Darn You Placenta!

Cecilia sleeping in the hospital bassinet

So, as I mentioned in my previous post, my placenta refused to detach after the birth of Cecilia.  After packing up stuff for myself and Cecilia, Jeremy and I drove to Thunderbird Hospital followed by Connie.  We arrived around 6:45 AM, and when I got out of the car, I felt light headed.  I wasn't losing blood, so I wonder if it was from the lack of food and sleep.  I had eaten two pieces of toast with butter and honey around 5 AM, but that probably wasn't quite enough.  

Connie came in with me, had me sit in a wheel chair, and wheeled me over to the check in area of the ER.  She told them we were the home transfer and we needed labor and delivery.  I waited in the wheel chair with the gentleman from check in while Jeremy and Connie parked the cars.  The gentleman was asking me about the home birth.  He told me I was brave and his hero.  He was impressed that I would have a baby at home with no pain medication.  I told him my pain medication was a tub full of warm water.  

Connie, Jeremy, and Cecilia joined us, and I was wheeled to labor and delivery.  I can't remember if they hooked me up to and IV of pitocin first or if they did the ultrasound first.  I think they hooked me up to the IV.  I remember feeling cramps and thinking, "Oh good.  This placenta is coming out."  Well, no.  No, it wasn't.  Dr. Bell came in and spoke with us about possible causes for the placenta not detaching.  She mentioned placenta accreta, which is when the placenta attaches too deeply to the uterus.  It is something I know all too well about because my sister Rachel had it and had to have a hysterctomy because of it.  The doctor kept talking about how the placenta could have attached to my uterine scar from my cesarean, but Connie and I basically rolled our eyes at this.  My placenta was posterior and nowhere near my scar.  We found it hard to believe that my placenta would have become low and anterior.  That being said, placenta accreta was still a possibility.  

The ultrasound tech conducted an ultrasound, and it was impossible to determine if the placenta was attached deeply.  Shift change brought on a new doctor, Dr. Ghandi.  She came in and told us that it was possible that I would simply need a D & C (dilation and curetage) to remove the placenta, but if it was a case of placenta accreta, they would need to also remove my uterus.  This was much more serious and something they were not prepared to do at this hospital.  They would need to transfer me to a hospital another 30 minutes away that has a larger staff and does these types of procedures every day.  

Connie headed home for some much needed sleep, and I nursed Cecilia before taking my first, and hopefully my last, ambulance ride, minus the lights and sirens.  I took about a 15 minute cat nap on the way, which was pretty helpful.  I was brought up to OB triage, where nurse Shannon was prepared for me.  She had read all of the details of my transfer ahead of time, and her sense of humor helped put me at ease a bit.  She had a badge holder that read, "OB nurse at your cervix".  I already had an IV from Thunderbird hospital, but she had to give me another just in case they needed it.  A couple other nurses joined us for some conversation at one point, and upon hearing who my midwife was, said I couldn't have picked a better midwife. They all knew Connie or knew of Connie in some way.  I couldn't have agreed with them more.      

They wheeled me next door for an ultrasound and told me I could nurse Cecilia during it if necessary. She slept in Jeremy's arms the entire time though.  Dr. Cedars, a high risk OB/GYN came in and introduced himself.  He was a kind, grandfatherly type gentleman, and he took a few minutes to discuss his plans for me.  He said he was going to do the ultrasound and then possibly an MRI.  He conducted the ultrasound and couldn't find anything significant as to why the placenta wasn't detaching.  He said he thought it would be a straightforward D&C, but he wouldn't really know until he got in there.  He didn't think an MRI was necessary.  He asked me if I was done having children, and I told him I was.  He said, "That makes my job easier."  Then he explained that if he found that this was a case of placenta accreta, they would need to remove my uterus.  I asked him what was involved in that procdure, and he said they would go in like a c-section.  That's when the tears started flowing, and I said, "One of the points of doing a VBAC was to avoid major abdominal surgery."  I kept thinking about trying to take care of my girls after having had major surgery, and I knew I really didn't want that.  A bigger concern for me was breastfeeding Cecilia.  I asked him if the anesthetic and other meds would interfere with me breastfeeding, and he said no, it would be just like having a c-section.  I felt so much relief.  

