NICU Visitation and Estimated Length of Stay

I forgot to mention in my last post some information about Ian's NICU
stay.

Visitation policy - Parents of the patients are the only visitors
allowed in the NICU at this time due to flu season precautions. Ryan
and I are allowed to visit 24/7 unless we are ill, then depending upon
the severity of the illness we may be restricted from visiting for a
period of time (a cold would just warrant wearing a facemask while
visiting).

Estimated length of stay - At this point in time, we have been told by
the neonatalogist assigned to Ian to expect his being in the NICU
until his due date plus or minus two weeks (due date being March17th).
They are very vague at this time because Ian is the one in charge of
his destiny. Only as he progresses through the milestones that he
needs to hit before discharge (maintaining body temperature, feeding
on his own to maintain weight growth by bottle feeding and
breastfeeding, breathing on his own, etc.) will we get a better sense
of when he is closer to coming home. It will likely be sometime in the
next 2-1/2 to 9 weeks. Hopefuly on the shorter end of that!

Sent from my iPhone

4 Days Old - Birth story and update

I meant to post an update on Wednesday, but time has passed by very quickly and it is already Friday today! So this post will be rather lengthy post.

Update on me first: I was discharged from hospital on Wed night! Looks like things with my health are looking good post-delivery. The O2 saturation issue resolved itself post-delivery. My liver function still has some high values but they were decreasing each day so my OB will check again in two weeks at my follow-up visit to make sure it's still decreasing. She thinks that the issues I was having may have been the beginning stages of pre-eclempsia. It's wonderful to be home now with Keira after 59 days in hospital. I started crying the minute Ryan wheeled me outside to wait while he got the car. He said it is cold out, but I insisted I wanted to wait out there. I'm gaining strength back slowly but surely although very tired by the end of the day. Today I'm making sure I take it a little easier.

Birth story: After 7 weeks on hospital bedrest with a shortened cervix and history of pre-term labor, I went into labor on Sun 1/17 at 31w4d. After stopping labor with magnesium sulfate for 24 hrs, suffering from pulmonary edema, complete bedrest for 3-1/2 days then only getting up to go at a bedside commode, I was off all meds for 5 days. My OB said on Friday that she didn't want to put me back on tocolytics due to the risks to my health so next time labor came, we would not be stopping it. On Sunday at 32w4d, I began contracting again. I got one shot of terbutaline to see if that knocked them out. Within two hours they started up again and by 5:15 pm, they were 3-5 minutes apart but not very strong. I was checked by a resident and found to be dilated 1-2 cm. I was transferred down from the high-risk unit to L&D for continuous monitoring to see if I was in labor. I lost my mucous plug shortly after arriving on L&D. By 6 am, contractions were getting stronger and pain was increasing. At 8 am, one of my OBs came in and checked me. I was only 2 cm dilated now. At this point I was in a lot of pain and about came off the bed when she told me I was only a two! I though for sure I was at an 8 or 9 based on the level of pain I experienced during labor with Keira. I was at like a 9 pain level, way past the level I ever felt with Keira (only got to like a 7-8). The doctor suggested I get up and shower and eat some breakfast to see if that helped a little to relax me some. At 10:00 am, my OB came in and checked me, I was now 5-6 cm dilated with bags bulging. At this point she asked if I wanted an epidural and said that since I was in so much pain already it was not likely to get much worse as I was progressing quickly. I said "pass" on the epidural (I didn't have one with Keira and really wanted to make it without one this time around). She came back at about 11 am to check on me and said she could break my water to help things along. I said yes, so she broke my water and I was 7-8 cm dilated. There was muconium in the water so baby boy was under some distress. Over the next 10 minutes the pain increased by a little bit and before I knew it, I was feeling the urge to push. The bed was not broken down and they were trying to get the NICU team in there. I had to hold off pushing through 2 contractions and man that was difficult! They finally broke down the bed and I pushed for maybe 5 contractions. He was born at 11:29, just 3-1/2 hours after being dilated only to 2 cm. He had a tight nuchal cord, but came out breathing at only 32w5d gestation (I had the steroid shots at 24 wks and a booster the week before to help with lung maturity). Shortly after his mouth was cleared of muconium, he turned blue from apnea so they bagged him to keep him breathing. I got to see him briefly in the incubator before they took him to the NICU with DH following.

Birth statistics: Ian William was born on Mon. Jan. 25, at 32w5d weighing 5 lbs 11 oz and 19 in. long. My EDD was March 17th. His Apgars were 7 and 8 which is great for his gestation.

