Reflux?

Over the past week or so Stella has started to get more and more uncomfortable after eating. There were also a few days last week where she emptied her entire stomach contents spitting up. I've spoke to a few different lactation consultants trying to figure out what's going on. 

When she first came home I was offering her both breasts with each feeding. This whole breastfeeding a singleton is new to me. L & C always just ate on one side, but I was under the impression that when feeding a single baby you should let them finish on one side and then offer the other. I think as a result she was eating too much and that's what was causing the extreme spitting up. 

I started to think maybe I have an overactive letdown. I can tell when my milk lets down that she struggles. She sputters, gulps, pulls off sometimes, and milk pools out of the sides of her mouth. I've been trying to nurse her in a more reclined position so at least gravity is working against us. It just doesn't seem to be making much difference. She never eats more than 10 minutes and won't comfort nurse. I've been pumping in the mornings since I'm so full and get between 5 and 6 ounces in 10 minutes. It's reasonable to think she gets a lot of milk in a short amount of time. 

All of her signs and symptoms seem to point to reflux. There are times she spits up, but other times I hear it and then she cries (silent reflux). After eating she'll grunt, clear her throat repeatedly, arch, and she gets awful hiccups if you lay her flat. She also has a tendency to sound congested. She hates her carseat and will generally scream in the car as well. 

I've tried feeding her more frequently to ensure she gets less and isn't as full and uncomfortable. I've tried eliminating dairy from my diet, gas drops to no avail, wearing her, keeping her upright after eating, changing her diaper before feedings so we don't have to put her flat after, nursing in a reclined position, and even a Hyland's homeopathic product that's supposed to help neutralize stomach acid. Nothing seems to be making a huge difference and I'm feeling frustrated and discouraged. 

So, this afternoon I'm taking her to the pediatrician. I'm not jumping up and down to get her on any kind of medication, but I'm at a loss for what else to do. I'm not even sure the ped will want to put her on anything. When I talked to the nurse last week she told me she was too young and to give it time. Poor baby Stella is so uncomfortable and cries a LOT. I feel so helpless.

My experience with L & C tells me that medications do help and make a difference. I'd hate to reach that same point we did with Lucy where Stella starts to associate eating with pain and then refuses to eat. The thing is, L & C are still on Prevacid. We've tried a few times to stop but every time they wake up screaming in pain and stop eating well. I don't really want to get her on something thats so hard to get off of.   

So I guess we'll see what her dr has to say. I'm curious to see what her weight gain has been like and to get his input. I'm hoping that something will make a difference soon and that I'll have a baby that's content a least a little bit of the time when awake. This whole crying any time she's awake thing is not fun. 

Transitions

It's safe to say my family has gone through a huge transition with the birth of Stella. L & C had only ever spent 3 nights total away from us when they went to stay with my in laws while we were in the hospital. Bringing Stella home is one of the biggest changes we've all gone through. 

Our first few days home as a family of five were challenging to say the least. I think having a c section and being unprepared didn't help. I went from doing almost everything for the girls to being unable to do a lot of simple things. I couldn't lift them, change diapers very easily, help bathe them, or carry them. It was tough for everyone. Top that with post-partum hormones and feeling guilty for turning their lives upside down and it's safe to say there were a lot of tears from everyone. Clara in particular had a really tough first few days. There were a lot of tantrums, time outs, and tears.

W and I are trying to be as consistent as possible with the girls. Now that I'm feeling better and more able to help, they are doing much better. They really do love their baby sister and I often find them bringing her blankets, pacifiers, toys, and giving her kisses and fist bumps. They talk about her all the time and ask about her if they don't immediately see her. They also seem to have a lot more patience for her crying (especially in the car) than I do. When I put her in the car seat they'll come over and say "baby happy" in hopes that she doesn't scream her head off like usual.  

It seems at this point a lot of the issues we're seeing with the girls are just typical two year old things. They fight over things like good sisters and don't have enough language to fully communicate their wants and needs, especially when they get emotional. Sometimes I think life would be easier if we waited a little longer to have another baby, but I'm also excited for my girls to grow up together. I know before long the girls won't even remember a time without Stella in our family. The thing about infertility is you don't really get to plan your family and time things "perfectly". 