Before going down to pre-op, I asked to nurse Cecilia.  She was so sleepy though and wouldn't wake to nurse.  This was stressing me out because I could be gone for quite some time.  Nurse Shannon had me use the restroom, and as I was walking down the hall she said, "I hope your placenta falls out on the way.  Come on placenta!"  No such luck unfortunately.  LOL   When I returned from the restroom, Shannon said, "If you end up in surgery for 5-6 hours what do you want us to do to feed the baby?"  This killed me.  I told her that I didn't want Cecilia to starve, so they could give her small amounts of formula as necessary.  I had also talked to Connie about the possibility of having one of my friends bring some expressed breast milk, but we were so far that I didn't want to trouble anyone. 

I had a heavy feeling as they wheeled me to pre-op.  At least Nurse Shannon recommended that Jeremy and Cecilia stay up in OB triage to wait for me rather than going to the operating waiting room with the general public.  Nurse Shannon said there was no way she would want an hours old newborn down there, and we were so grateful to her for speaking up.  They would also have formula , diapers, wipes, and anything else Cecilia would need.  

They got me checked in, and the anethesiologist came to discuss the plan for me.  She reminded me of Karina Smirnoff from Dancing with the Stars, and she asked me if I understood what was going to happen.  I confirmed I did, and she explained her part in the procedure.  I had to sign consent forms to have my uterus removed, and she was trying to sell me on all of the benefits of not having a uterus since I was done having children.  She was making me quite upset, especially since it wasn't exactly about losing my uterus.  It was more about the fact that I didn't want to go through major surgery!  She was extremely insensitive and was even trying to make jokes.  I asked her if I would be able to nurse my baby following the procedure, and she told me I would have to pump and dump for 24 hours.  I told her what Dr. Cedars said, and she double checked one of the medications.  She said it should be fine after 12 hours, but then one of the nurses spoke up and said that the medication has a half life in the body.  I should be fine to nurse after just 6 hours.  The anethesiologist agreed, albeit reluctantly.  The pump and dump for 24 hours is just the standard spiel they give.  

As I'm lying in bed just waiting, Nurse Shannon appears with Jeremy and Cecilia.  She said that Cecilia started sqwaking for food not too long after I left.  Thank God!  I nursed her until she had her fill, and everyone was excited to come see the brand new baby.  After everyone oohed and ahed over her, Jeremy took her back to OB Triage, and the anethesiologist began giving me medications through my IV.  They started wheeling me to the OR, and I was already becoming very sleepy.  I prayed the whole way down the hallway "Please don't let them cut me open.  Please don't let them cut me open."  The last thing I remember was entering the OR and being told that they were going to transfer me to the operating table. 

Now in recovery, the first memory I have was an oxygen mask over my face and me pulling it away to cough up a bunch of phlegm. The next thing I remember is a faint voice saying, "You still have a uterus."  Relief washed over me, and I just thanked God for guiding the doctors and nurses and for  protecting me from needing a surgery.  It took me awhile to fully wake from the anethesia, but thankfully I felt good when I finally did, other than having a terrible cough that was a side effect of being intubated.  They wheeled me up to my hospital room where, standing next to Jeremy and Cecilia, was my friend Meguire holding her nearly 3 month old Johnny.  She looked like an angel to me, and I almost burst into tears in that instant.  I knew why she'd come.  She brought expressed breast milk for me to give to Cecilia so I wouldn't have to give her formula.  Let me say that I don't think formula is the devil, but I would much prefer to give Cecilia something less artificial if I can help it.  Meguire hugged me, and I just knew that things would be okay.  My friends are amazing, and tears are welling up in my eyes as I type this now. She had been there awhile, so she didn't stay much longer.  I was glad I was able to see her and hug her before she had to go though.  

It was a little tricky holding Cecilia with all of this going on.