Update on Ian: Baby Ian is doing well so far in the NICU. He was taken off CPAP on Wed and now on nasal cannulla with 21% air, both of which were to give a little help fully inflating his lungs. He was only on a little oxygen on Monday and since then has been on room air. He's breathing pretty heavily so he has a feeding tube for now. Attempting to suck a bottle too is too much for him at this point, but his tummy is tolerating food well with no reflux issues. He was up to 15 cc's every 3 hrs just yesterday and is moving to 20cc's today. His weight yesterday morning and this morning is 5 lbs. 7 oz. So he's lost a little bit but maintaining it fairly well. Hopeully that will continue! I'm pumping every 2-1/2 hours and my milk has come in like gangbusters so he's getting my breastmilk for the most part, but is still on IV nutrients that are decreasing daily. He was put under phototherapy lights on Wed so he's just chilling in his isolette with his glasses on. His billirubin level on Wed was 12 and is at 10.5 today so not increasing but will continue the light therapy. He maintains his own body temp fairly well but needs a little assistance. He's possibly suffering from a bacterial infection, but the blood tests show that it is getting better so they are keeping him on the antibiotics so his body doesn't have to do all the work to fight it if in fact he has one. His lungs appear to be clear of muconium, but he's being X-rayed periodically to doublecheck nothing changes.

He has a beautiful head of black hair and started opening his eyes on Wed and was really checking me out yesterday. Ryan and I are able to hold him and change his diapers. He loves to suck on his pacifier and is already figuring out how to put his fist to his mouth to hold it in! He loves to grab things with his hands and gets a good grip on my fingers. He has pulled his feeding tube out twice so they put it in through his nose in hopes of preventing further pull outs.

Update on Keira: Keira was so happy to see me on Wednesday night! She has been giving menlots of hugs and keeps saying "Mommy!" and wants to sit next to me for meals. We are making sure not to leave her right now so have visited Ian after she goes to bed. She has to make sure in the morning that Daddy and Mommy are home and have not left. Last week was the most difficult on her of the 8 weeks I was gone as Ryan was at the hospital with me most of the week since we really didn't know what was going to happen. Slowly she will gain confidence that we aren't leaving again. As for being a big sister, we have told her that Mommy had baby Ian and he is at the hospital. She continues to look for him in my belly. It ha helped to show her pictures of Daddy and I holding him and we tell her that we are holding her little brother Ian. When I go upstairs to pump my breastmilk, I tell her that I am going to make milk for baby Ian. This afternoon when I went upstairs, I said I was going up to make milk and she said "Ian" so she understands what I'm telling her. Hopefully seeing the pictures ofbhim over the next few weeks will help in the transition when he comes home. She loves babies and I think she will be a great big sister and really want to help Mommy in caring for him. I can't wait until she meets him!

It is difficult to leave Ian in the hospital but I know he is being well cared for. Being home allows me to see both my babies - Keira and him. Also, I am able to start the slow recovery from 8 weeks of strict bedrest. When it is time for him to come home, I should be in much better shape for the duties of caring for him.

I haven't gotten on my laptop since coming home so I'll try to upload pictures of him soon! In the meantime check out the couple of pics I posted on Facebook.

Sent from my iPhone

Welcome to the world, Ian William!

Ian William was born at 11:29 am this morning, Mon. Jan 25th, weighing 5 lb. 11 oz. He came out breathing on his own and after a small relapse, is now on CPAP to help his lungs fully open and breathing room air. He is doing pretty well so far in the NICU. He has quite a bit of black hair for 32w5d. Labor and delivery was quick and painful but without epidural. I am recovering now but had some complications during labor, possibly with edema again, so had some tests done to make sure I am okay.

Ryan was able to immediately follow Ian to the NICU for about an hour, then spent another two hours with him this afternoon. I saw him briefly at birth when he was delivered and before the NICU team took him down in an isolette to the NICU. Then at about 6:00 my nurse took me down to see him and touch him for about 20 minutes.    

Sent from my iPhone

32w2d: Day 54 - Still limping along

I'm 32 weeks 2 days along today. Every day is a small victory for us right now. I'm still hanging in here pregnant in a room on L&D (Labor & Delivery) rather than on the high-risk unit.

On Wednesday evening, I was permitted to begin eating solid foods again and I was taken off IV fluids then too. I'm now only receiving antibiotics through my IV every 6 hours.

Yesterday morning I was taken off 24-hr monitoring and will now only be put on for my NSTs each morning and if I feel that contractions have picked up. Contractions have continued to be sporadic and not very strong.