Tomorrow W goes back to work and I take back over. I have help lined up a few days a week (my FiL is taking the girls to gymnastics every wednesday and my MiL has agreed to help Tuesdays). My mom has also said she'd help but it really depends so much on her mood how much she's able to do. I'm super nervous about having to care for all three girls mostly alone, but I'm also somewhat looking forward it. Having him home has been amazing and great, but in some ways it makes life more difficult. Getting out the door always seems to take longer with him and I don't feel like he's as firm with the girls. I've noticed a lot more negotiating and whining/crying since he's been home. 

Wish me luck (and a TON of patience) tomorrow as I take over with my three amazing little girls. I can do this!

A Shift

I'm used to getting a lot of attention when we go places, I have twin girls. The thing is, I'm used to this attention generally being positive. I do get a lot of "you have your hands full" comments that sometimes bother me (especially when someone says that rather than helping hold the door for me), but generally people are very positive. I hear all the time how well behaved and cute my girls are. It feels good to have people comment on things I've worked so hard on like L & C's behavior. They are good girls because we've worked so hard on following directions and behaving in public. 

The thing is, since Stella joined our family there seems to have been a shift. Instead of the friendly smiles and comments I'm so used to, now it seems people aren't so friendly and supportive. People stare, give dirty looks, roll their eyes, and say negative things. We haven't been too many places, but those positive and nice comments seem to be a thing of the past. I know L & C are tiny and look younger than they are, but whose business is it other than our own how many children we have and how close in age they are? 

I'm struggling with this because I look at my children and feel so lucky and blessed. I'm trying to stay positive and smile back even when people are staring, but I'm nervous about taking all three places by myself. It's tough to feel judged rather than supported. 

I know the confidence and ability to disregard these looks and comments will come with time, but it really doesn't make going places all that enjoyable at the moment. 

On a related note, W goes back to work next week and I'll be trying to handle all three girls by myself. I'm nervous but also looking forward to getting back into the swing of things. I know that the more I take them places and do things with them the easier it will get. It doesn't make me feel any less nervous about it though. 

Gratitude

Because of the way that I've been feeling lately, I thought it would good for me try to change my focus and mindset. I know a lot of my outlook depends my attitude, so I'm trying to shift that. 

I got together with a few of my fertility buddies this past weekend. One of them had the same dr for her son as I did for the delivery of L & C. She said she recently saw this dr for an annual visit and she mentioned something about my friend being one of her favorite patients. My friend then said it was because she wrote her an amazing thank you letter and sent her flowers after the birth of her son. 

This really got me thinking. To be honest, I never really thought about writing a thank you letter to my ob/gyn after either birth. I've thought about it for Dr. Braverman, but haven't ever actually done it. 

I've decided I'm going to write Dr. L a thank you note. I think doing this will be a good exercise for me in gratitude and gratefulness. It will help shift my focus to the positive surrounding Stella's birth. 

Definition of gratitude: the quality of being thankful; readiness to show appreciation for and to return kindness.

I've also started to try to focus on the things I can be grateful for every day. Yesterday as I sat inside and watched W playing outside with the girls in the snow (!!), I thought about how grateful I was for our warm home and a wonderful husband who is such an involved and amazing father. I appreciated that he gets three weeks off from work to help our family acclimate and assemble as a new unit of five. When one looks around and focuses on life in a positive way, they find there's so much to be grateful for. 

New Page

Just in case you're interested, I added a new page of pictures during my pregnancy with Stella. You can click on the link on the top of the page to check it out. 

Stella's Birth Story

The way my daughter entered the world wasnt how I pictured or envisioned it. She arrived safely and was screaming within a few seconds of her birth, but I can't say I was prepared for how everything would unfold.

It all started on Thursday October 1st. I woke up feeling similar to how I'd felt all week; super nauseous and exhausted. I planned to take the girls to story time at the library at 10:30 and my mom was going to join. Sometime during the morning I went to the bathroom and when I wiped I noticed I was losing my mucous plus. Since I was already feeling super nauseous it actually made me gag and throw up. 

Not feeling much different (maybe a little more crampy) I stil decided to go to the library. My FiL also met us there and my mom rode with me. When we arrived Clara wanted nothing but me. She was crying and carrying on so I carried her some. At 39+ weeks pregnant I was struggling with carrying her. 