I managed okay though.

They were able to save my placenta for me, so at one point, Connie's daughter Monica came to pick it up and encapsulate it for me.  

When Cecilia awoke, I attempted to feed her the warmed breast milk.  Even though the nipple was meant for newborns, the flow was still too fast for her, especially since she was used to the thickness of colostrum.  I asked my sweet nurse for a syringe, and she promptly brought me one. I tried just giving Cecilia a drop or two at a time, but she still seemed to gag on it.  She was able to eat enough to satisfy her, and she went right back to sleep.  By the time she woke up, I was able to nurse her.  She showed no ill effects from the anethesia, and again, I had something else to be thankful for.  Jeremy told me that the doctor came in to tell him how things went.  He said they needed to keep me overnight for observation because they doctor thought he put his thumb through my vaginal wall or my uterus, but when he double checked he could see no sign of having done so.  They wanted to make sure my bleeding was under control.  My hemoglobin went from 13.5 down to 12, and they wanted to be sure it didn't drop much further.  

View from our hospital room

This post is really long, so I'm going to shorten the last part of it.  Our friends Doug and Suzanne, Cecilia's godparents, visited and brought us a much needed phone charger and some yummy snacks. Cecilia slept and nursed pretty well, and Jeremy and I were able to also get some sleep.  My nurses were phenomenal, and I couldn't have asked for better care the whole time we were at Good Sam, well, except for the anethesiologist.  They blocked out a whole room for us, so Jeremy was able to sleep in the other hospital bed rather than in a chair or some fold out contraption he probably would have had.  No one told me about ordering food, so I had to settle for whatever they brought me.  Dinner was meatloaf and gravy and a baked potato.  Breakfast was pancakes, applesauce, and bland oatmeal.  I would have chosen protein, but oh well.

Jeremy was on diaper duty much of the time.

Snuggling with Daddy in his bed

More Daddy snuggles while waiting to be discharged

Dr. Cedars came and talked with me about the D&C.  He said they could find no reason for my placenta not to have detached, and he said the procedure was simple.  He said if my blood count was stable, they would release me at noon.  That's exactly what happened, and we were so excited to go home to see Genevieve and have her meet Cecilia.  It wasn't how we planned things, but it ended pretty well.    

Genevieve meeting Cecilia for the first time.  She wanted to hold her hand.

G giving C some love

    

Welcome to the World Cecilia!

The look on my face says it all.

Disclaimer: This post is about childbirth, which will naturally involve some TMI.  I have tried to keep it mostly PG though. ;)  I don't have much concept of time throughout these days, but I've tried to place events in the right order.  I've also chosen to leave out some details, but I'm sure this will still be a long post.  I hope you enjoy the story of Cecilia's birth!

I woke up Friday morning 9/12 feeling a little crampy.  When I used the restroom, I discovered some "bloody show".  If you don't know what that is, be careful googling it.  At my midwife appointment I learned that I was 90% effaced and not quite 3 cm dilated.  Cecilia was even lower in my pelvis than the previous week, and Connie could feel a bit of a bulging bag of waters.  We had a good feeling that Cecilia might arrive by Saturday evening.  Things were getting exciting in the Davis house!

By Friday late afternoon/early evening, I started having some minor contractions that were spaced about 15 minutes apart.  I continued about my evening somewhat normally.  At some point I decided it would be a good idea to lie down and get some rest in case things picked up.  I wanted to have as much energy as possible.  I was able to sleep somewhat easily, but awoke around 3:00 in the morning with excitement and a need to eat and time contractions.  By the early hours of the morning, my contractions were becoming closer together.  I thought for sure things were progressing.  I went back to bed, and my contractions had spaced out and weren't so intense.

All day Saturday I had contractions that were spaced about 7-11 minutes apart.  After my first nap, I woke up to an intense contraction, so I thought I should get up and move around some.  I spent most of the day in my room bouncing on an exercise ball and watching TV to distract me.  My parents were here and helped Jeremy attend to my needs and entertain Genevieve.  They were great about supplying me with food and drink to keep up my energy.  Jeremy and I listened to a little Jim Gaffigan as I labored, and the humor helped me deal with my contractions.