Also yesterday we met with a neonatalogist regarding what to expect should I deliver soon.  At this point, a 32-weeker would be likely facing a stay in the NICU of probably 3 weeks (with release likely around 35 weeks gestation, possibly as early as 34-1/2 weeks) and dealing only with short term issues so that is good. The issues the baby would be dealing with in NICU would be (1) some respiratory issues due to immature lungs and possible apnea (forgetting to breathe), but I have received betamethasone shots at 24 weeks and this past Sunday which should have helped a lot in maturing his lungs more quickly in utero, (2) feeding issues relating to learning how to suck and swallow plus learning to breastfeed, and (3) body temperature regulation but if he is as large as the ultrasounds have indicated that would help as he would likely have more body fat and be able to move out of the isolette sooner than most. Other likely  issues to be dealt with would be jaundice and weight gain, but those are things that we dealt with when Keira was born and are normal with any pre-term baby. Of course there is always the possibility of other unknown factors like infection, but as far as delivery after 32 weeks, if all goes well and he is as healthy as his ultrasounds have shown, he should not have to spend too much time in NICU.

Until this morning, I was on complete bedrest. My catheter was removed last night and I now have a bedside commode. I am now allowed to get up from my bed and walk the four steps to the "bathroom" next to my bed. How glamorous, you say? Yes, I know you're jealous!!  As of now there is no talk of showers and I'm pretty sure I wouldn't be able to do one. These five days in bed have taken a lot out of me and I'm in some pain when I do get in and out of bed for my brief potty breaks. I can really feel the change in my cervix length when I am upright or when baby moves down low in my abdomen. Ouch! I was able to get my hair washed from my bed yesterday which felt very good. Quite the process and my nurse was fabulous to help get that done.

Ryan has been spending most of his days here and has slept here every night since Sunday. Monday was a holiday and he took off work Tuesday. He went into work on Wednesday, but has worked from my hospital room both yesterday and today. He goes home for a couple hours each day to spend time with Keira and get showered. It has helped me having him here as this week has been quite the roller coaster with all the uncertainty.

I was experiencing some contractions this morning during my NSTwhich were about 4-8 minutes apart but not very strong. I was not feeling all of them. My doctor was called and she directed that I should drink lots of water and make sure to empty my bladder. Yes, the catch 22 of contractions: must stay hydrated but must not let bladder get full! Since the contractions didn't get any stronger or closer together I was able to be taken off the monitors with orders to let my nurse know if the status of my contractions changed.

My doctor rounded on me this afternoon to see how I am doing. She reiterated the need to continue to drink lots of fluids and empty my bladder promptly to help keep the uterus calm. She asked about the vaginal pressure I am feeling and since I don't feel that the pressure is increasing, constant, or that baby is coming, she did not perform a pelvic exam due to the risk of infection. She told us that she is not going to put me on any tocolytics going forward to stop labor the next time contractions increase and I go into labor. She feels the risks to my health (and possibly his) of doing so are higher than the risks to him being born early at this point. She wants me to work on keeping up my arm strength as much as possible in bed so that I am not in too weakened a condition when the baby comes. 

So it looks like I will remain pregnant until my uterus decides to eject baby boy. Ryan and I are both okay with that and are optimistic that everything will turn out fine for him. We are taking it day by day and every day that I remain pregnant is another day that he remains in utero baking and at least one day less in the NICU. Who knows? I could last one more day or could make it two more weeks. Only time will tell...

Sent from my iPhone

32w0d: Day 52 - 32 weeks and still hanging on...

I haven't posted for a while as there has been some serious stuff going on since Sunday night. But here is brief summary of the past few days from posts I made to my bedrest message board:

Jan. 17, Sunday night 11:30 pm or so:

31w4d today. Having bad contractions tonight-2 shots of terb and my 5mg oral dose didn't stop them. Was taken down to L&D at 10 pm for evaluation by doc-delivery or mag? There was strain on my cerclage so she had to remove it. She said contractions look like real labor, but put me on mag flush to see if we can keep me pregnant for as long as possible. Got one betamethasone shot and hope to at least keep me pregnant for 24 hrs (had 1st two shots at 24 weeks) to let it set in. He is still head down so if I was to deliver I could do it vaginally. Contractions are still coming but hope they will slow down.

Hoping for the best...need him to stay in for a couple more weeks at least.

Jan. 18, Monday evening sometime:

Quick update: still pregnant, still having a few contractions on magnesium nowhere like last night. Dr. plans to take me off Tues morning hopefully to put me back on terb. We are kind of out of options drug wise so we just hope to make it as long as possible.
Had growth scan just a while ago: baby boy is estimated to weigh 4 lbs 13 oz plus or minus 3/4 lbs today at 31w5d.