After the library we headed to the bakery for donuts. Once again, Clara was just inconsolable unless I was carrying her. In pain, I carried her the four or so blocks it took to get there. I was seriously ready to cry it was so uncomfortable, but we made it. At that point I still hadn't had anything to eat so ordered a smoothie and managed to have about 2/3rds of it. I was still feeling really nauseous. 

After lunch Lucy refused her nap. She cried and carried on for nearly an hour as I begged her in my head to go to sleep so I could also get a little rest. I was exhausted and defeated and wasn't able to really take care of myself. I didn't eat much of a lunch and was feeling so stressed from my day with the girls. 

When W arrived home I was so grateful. I'd been feeling crampy and having lots of pressure and was glad he was home to take over with the girls. Around that time I texted our doula Jen to tell her I had lost my mucous plug and that I was feeling really crampy. 

Since the girls continued to be cranky we decided to take a walk. It was a beautiful day so it seemed like a good idea. As we walked I felt more and more contractions and started tracking them on my phone. They were about 10 minutes apart at that time. Clara ended up throwing another huge fit on our walk as she didn't want to be in the stroller and only wanted to be carried. It was exhausting to say the least. 

We got back and had dinner. I still wasn't hungry so didn't eat much. The contractions and cramping continued pretty consistently but we still did baths and put the girls down for the night. I again texted Jen to tell her things weren't really slowing down and to give her the heads up. 

As the evening progressed the contractions weren't stopping. I bounced on my ball, relaxed as much as possible on the couch, and then decided to take a shower. I made W come with me to keep track of contactions while I was in the shower and because for some reason I didn't want to be alone. 

Around 10:30 I called my drs office. I spoke with the one dr I hadn't met yet (Dr. B) and she suggested I go to the hospital to get checked. She also said I could skip my evening Heparin injection. It didn't feel like we really needed to go in at that time so I texted our doula. W made me a quesadilla and I was able to eat that. It was one of the few things I ate all day. At 11:30 we asked Jen to come to the house. A little earlier we had told my FiL to also come to stay with the girls.

The doula arrived about an hour later and I labored at home for quite some time. Since it was a VBAC Jen suggested that at around 1:45 am we leave for the hospital. My contractions were regular and I was unable to talk or rest much during them. Jen helped to get me situated in the car and suggested I lay down in the backseat rather than ride in the front. She followed behind us. 

The car ride felt really long. I tried to stay calm and relaxed, but it was difficult. It took us about 35 minutes to get there. The final turn to the hospital corresponded with a huge contraction and I remember that feeling like the hardest part. 

We arrived at the hospital around 2:00 AM and they took me to triage on the labor and delivery floor. The first contraction I felt I tried to get onto all fours, but the nurse yelled at me and told me I needed to lay back so she could get me hooked up to the monitors. I was a little shocked to say the least. A resident checked me and I was 4 cm dilated, -2 and 70% effaced. They said they'd call my Dr and come back to let me know the plan. My dr decided to admit me and at 4 AM they drew my blood. By 4:30 I was in a room and hooked up to monitors. I had no idea how awful those monitors would be. 

For the next few hours I labored in the room. I rested, bounced on the ball, labored on all fours, walked, and tried anything else our doula suggested. At 5:30 AM Dr. B checked in and told me there was no need to check my cervix again unless my water broke or I felt the urge to push.

At 7 am the nurses switched and somehow I got two nurses assigned to me. By 9:15 I found out the Drs also switched shifts and Dr. L came in to see me. She wanted to check me and I agreed. I was 5 cm dilated, still -2, and 80% effaced. Around that time my contractions slowed so we tried walking. I can honestly say that there wasn't a 10 minute timeframe during my whole labor where the nurses didn't come in to mess with and adjust my monitors. The most comfortable position I found was folded over, yet any time I'd get in any variation of this position the nurses would come in and insist on adjusting the monitor. I don't think there's anything more unpleasant than strangers touching, poking, pushing, and tightening two belts around your waist while you're contracting. I would beg them to let the contraction end before touching me and pushing on my belly, but they never listened. Even if I was sitting on the toilet they'd come in and insist on making their adjustments. I didn't want to really be touched at all in labor and to have strangers doing it every few minutes was really unpleasant. I really feel like this impacted my ability to relax. It's hard when there are tight belts around your waist and people constantly in your face messing with them. Not to mention, any comfortable position was out since the monitors couldn't pick up a signal when I was in them. Being upright, walking, or in bed were the only reliable positions to pick up the signal. As a result I did a lot of laboring leaning on W or Jen and  basically slow dancing. I didn't realize how great it would be to have a doula who was short like me because she was the perfect height to lean on during contractions.