Getting a little support through a contraction

I decided to try out my birthing tub just to see what it felt like.  It was so warm and immediately relaxing.  I didn't want to stay in it too long for fear that it would slow things down.  Genevieve was fascinated by the tub and kept touching the water.  She also checked on me a lot throughout the day. She would put her hand under my chin and say, "It's okay mama."  She gave me some hugs and kisses while I was in the tub and then was called out to play with Grandma and Grandpa.

At some point, after hours and hours of this early labor, I began to feel discouraged.  I began to doubt things would progress and my body would ever start actively laboring.  I thought I was doing something wrong and that I should be doing something more to encourage things to speed up.  I texted Connie that I was feeling discouraged and that I was going to lie down and rest again while I still could.  It was hard to actually sleep, but I know that I dozed between contractions that were around 10 minutes apart.  I awoke to a sharp contraction and had several more following that one. Connie left me an encouraging message, and at this point, I just decided to quit over analyzing everything like I always do and to just let my body do what it's supposed to do.  I quit timing contractions for awhile because it was causing me a little anxiety to see them go from being five minutes apart to spreading out to 7 and 9 minutes apart again.  The contractions continued being fairly intense, and it was difficult to tell when one started and ended because I was feeling crampy in between.

At some point, I lost my dinner in the toilet, but I felt so much better afterwards.  Jeremy helped me time my contractions, and by around 11:00 PM, they were anywhere from 3 1/2 minutes to 5 minutes apart and lasting a minute and 20 seconds to two minutes long.  I told him that I felt like I really needed Connie, but I didn't think I could talk to her.  He told me to just wait until after my next contraction.  Unfortunately, another contraction followed that one pretty quickly, so I made him call to update her and tell her I needed her.  She said she knew that I really needed her if Jeremy was calling, so she left right away.    

As soon as Connie walked into my bedroom, I felt immediate relief and a sense of peace and calm wash over me.  That's just what Connie does.  She assessed me and baby at this  point.  Cecilia sounded great on the monitor, and Connie determined that I was still only 2-3 cm dilated.  What?!  How can that be?!  This was the news I was fearing.  However, she said that as she was checking me, since my cervix was just mush, she was able to open me to 6 cm.  She said, "Things are going to change now."  Change they did!  I rolled over slightly to my side and rode out a major contraction.  I had another and then decided to use the restroom.  Connie asked me if I'd been walking around, and I hadn't really been since the baby felt so heavy.  It was decided that I should be walking around so the baby's head can press against my cervix more and hopefully keep things moving in the right direction.

My mom sliced me half an apple and made me some red raspberry leaf tea with honey.  I basically walked from my front door to my back door, picking up an apple slice along the way.  I think I carried and drank my tea as I walked.  Occasionally, I would walk down to my room for a moment of privacy.  For one or two contractions I would lean over my exercise ball or go on my hands and knees to breathe through the contractions.  In through my nose, out through my mouth.  In through my nose, out through my mouth.  Connie suggested holding up my belly as I walked so there wasn't so much pressure.  I did this for awhile, and as I turned the corner to go down to my bedroom, I dropped to my hands and knees to ride out the most intense contraction I had yet to feel.  I told Jeremy that I wanted to get in the tub now, and I crawled down my hallway all of the way there.  I stripped down to my sleep bra and climbed in.

Upon entering the tub, I felt immediate relaxation.  I could still feel every contraction like a dagger, but being able to hang over the side of the tub and let my body just melt into the water was the best feeling.  I just concentrated on breathing through the contractions as I hung limply over the side.  My fears of the water slowing things down were quickly assuaged as my contractions continued coming.  All of a sudden, I felt a POP!  I looked at Jeremy and said, "I think my water just broke!"  Then I said, "I need to go to the bathroom!"  I hopped out of the tub and took care of business.  As I stood up. my water poured out onto the floor along with the membranes.  Jeremy flew around the corner to get Connie, who already happened to be coming down the hallway.  She assessed that my water was clear, which is a good thing.

