Sunday, May 4, 2014

Gianna' Birth Story

Since I shared Rocco's birth story, I feel I should also share Gianna's. But first, I feel a little back story is needed:

For the months leading up to her birth my blood pressure was consistently around 140/90 with several spikes up to 155/100 ("good" blood pressure is 120/80 or lower). My midwife sent me to the hospital's triage to do blood tests, NSTs, urine collections, ultrasounds etc. about every other week for the last month and a half of my pregnancy all because of that darn high blood pressure and worries that it was a sign that I was developing either pre-eclampsia or HELLP syndrome again. These hospital trips were on top of my regularly scheduled weekly NSTs at her office and my appointments with the MFM (high risk doctor) at the hospital. It was exhausting. When I was 35 weeks pregnant, the MFM finally made the decision that as soon as I hit 37 weeks I was to be induced.

So on May 4th, I reported to my scheduled induction at Winnie Palmer Hospital at the lovely time of 4am. Why the hospital felt they needed to schedule an induction at such an ungodly hour, I do not know. You would think they would at least try to let a pregnant woman get some sleep before forcing her body to go into labor, but hey, what do I know? By the time I was checked in with IV and fetal monitoring hooked up, it was already 6am when they finally started me on Pitocin.

I honestly kind of forgot how bad Pitocin was last time, probably because I wasn't on it for too long before I had my epidural. When you are on Pitocin, contractions come much stronger and faster than they would have had you gone into labor on your own. So after 7 hours on the medicine from contraction hell without any pain assistance I decided to ask for a progress check at 1pm. I was already 2 centimeters when I initially checked into the hospital at 4am, so surely I felt I had to be at least to the halfway point, right? Wrong. I was told I was only at 3 centimeters. I decided I had had enough and called for my epidural! It turns out that was the right decision because shortly after blissfully being numbed from the waist down, my water broke and I quickly jumped to 6 centimeters within half an hour - I imagine that would have been painful.

Around 2:30pm I began to feel a lot of pressure despite my epidural, so I called my nurse for another progress check as I was pretty certain it was go-time. The nurse came in and as she was getting her gloves on she was telling me that basically I should expect for it to be at least a couple more hours before I will be ready to push, and how she usually has a good feeling of when her patients are close to being ready because she monitors their contractions remotely from her desk. After she was done with this spiel she finally checked me and much to her surprise, I was completely dilated and ready to go. I tried to hold back my smirk.

While she was still checking me it quickly became apparent that my water hadn't fully broken earlier because all of a sudden there was a very audible "pop", followed by a lot of fluid. The nurse rushed to get the midwife who was on call.

Almost immediately they put an oxygen mask on me, I assume just to be safe as I was breathing fine but perhaps that was more for the baby than for me. I was then instructed to push during my contractions and that went on for about 15 minutes. That's when the midwife decided to give me yet another episiotmy because the scar tissue from my last one with Rocco was preventing further progress despite how well I was pushing. Apparently that was all that was needed, because with my very next contraction, at exactly 3pm, Gianna Eve Mintz was born!

Scarily, she was born with her umbilical cord wrapped around her arm in such a way that it was pinned to her shoulder, and then the cord was wrapped twice around her neck. Luckily the cord wasn't wrapped tightly so she was able to breathe easily as they quickly got her untangled, as evidenced by her unhappy crying, which is of course music to every mother's ears during delivery. They plopped her on my chest for a little bit while they cleaned her up and then took her to go weigh and measure her. Her official stats were 5 pounds 2 ounces, 18.5 inches long, and apgars of 8 and 9.

Gianna doing skin to skin right after they had weighed and measured her

Someone doesn't know how to calculate military time

Rocco meeting Gianna for the first time

Once again, my delivery seemed relatively easy. But like last time, that was not necessarily the case. Thankfully though, things didn't take as bad of a turn for the worse as it had with Rocco. My blood pressure continued to climb post delivery to 180/110, so at midnight they started me on Magnesium Sulfate to prevent me from going into a seizure and to help lower my blood pressure. This medication made me horrifically sick last time, and this time was no different. After a couple of hours of being unable to even keep small sips of water down, they finally lowered my dosage so that I was able to deal with the nausea enough that I could get some rest, seeing as I hadn't slept since I woke up at 3:30am the previous day to make my trip to the hospital. Unfortunately, part of the protocol for being on that medication is that a nurse has to come in and take your blood pressure and other vitals every hour, on the hour, for 24 hours straight. So any sleep I did manage to get was short lived with all the hourly interruptions. 

Meanwhile, Gianna's blood results showed an elevated white blood cell count, indicating she might have an infection of some sort. This meant she had to have an IV placed and was put on antibiotics. This also required us to stay at the hospital for 48 hours from that point on to wait for the blood culture to come back to make sure she wouldn't need any additional medication or monitoring. So at 11pm on May 6th we finally were discharged once we got the all clear from her lab results.