Around 12:30 pm they suggested the whirpool tub and I agreed. Jen left to get herself some food and I labored in the tub. They really only let me stay in the tub for about 20 minutes before they asked me to go back to my room so they could get me back on the monitor. While I was in the tub we used wireless monitors. The tub was nice and seemed to help me relax, but once again the nurses were in the room every few minutes and I wasn't allowed to stay in very long.

Around 1:30 PM Dr. L wanted to check me again. At that point I was only 6 cm dilated and still -2 and 80% effaced. She wasn't very encouraging about my lack of progress so at 2:30 I tried walking again.

At 3:30 PM a hospital midwife came in to see me. I remembered her from Lucy and Clara's birth and also knew she delivered one of my friend's babies. She commented on how exhausted I seemed, how she could smell ketones on my breath, and how I seemed to need a little push to get things moving again. My contractions had started to space out and she said we needed to get them closer together to get things progressing. She was worried about my level of exhaustion and dehydration and suggested we start IV fluids and a bolus. I was so exhausted and didn't want to hear what the midwife had to say. She wasn't super optimistic about things and really focused on my level of exhaustion. The whole time I was in labor I was so afraid of feeling more nauseous and vomiting that I wasn't able to drink much water. I wasn't allowed to have any food. Jen offered me a drink after every contraction and I would take little sips, but my body needed more. It was obvious by the ketones on my breath.

At 4:30 PM I finally consented to start the lowest dose of Pitocin (2 mg) in order to help things progress. I really feel like this was a turning point and wish more than anything I would have made a different decision at that time. I was just that Dr. L and the midwife made valid points. I was so exhausted I started to fear I wouldn't have the energy to push my baby out. I remember talking with Jen and her saying pushing would feel different because I would be more active rather than passive like getting through the contractions.

Little to my knowledge, the pitcoin got turned up every half hour. No one asked, no one told me, and I had no idea. All I know is that I went from feeling like I could stay on top of and ahead of my contractions to feeling totally out of control. Jen had told me to picture each contraction as a wave and myself as surfing those waves. To picture myself staying just ahead of those waves in order to stay on top of them. Things got so intense so fast and I had been laboring for nearly 24 hours. It was amazing to me the difference between natural contractions and contractions on Pitocin. At 6:30 the Pitocin got increased to 6 mg and by 7:00 PM I was asking about pain relief. I debated the narcotic pain medications but after a few more contractions I asked about the epidural. When the dr told me the anesthesiologist could be there quickly, I told her that's what I wanted.

At 7:00 PM a new nurse also came on. At 7:30 my water broke in a huge gush as I stood up to lean on Jen during a contraction. It was a really weird sensation and felt like a huge water balloon came out of me and gushed onto the floor. Jen happened to be right in the line of fire and her pants and shoes got covered in my amniotic fluid. She said since my fluid levels had been high that was likely why there was so much fluid. The Dr checked me agin and I was 7 cm dilated, and still -2 and 80% effaced. By 8:00 PM the epidural was in place. I couldn't believe the difference. I went from feeling totally out of control of my contractions to not even being able to feel most of them. It was absolutely amazing and allowed me to rest for a bit.

At 9:30 Dr. L came in to tell me that the baby was experiencing decelerations with each contraction. She started to seem concerned, yet let me try different positions. I laid on my left side and they came in to tell me it was still happening. They tried oxygen and switching me to my other side but the baby wasn't tolerating things. With each contraction her heart rate would fall to around 100 and take a minute or so to recover. I started to watch the monitors and I saw her heart rate falling. It wasn't recovering after the contractions and I watched the door waiting for the dr to come back. The dr checked me again and I was 8 cm dilated. It was at that time that she also discovered meconium in the amniotic fluid. I knew at that point it was likely over. The dr let things continue with the decels until 10:45 PM when she came in and said she strongly suggested a c section. We asked for a few minutes to discuss things, but I knew it was over. At 11 PM I consented to the c section and I was wheeled into the room at 11:50 PM.

