took Ellie and assured us that she would have a big day and not to worry about her. I was checked into the hospital and hooked up to monitors...again! My blood pressure was not alarming at all but I was registering some minor contractions. Since I had surgery 2.5 years ago to have a permanent cerclage placed (transabdominal cerclage), it is very important that I not go into full blown labor as I run the risk of it ripping out and causing serious issues for me.

The hospital doctor didn't seem concerned and since my blood pressure was within a normal range, she was planning to send me on home. It became very apparent that she (the doctor) didn't have any understanding at all about the TAC that was placed inside of me. The hospital doctor decided to check me, and it turns out I was actually dilated, which concerned us because that puts me at risk for the permanent cerclage to rip my cervix. However, the hospital doctor was not concerned.  At this point, Tanner became concerned as my contractions were picking up and he had no intention of leaving the hospital with me. He suggested that she contact either the doctor on call for my doctor or the doctor who placed the TAC since they were both extremely aware of my history and the need to be extra cautious.

We were very concerned that they were going to send me home dilated and contracting. When I was pregnant with Robby, I was sent home from the hospital (dilated and contracting) by a hospital doctor and was told that I was fine. That night I went into full blown labor with Robby, and later found out that the doctor at the hospital knew that my water was bulging at the time she sent me home, but sent me home anyway.  We know that my labor progresses extremely quickly, and we were scared that if they dismissed me that the TAC would rip and put my life and Alice Ruth’s life in danger.

I was very disappointed in the lack of knowledge that there was surrounding my permanent cerclage. During both of my visits to labor and delivery, I was made to feel bad about the fact that in 4 days, I was going to have a scheduled c-section. I was repeatedly asked by nurses and doctors why I would not even try to have a vaginal birth, even though I had already explained my permanent cerclage. In addition to my TAC, there were two other reasons for my need to have a c-section which were that I had an accessory placenta, and because of the way that Ellie had to be delivered (emergency c-section with a vertical and horizontal cut to my uterus).

Luckily, at this point in the day, a shift change happened! Two new nurses came in to introduce themselves and their faces seemed alarmed as they looked at the monitor. They both came over and felt my belly and commented on how hard it was and asked me if I was feeling that. Uh...YES! Next thing we knew.....the new hospital doctor was in and letting us know that she had placed a call to my doctor (on call) and to an on call Maternal Fetal Medicine doctor as to how we should proceed from here. Within a few minutes the hospital doctor was back saying that we would be going into surgery soon....and from that minute on, everything became a whirlwind.

Immediately there were papers to sign, an iv was put in, and surgical clothes were brought in for me and my mom. Tanner decided early in the pregnancy, that just like with Ellie’s birth,everyone would be better off with him waiting with my dad and my mom would be in surgery with me.

My dad dropped Ellie off to be with my brother and his fiance, so my mind was at completely at ease as I went into surgery-without any worries about how Ellie was doing. Very quickly we were out of the labor and delivery room and wheeling down the hallway to the operating room. Everyone was very kind and friendly...and all seemed to know my story of premature births.

I was feeling happy, anxious, and excited. It was such a different feeling than when I delivered Robby and when I delivered Ellie. It was just such a nice feeling to have, knowing that Alice Ruth had been in utero long enough to be born without the struggles that Ellie had. This c-section was very different from my c-section with Ellie, as with Ellie, it was a true emergency c-section with not much time to spare. With Alice Ruth, it needed to be done quickly for me and my body, but Alice Ruth was not in any danger. They gave my mom “the layout of the land” so to speak, what to touch, what not to touch, where to sit, and when she could and could not take pictures.The anesthesiologist was very personable and talked to us through the entire surgery.

The actual surgery did not take long at all and before I knew it, out came Alice Ruth. My first thought when I saw her was: Oh my goodness! She is so big! I got just a brief look at her as they were taking her over to clean her off and check her breathing. This is the point, the exact point, where I began to panic and the panic overtook some of the excitement I was feeling. The panic I was feeling was about:

Lung development.


Premature lung development was the reason Robby could not be saved.

Premature lung development is the reason that Ellie was on a vent for weeks on end, and then a cpap, and then a nasal cannula for her first 4+ months.

It is also the reason that Ellie was diagnosed with Chronic Lung Disease at 18 days old.

There were two nurses working on Alice Ruth and they patted her back and patted her back and patted her back. They suctioned her nose and mouth, over and over. They put the mask on her to give her breaths. All the while I could hear the beeping. It was a very familiar sound as I heard it in the NICU and then I heard for many, many months after Ellie came home. It was the beeping on a monitor and it was signaling that her oxygen level was too low.

The anesthesiologist (again) was just amazing. He kept talking to us and he kept things very light. He mentioned several times that many, many babies go to the NICU for just a very short time while the fluid clears from their lungs and their breathing evens out. As he spoke these words, I knew that he was right, but I desperately wanted my little Alice Ruth to go with me….to my room!

The surgery was completed….the doctor was finished and the room was clearing out. They started to move my bed towards the door to take me to recovery. All the while, the 2 nurses continued to work on my little one. The anesthesiologist then stopped them from moving my bed and told them that there really wasn’t any reason to make me leave Alice Ruth right now….to please give me this time with her. I could have cried. That was just the nicest thing anyone could have done for me at that particular moment.  

After (I don’t have any idea how long) a very long time, it happened. Her breathing actually became “normal!” They left Alice Ruth hooked up to the monitor so we could watch her oxygen level, and then they handed me my baby. I can’t even put into words the feeling I had as they handed her over to me!

We rode out of the operating room together. It was just the most unbelievable feeling. During Ellie’s NICU stay I watched so many women being wheeled out with their brand new babies on their chest, and now here I was able to experience this. I was able to do this thing that is so normal for everyone else.

Tanner and my dad were waiting in my recovery room which was just basically across the hall. They couldn’t believe how long it all took. After I was settled, Alice Ruth and I enjoyed time together….skin to skin.

My dad left the hospital to go and pick up Ellie and even though it was late, she came up to meet her new sister. After a short visit, my parents took my 4 year old, birthday girl, Ellie,  home to put her to bed.

Alice Ruth’s  breathing remained great and within a couple of hours, they removed the monitor from her and we had our first night together….me, Tanner, and Alice Ruth.

Sunday was a good day for both of us. I was recovering and Alice Ruth was eating, sleeping, and going through diapers….just like she should! Late on Sunday night they did a car seat test with Alice Ruth to make sure she could sit in her car seat and continue breathing regularly. The test was an hour and a half and she hated it….but she passed!

Monday morning, my 4 pound, 11 ounce Alice Ruth (she was down from her birth weight) was cleared to leave the hospital and so the only thing we were waiting on was my release. My doctor was back in town now, but I was sure she was very busy from being gone. The nurses let me know that she would not round until late that night. The gem of a nurse, Margaret, who had been taking care of Alice Ruth and me on Sunday and then again on Monday told me that she would go and call my doctor and ask if she would sign off so I could leave! I laughed….thinking she was teasing...and I said: “Just tell her it is Amanda Smith and that I am sure she knows exactly why I am so anxious to leave here with my baby!” Well, she wasn’t teasing, she did actually call my doctor, and she did tell her what I said! My doctor laughed and said yes, she knew why I needed to leave and told her to give me the dismissal.

Alice Ruth and I left the hospital less than 48 hours after my c-section….together.

This is the first time, after the births of 3 children, that my baby and I have been able to leave the hospital together.

Our little family truly has been so very blessed.