Despite how exhausted I was from the lack of sleep between the hourly nurse interruptions and having a newborn, and being in a little bit of pain from delivery, I felt pretty ecstatic overall. I felt like I had managed to dodge the HELLP syndrome bullet, Gianna's blood culture came back fine, and no particularly crazy medical interventions were needed during the delivery or afterwards. I finally had my relatively happy birth! Unfortunately this happiness was rather short lived.

The very next day we had a morning appointment with her Pediatrician (who does not have rights at the hospital, so we had to take her to that appointment separately from her hospital stay). Initially she seemed fine, her weight had dropped by a couple of ounces but that's to be expected.

In the waiting room of her Pediatrician's office
Getting weighed at the Pediatrician's office - down to 4 pounds 14 ounces from her birth weight of 5 pounds 2 ounces

However, during the course of her checkup the Pediatrician noticed something no one at the hospital did - she has a cleft palate. Now, I know what most of you are thinking. You're thinking of a cleft lip, which is not the same thing, though babies who have cleft lips can also have cleft palates. Her particular cleft palate is where the soft palate (towards the back of the roof of her mouth) is incomplete resulting in a u-shaped hole in the tissue that separates her mouth from her nose internally. Externally, you can't see anything at all. This congenital defect occurs in about 1 out of every 2,000 babies.

This discovery led to us having an immediate appointment the same day with a craniofacial pediatric surgeon, who then got us into an appointment the very next day with a feeding specialist. The end result of multiple appointments with the pediatrician, surgeon, and feeding specialist is that when Gianna is 8 or 9 months old she will have to have surgery to repair her cleft palate. Meanwhile, it has been determined that she is currently able to feed effectively from a bottle, but due to the cleft in her palate her suction isn't the same as a normal baby. Every time she sucks or swallows, she loses suction which makes a noticeable popping sound whenever she is sucking on a bottle or pacifier. This loss of suction makes it almost impossible for her to breastfeed effectively, as she gets very frustrated constantly having to regain her latch due to loss of suction. As a result she is now solely bottle fed pumped breast milk. I was going to have to pump eventually anyways when I return to work after 12 weeks, just like I did with Rocco, so it's not too much of a hardship to start that process earlier than expected. However, Rocco and I had a great, easy nursing relationship for the times when he was not in daycare, which continued up until he was 15 months old, so I am kind of mourning the loss of that special bond that I can't have with Gianna. Not to mention the convenience of breastfeeding. Seriously, so much more convenient! *Sigh*

Mainly, I am scared to death of her undergoing surgery before she will even be 1 year old. You may be thinking, if she is eating from a bottle fine, why would she still need surgery? Is it optional? As it turns out, your palate is a very important part of the process that allows you to clear/pop your ears (like you would do on a plane, and something you do regularly without even realizing it). As a result of the cleft, she is unable to do this important function and as a result more likely to have multiple ear infections. She then may start to have trouble hearing due to build up of fluid in her ears, which will delay her speech, as speech starts with being able to recognize sounds for her to try to mimic. Additionally, the cleft can distort her speech, causing it to sound garbled. Due to these issues, she may need to see an ENT for ear tubes and a speech therapist at some point in time further down the line, potentially even after her cleft palate surgery. On top of all that, she may also be referred to a geneticist as children with a cleft palate but without a cleft lip have statistically a 40-50% chance of having a broader disorder/syndrome. For now, she shows no signs of having any other major issues but she is still very young and that can change as she grows older and has developmental milestones she needs to reach.

Unrelated to all of the above, she does have one other small, mostly cosmetic issue: she has a hemangioma on her head, about two inches above her left ear. A hemangioma is a non-cancerous tumor consisting of an abnormally dense group of extra blood vessels. Hemangiomas can develop anytime during the first couple months of life and grow larger for up to a year but then become smaller on their own, with most disappearing almost completely by age 10. In Gianna's case, she was not born with a visible hemangioma but she now has what appears to be a large raised red spot the size of about a nickel over the course of just a couple of weeks. On the medical front, it's likely no further intervention will be needed since the hemangioma is not impending anything vital, such as an eye or mouth. Only if it continues to grow at a rapid rate will it require monitoring via an MRI and potentially laser treatment or surgical removal. Cosmetically, she is lucky in that once her hair starts to really come in, it will easily cover up the hemangioma even if it never gets any smaller than it is now. However, Rocco had basically no hair even when he turned one year old, so that might take a while.

Overall, Gianna's health seems basically fine minus all the above stuff, and for that I am very thankful. I am also very grateful that her birth did not trigger another major medical episode for myself, like I had with Rocco. So until her palate surgery comes up, I will focus on enjoying this wonderful addition to our family. She already fits in perfectly, so much so that it's already hard for me to remember what it was like when we were just a family of three.

Our family is finally complete

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