When I got into the OR they upped the epidural and I started to feel really numb. I was so cold and shivering like crazy. My teeth were chattering so hard it made my jaw hurt. They brought W in at about 12:10 and Stella was born at 12:25. I felt lots of tugging, pulling, and it smelled really bad when they cauterized things. They didn't lift Stella above the drape, and instead brought her right over to be suctioned. It took a few seconds and then we both heard her cry. They put a diaper on her and gave her to W to hold skin to skin. It was then that I was able to see her little face. Originally they said I could do skin to skin but at some point that changed. To be honest, I'm not sure I would have been able to hold her because I was shaking so much. The anesthesiologist had a heater that he was blowing on me. It helped to warm me up, but didn't make the shaking go away.

When they brought me to recovery (around 2:00 am) the Dr came and talked to me. She told me that my c section was "exceptionally difficult" and that there were a lot of adhesions and scar tissue, especially on my right side. Her scrubs were covered in blood and she said it was a good thing it hadn't been a true emergency because she may not have gotten the baby out on time. It took her 25 minutes to get to Stella.

Our doula Jen stayed with us in recovery for a while and helped me get Stella to nurse. She is also an IBCLC and was very helpful. It felt super awkward to be reclined, but Stella still latched and tried for a bit before falling asleep.

What wasn't shared with me immediately after surgery was shared the following days. Dr. L came in the following day and reiterated the difficulty of my surgery. She also said my incision was "paper thin". I honestly had no idea what that meant at the time.

At one week I had a follow up to look at my incision. I saw Dr. L and we discussed everything. I asked for clarification and she said that when she opened me up I had a "window" and that had she poked with her finger she could have opened my uterus. 

The next day I messaged one of the others Drs in the practice on Facebook. She is the one who is in our local mom's of multiples group and who got me into the practice. I asked her about the "paper thin" description and she explained things further. Apparently I had a "dehiscence" or "window", meaning the muscle layer of my previous incision had separated. The uterus has three layers; the endometrium which is what we shed every month, the myometrium which is the muscle layer, and an outer thin mucousal layer. My myometrium was no longer intact and that's why my incision was so thin. My uterus had started to rupture and Stella's decelerations were a result and signal of that. 

The days and weeks following her birth have been difficult for me. I'm still processing things and having all the post-partum hormones certainly don't help. Each day I feel a little better and I know I'll be fine, but talking to friends, W, and our doula has really helped. I'm so grateful we hired Jen and that she was there to support me in labor. I honestly don't know how anyone labors without a doula. 

  I know that the most important thing is that my daughter is safe and healthy, but I can't say I wasn't disappointed and sad about her birth. Even though I wrote a birth plan in case of a cesarean section, I honestly didn't have an open heart and mind to that possibility. I changed OB's at 20 weeks, hired a doula, and educated myself about vbac via documentaries and books. I truly thought if I wanted it and tried hard enough it would happen. I wanted this experience to be healing from my last birth. Throughout my pregnancy I said the most important thing to me was that I be able to hold my baby when she was born. I didn't get that experience of holding my daughter on my chest immediately after she was born and I think I'll always be sad about that. 

On the other hand, Stella's birth was a much better experience from Lucy and Clara's. I was conscious, we both got to hear her cry for the first time, and W was able to hold her skin to skin. I held her in recovery and was able to nurse her within the first hour of her birth and she never left our sides. I labored for 29 hours surrounded by the love and support of my husband and doula, and gave birth to my beautiful daughter. I know that the Dr gave me the best possible chance for the vbac and also let the decelerations continue for quite some time before insisting on a cesarean. For everyone's health and safety it's best I had a cesarean. 

I'm so grateful to have another beautiful daughter to love and snuggle. It's been a difficult recovery physically and emotionally, but my heart is so full!

My first time holding her.

Nursing in the recovery room. 

Lucy meets her baby sister for the first time. 

Kisses from Clara. 

First family photo. Perhaps not our best, but its our first one all together. 

All my girls. 

Kisses for baby Stella. 

Proud big sister. 

I think she loves her!

Ready to go home. 

Proud mama. 

She's Here

On October 3rd, 2015 Stella Kathryn was born. She weighed 7 pounds 1 ounce and was 21 inches long. Hopefully I'll be able to write down the details her birth story soon and share them.