My favorite place to be while in labor

Connie checked me again at this point and determined I was 9 cm dilated.  I couldn't believe we were so close to meeting our daughter!  Connie says that I pretty much hopped back into the tub at this point, and that's how I remember it too.  I hung over the side again, and my contractions were coming closer together - like every minute and a half to two minutes.  I had my eyes closed and completely shut out the rest of the world.  I could hear Connie typing on her computer, and then I felt the urge to push.  I said so, and Connie said something like "Go ahead and push."  Push I did.  I hung there in a somewhat seated position with my legs out to the side, and I pushed through a couple of contractions. I mentioned that I thought I felt the "ring of fire", so Connie asked me if I could get up on my hands and knees so she could take a look at where we were.

Hands and knees felt like the right position to be in anyway, and I continued pushing with each contraction.  I took a deep breath in (or tried to anyway) and breathed out through my mouth as I pushed Cecilia down.  I was surprised that I could feel exactly where I needed to push.  I was in awe of the human body.  Roxanne, Connie's birth assistant, who arrived right after I felt the urge to push, monitored Cecilia's heart rate and supported Connie in other ways.  Cecilia's heart rate was great the whole time.

Connie had me try lying on my side in the tub and holding up one leg to push through a contraction, but the water was just too deep for me in this position.  Back to hands and knees I went.  I braced my feet against the side of the tub.  One hand gripped the opposite side of the tub, and the other hand was on the bottom of the tub supporting me.  Connie encouraged me and guided me in pushing through the contractions as my parents and Jeremy looked on and provided positive words.  This was my favorite part of labor because I could feel the progress I was making.  Yes, it was painful, but it was a good pain in a weird sort of way.  All of labor is a productive type of pain, but pushing felt more so for me.

At 3:48 AM, on Sunday, September 14, 2014 Cecilia Giovanna Davis was born after about 40 minutes of pushing.  She popped out and I immediately turned my head around to see her.  I had to lift my right leg over her umbilical cord, and that's when Connie handed her to me.  I just remember immediately resting my head on Jeremy's shoulder with a feeling of pure elation washing over me.  I held Cecila and looked at her marveling at what I had just accomplished.  It is a moment in time I will never forget.  When her cord stopped pulsing, Connie clamped it, and Jeremy cut the cord, something he wasn't able to do with Genevieve.

Cecilia looked so beautiful!  I don't remember when she cried, but I remember hearing it.  Roxanne gave me a shot of pitocin in the right arm since I had a lot of bleeding after my c-section with Genevieve; we were just being cautious.  I got out of the tub and onto my bed to deliver the placenta.  It, however, did not seem to want to come out.  Connie had me squat (I'm sure I just painted a lovely picture for you), but it still wasn't coming out.  After Cecilia was wrapped up in a blanket, she was brought to me to nurse.  Nursing is supposed to stimulate uterine cramping/contractions that help the placenta detach and deliver.

Nursing Cecilia for the first time

This did not work, so Connie gave me a couple of herbal treatments and spent some time massaging my abdomen to help release the placenta.  She stitched me up at this point while waiting on the placenta.  Then she gave me some Cytotec and still nothing. Roxanne massaged my abdomen some more and did what she could to help the placenta release.  She kept me company as Connie bustled about packing and cleaning up.  It was so comforting having her there. After giving me some more time, the decision was made to transfer me to the hospital to figure out why it wasn't detaching and to get it removed.  Connie called Thunderbird Hospital to let them know we would be coming, and then we started packing up while Grandma and Grandpa got some snuggle time with Cecilia.

I was so bummed to have to transfer.  I was really looking forward to getting some rest with my new baby and then having Genevieve come in to meet her new sister when she woke up.  I told Connie that with me, there's always something!

I am so blessed to have had the amazing birthing experience.  I am thankful for my loving husband Jeremy who massaged my back and did anything I asked during labor.  I am thankful for my parents and their care of Genevieve and me.  I am thankful for Connie, a gifted midwife, and her loving assistant Roxanne.