Hoping we can make it another few weeks but I'll take everyday we can get at this point.

Jan. 19, Tuesday morning:

Update: still hanging on and playing the wait and see game. Took me off mag at 10 pm last night and did well overnight with only minor contrax maybe 15-30 min apart. Still doing well this morning so got to eat liquid lunch, but about that time contractions started to increase in frequency but not strength so gave me Procardia. Currently playing waiting game to see what will happen-does Procardia help or do I continue to contract...

I was given the steroid shots at 24 weeks and a booster Sunday night at 10 pm. I think everything has been done to hopefully help him along if it is his time. 32 weeks tomorrow...

Jan. 19, Tuesday afternoon:

Diet restrictions are due to the possibility of needing to put me back on mag I believe and also in case I end up delivering I'm sure. The mag supposedly does not play well with others! I was getting nauseous overnight Sunday just from eating too many ice chips for dry mouth (awful dry mouth on mag!!)

Jan. 20, Wednesday morning at 9:30 am:

After a rough bout of it since Sunday evening when I went into labor, things seem to have stabilized a bit this morning. Yesterday coming off the mag and terb, I was still contracting quite a bit. My doc kept me off meds until about 1 pm until my contractions had picked up speed a little. So put me on Procardia every 6 hours. After several hours that didn't seem to be helping so tried Toradol, no help there either.

Meanwhile, whiile on the Procardia, I was not feeling the tightening of the contractions at all, instead felt this full body tremble that was not discernible to anyone but me. This didn't go away until about 3 am this morning when I then started feeling the contractions in a wave of pain both during contrax and when baby moved low. This scared me as it felt like labor pains from Keira.

My O2 saturation levels were low since Monday (92-93%) so they had me on oxygen, but took me off this morning and I'm doing much better (97-98%). Looks like I was suffering from pulmonary edema (fluid in the lungs) from the magnesium.

Right now I'm off all meds and contractions are barely a blip on the screen. Baby is looking good on monitor. Cervix is still in tact so not dilated but definitely thinned out a lot. Today I'm still in L&D and told to drink lots of fluids. I think my urine output is not yet what they'd like to see so hopefully that will improve today.

Not out of the woods yet, but much better outlook since even a few hours ago when I though full-blown labor might possibly be in progress.

I'm 32 weeks along today and glad to be here. I wasn't sure we were going to make it!

Additional updates re: baby:

Throughout all of this baby boy has been faring very well. His heartrate has been great throughout this ordeal. While on the magnesium sulfate, his heartrate was lower for him but still within the norm. Within hours of coming off the mag Monday night, his heartrate was back to normal and I was feeling increased movement from him. Since yesterday morning, his movement has been normal (read: back to painful at times!).

As mentioned above, I had an estimated fetal weight done on Monday afternoon and he measured 4 lbs. 13 oz. As of this morning, he is still head down.

That's all the news for now. Hopefully today will be a good day.  

Sent from my iPhone

31w0d: Day 45 - 31 weeks!!

I am 31 weeks along today! Yesterday was very busy so this update is a little lengthy detailing my most recent contraction saga.

I was still on Terb on Monday and I was having contractions at least every hour then started that afternoon with 2 per hour. Not so bad but being I have 6 more weeks to go until 37 weeks it was not good either.

My secondary OB decided that afternoon to switch me to Indocin on Tuesday morning to give my body another break from Terb. I got the first dose of Indocin at 6 am Tuesday morning and, by 8:15 am, I was contracting every 10 min and they were as strong as I have felt yet. Thankfully, a shot of Terb knocked them out after 30 min. My primary OB stopped by that morning while I was contracting and decided that since Indocin was not very effective, she wanted to try Toradol in place of Indocin, which is an IV drug similar to Indocin so usually more effective. I would be on the Toradol for only 48 hours.

Before being switched to Toradol, I had to have an U/S to check on baby's amniotic fluid levels (the meds can decrease fluid levels), and they decided to also check my cervical length since it had been a week since my last check. The great news is that my cervix measured at 3.1 cm up from 2.0 cm last Monday! Baby's amniotic fluid levels  were just fine so I was okay to be placed on Toradol.

At 2:30 Tuesday afternoon, I had an IV placed (two tries!) and my first dose of Toradol was pushed via the IV shortly thereafter. I had avoided getting an IV for 44 days so I was disappointed to have to get one, but it should only be for the 48 hours I will be on Toradol and there is no IV drip so no IV cart to push around when I get out of bed. It could be worse! 

So the Toradol worked decently for longer than the Indocin. However, at around 7:00 pm (about 4 hours after the dose), I started contracting every 8-10 minutes and within the hour I was put on the monitor.  Shortly thereafter, I began contracting about every 3 minutes. They weren't the worst contractions I have had but they were uncomfortable. A shot of Terb dulled them, but it did not stop them as it did that morning.  Since they had dulled and were not getting closer, the on-call doctor decided that I should be kept on the monitor and wait until my next dose of Toradol at 10:30 rather than giving me another shot of Terb. I got my next IV push of Toradol at 10:15 pm and the contractions immediately slowed to 10 minutes apart and within 30 minutes had died out completely. By the end of it, I had been contracting every 3 minutes for 2 hours and was on the monitor for a total of three hours! Absolutely exhausting!

Fortunately, I was able to get to sleep shortly thereafter and my sleep was not interrupted by contractions. I got a pretty decent 8 hours of sleep.

When I woke this morning, I was worried that today would be very bad since I was supposed to be on the Toradol until tomorrow morning. It actually turned out okay and my contractions pretty much stayed at 20-30 minutes apart and were not strong at all. Thank goodness!! My secondary OB rounded this morning and decided to discontinue the Toradol after tonight's dose at 10:30 pm and put me back on 5 mg Terb every 4 hours starting at 1 am. Since my cervix is not shortening and has in fact lengthened, my contracting on the Terb doesn't seem to be a problem right now and I was having fewer contractions on it than the other medications. We will see how things go over the next few days.

Bonus news from my ultrasound yesterday: baby boy has lots of hair already! The U/S technician pointed out that he has lots of hair on the back of his head and on the top of his head as well. I am looking forward to seeing how much hair he has compared to Keira when she was born!

I should have my next Estimated Fetal Weight U/S next Monday as it will have been 3 weeks since my last one. I can't wait to see how big he has grown!

I'm just happy to have made it this far after the past two weeks of contractions. It seems as though they may continue to worsen though as the weeks go by.

7 days until 32 weeks! 21 days until 34 weeks! We are getting there...slowly but surely.

Sent from my iPhone

30w4d: Day 42 - 6 weeks in hospital

Wow! I'm 30 weeks 4 days along now. I have been here in the hospital
for six weeks now. I have about 6-1/2 more weeks to make it to 37 weeks.

As of my last update on Wednesday, I was hopeful that the break from
Terbutaline would give me a break from the contractions. Well, the
break lasted all of 36 hours. On Thursday night, I started having
breakthrough contractions 11-12 minutes apart for about an hour before
my next dose of Terb was due at 10:30 pm. Also I was having to go to
the bathroom like every 30 minutes and felt like I wasn't able to
empty my bladder as the baby felt so low. That 10:30 pm dose knocked
them out, but it was not good that I was contracting that frequently
so soon after switching back to Terb.

I informed my OB of this development on Friday morning and she was not
happy to hear this. She asked if I was feeling the side effects from
the Terb and I told her I had for the first 24 hours or so but wasn't
anymore. She did a pelvic exam to see if I was dilated and probably to
feel how low the baby was. She didn't say anything was wrong. She had
me give a urine sample to check for infection and that came back
negative. She increased the frequency of the Terb to every 4 hours
from every 6 hours to get me through the weekend and said she would
put me back on Indocin again for a couple days starting Monday to give
me another break from the Terb.

Since increasing the Terb to every four hours, I have not had any
breakthrough episodes. However, I have continued to contract when I
need to go to the bathroom and the frequency of my need to go seems to
be every 45 min to every hour, if not more frequent. Thankfully, I no
longer seem to be contracting every time I get out of bed, but that
may change when I move to the Indocin tomorrow.

I am definitely feeling more pregnant every day: more frequent
bathroom trips, sometimes when I move around I will feel pressure on
my cervix from the baby, and I am feeling some slight back pain from
the weight of the baby belly.

I would really like to fast forward a couple of weeks to get to a
gestational age for baby boy where a long NICU stay would not be
likely. At this point, we are looking at probably 6-9 weeks in the
NICU although the risk of long-term issues has decreased some.

Countdown to 32 weeks is 10 days, 34 weeks is 24 days, and 36 weeks is
38 days...please let them go quickly!

Thanks to my visitors this week: Gabrielle and Matt, Andrea (thanks
for dinner and the Frosty!), and Scott and Lauren (thanks for the
yummy pumpkin CC muffins!). Ryan and Keira visited on Monday and
yesterday they visited and brought Grandma Janet too! Ryan was able to
visit me twice this week since Grandma Janet is here again to help
with Keira. At this point in my stay, a day without visitors is a long
day here, so I really do appreciate the visits!!

Here's hoping for another low contraction count week!

Sent from my iPhone