Connie and Cecilia

Roxanne and Cecilia

My next post shall tell the tale of my hospital transfer.  Stay tuned.

Dear Cecilia

Dear Cecilia,

     I have been meaning to write this letter since May, but I have just not made myself sit down and do it.  Your daddy, big sister, and I are anxiously awaiting your arrival.  You are due in just 6 short days (or long days depending on how I am feeling at any given moment).  We think it would be funny for you to come on your due date because that would mean everyone, including our kitty Pawncho, would be born on a Wednesday, and Wednesday's children are "full of woe".
     It is has been such a blessing to carry you and nourish you with my body for these 39 weeks.  You used to be quite rambunctious and loved moving all around in big bursts after 10:00 at night.  Now, your movements have slowed and come at less predictable times.  I bet you are nice and settled and have also run out of room!  It is fun to feel your little elbows or feet poke out on my side.  I pushed on one the other day, and you quickly pulled it away from me, making me laugh.  I can't wait to kiss those little feet on the outside!
     I am so ready for your birthday and feel no anxiety at all, unlike how I felt before your sister Genevieve was born.  I think your daddy might have some anxiety, but he is doing a pretty good job of not expressing it.  The other night when I was rocking Genevieve, she kissed you and said, "happy birthday Cecilia".  I told her it wasn't your birthday yet, but she should say it on the day you come out to see us.  You are going to love your sister so much, and I know she will love you too.
     Your daddy and I wonder how much you will be like your sister and how different you'll be from her.  Will you have her narrow, little feet and wispy, golden hair?  Will you have any food allergies or be tongue tied?  Connie thinks you will be bigger than Genevieve was at birth, and I am thinking that is probably accurate.  There are so many great things in store for you, my sweet Cecilia.  So many people already love you and have been praying for all of us.  Your family and our friends are so excited to meet you!  We are ready for you, so you just come when you are ready.
 
                                                                                                                               Love,

                                                                                                                               Mommy

Rock Me, Mama

Genevieve is pretty easy to get to sleep these days, very much unlike when she was an infant.  For naps, all she needs is her white noise on, her blanket on her, and sometimes one or more "guys" (beanie babies, hand puppets, dolls...).  I kiss her, hug her, and tell her I'll see her when she wakes up.  Sometimes she plays around with her guys for a little bit and then eventually goes to sleep all on her own.  At bedtime, she usually needs a little help unwinding.  She turns on her white noise and gets in bed.  I put her blanket on her and rub her back while singing or playing a song from YouTube with my phone.  Common requests are Strength for the Journey, Speak Life, Twinkle, Twinkle, and Holy, Holy.  She gets to hear a song twice, and then I blow her kisses, tell her I love her, and say to sleep tight.  She sometimes says, "I love you too" or "I'll see you in the morning when the sun pops out".

Genevieve usually sleeps through the night very well, but she will wake up requesting food on occasion.  This is not a ploy to get up; she really is hungry and will NOT go back to sleep unless she is fed.  Sometimes she just needs half a banana to hold her over until morning, and she usually goes right back to sleep without any back rubbing or singing.

Last night, after going through our normal bedtime routine, I could hear Genevieve in her bed playing around and kicking her feet against her crib.  After awhile, I heard "Mom!  Mama!"  I went in and asked what she needed and why she wasn't sleeping.  She said, "Rock me, Mama."  I don't get many opportunities to rock her, so after telling her that my lap didn't have much room but we could try, I held her in the glider rocker.  She put one arm around me behind my back, rested her head on my 38 1/2 week pregnant belly, and put her other hand on my belly by her face.  Then she looked up at me with a sweet grin on her face as we rocked and said, "I'm sleeping on Cecilia."  She again rested her head on my belly and sweetly drifted off to sleep.  It was such a special moment to me as I realized I was holding my two precious girls in my lap.  I really wish I had a picture to capture this moment, but honestly, the picture will be burned in my mind forever.