Thursday, September 27, 2012

Little Man's Professional Debut

Yup, I am one of those mothers! I am constantly uploading pictures of my little peanut to Facebook and texting friends and family pictures too. So to continue the trend I will share some of the professional pictures that we had taken of Giovanni when he was only 13 days old. Enjoy!

Wednesday, September 19, 2012

Will It Ever End??

Over the past two weeks or so I have been experiencing an increase in headaches and pain at the base of my skull. I figured it was due to lack of sleep and stress. Friday afternoon I mentioned it to my doctor who suggested that I contact anesthesiology at the medical center. I ended up talking with the anesthesiologist that works in L&D and she said it was most likely that the blood patch that I had received after delivering Giovanni had broken up and that the leak started leaking again and that another one was needed. She offered to admit me into the hospital until they could do the patch on Monday but I refused as there was no way that I was going to go sit in the hospital and not take care of my baby. We decided that I would go to the medical center on Monday where they would admit me and do another spinal blood patch. The only part that made me nervous was that I had to stop my Lovenox Saturday night in preparation. Monday, just before noon, I was admitted back to L&D where they did the blood patch. Let me just say that it was awful! I ended up being quite dehydrated so they had to give me two liters of fluid prior to the procedure. Then, because of the dehydration, they had a hell of a time getting the blood out of my wrist to put into my spine. My poor wrist looks like I tried cutting myself with a rusty razor blade! Despite the Versed, the procedure hurt like hell and all I could do was cry...but I couldn't move at all. Despite the procedure itself sucking, the staff was wonderful and I felt better within hours of the procedure...except for where they inserted the blood patch...that still hurts like hell!

We also made an amazing discovery during our appointment with the lactation consultant on Saturday. After trying for an hour to get Giovanni to latch onto the breast, she discovered that he had a 3rd degree tongue tie and a 3rd degree upper lip tie. I can't understand for the life of me why this was not discovered sooner. I worked with multiple lactation consultants at two different hospitals and all they kept telling me was that Giovanni had a small mouth but eventually he would grow into it and then would be able to latch onto the breast. Not only am I am confused why this was never found, but I am also pissed that because of this missed problem, I missed out on a whole month of breastfeeding my son and put him through hell trying to get him to latch when it was absolutely impossible. First thing Monday morning we called a local doctor that uses a laser to correct these issues. He immediately scheduled Giovanni's procedure for the following day. The procedure itself went fine and was over in about ten minutes. As soon as the doctor brought him back to me I put him to the breast and he latched instantly. Although it only lasted a few minutes, I then knew that he could do it. My husband and I have to do these awful mouth stretches with Giovanni three times a day (he screams during them) to ensure that the ties don't reform. This has to be done everyday for the next two weeks. We go for a followup visit in the morning so that the doctor can check Giovanni's mouth to make sure there is no inflammation or infection.

Today we followed up with the lactation consultant to see if we could get Giovanni to latch, and stay latched, on the breast. Because of the frustrating 4 weeks he has had with the breast, all he did was scream. The LC explained that it is going to take a month for him to get the hang of things as that is how far he is behind with his breastfeeding skills. In the meantime I am pumping away and my output is slowly increasing. I pump anywhere form 2.5oz. to 4.5oz per pumping session. He is only eating 2.5oz per feeding right now so at least I am pumping enough to feed him. I went ahead and rented a hospital grade pump to use for a month or so as I really want to build my supply and the Pump in Style just isn't as good as a hospital grade pump. I will have it by next Tuesday so hopefully that will make a difference.

On a positive note, my little man is 4 weeks old today! I can't believe how the time is flying. He has already changed so much since his birth. He is now able to look at our faces, he can track movement with his eyes, and he can hold his head up for short periods of time during tummy time. I absolutely love watching him grow and I look forward to each new day with him!  

Friday, September 14, 2012

Needing Support

Last Saturday I posted about all of the issues I am having with feedings and my struggle to provide my son with breast milk. Since then I have realized that I am the only one that can deal with this situation as it is all my own. If I want the situation to improve I need to take steps to make that happen, not just bitch about how hard things are. Here is what I have done so far:
  • Contacted a private lactation consultant whom I am meeting with Saturday afternoon. I was going to meet with her this week and the LC from the hospital last weekend, but the onset of mastitis put a halt to that. Both my husband and I are meeting with this private LC for a 3 hour session. Her fee includes this initial visit plus unlimited email and phone support and a follow up visit if needed. 
  • Started taking Motherlove's More Milk Plus which is supposed to help increase milk production. This is an herbal breastfeeding blend the contains fenugreek seed, blessed thistle, nettle herb, and fennel seed. Not realizing that this particular blend didn't contain goat's rue, I ordered a bottle of seperate goat's rue (should be here next week) and I also ordered More Milk Plus Special Blend which actually contains goats rue for when I run out of this stuff. 
  • I am eating oatmeal every morning. Not only is this good for my milk production, but it is also good for my waistline!
  • I ordered a set of Pumpin Pals flanges for my breast pump as I have read incredible things about them. I just received them this afternoon and have only used them once but I can tell you that I love them so much more than the ones that came with my Medela. The prevent my nipples from getting irritated and they are also angled so I don't have to lean forward while pumping. I can actually sit back and relax. 
  • I have been using the Medela hands free pumping bra and while it is okay, I am not impressed by it. It stretches out after a few uses which allows the flanges to move during pumping which in turn leads to leaking milk. After reading through pages of support forums on breastfeeding, I decided to order the Simple Wishes hands free pumping bra. All the reviews say that it keeps the flanges nice and tight to your body and is strong enough to support the wight of the bottles filling with milk. I just checked the tracking and that should be delivered tomorrow afternoon.
My ultimate goal is to be able to exclusively breastfeed my son...with or without the nipple shield. While I understand that formula isn't going to harm him, breast milk is extra important because of my CVID and that is why I am putting so much pressure on myself to provide him with this. We will not know for months if he has been afflicted with CVID like me so right now it is so important that he receives what antibodies I have through my breast milk. While lactobacillus bifidus, lactoferrin, lysozyme, all found in breast milk, provide him with passive immunity, the most important component for him is the secretory IgA. As of my last set of blood work with my immunologist, my immunoglobin levels were normal which means that Giovanni is getting a normal amount of immunity from me. If he does in fact have CVID, with his underdeveloped immune system, breast milk becomes crucial as he gets this immunity from me and that is not something that is provided in formula. I am actually going a week from today to see the immunologist to see if it is necessary for me to start back on the IvIg transfusions. The pediatrician has also raised some concern regarding some of the scheduled vaccinations coming up at his 2 month appointment. According to the literature, infants of mothers with CVID should not receive the vaccination for Rotovirus, Chicken Pox, or the MMR. When I go next week to the immunologist I need to talk to him about that. If my immunoglobin levels are stable, and he is recrieving my breast milk, will that protect him enough to receive these vaccinations...that is the question we need answered. All I need is a very sick infant on my hands!

Saturday, September 8, 2012

Feeding Woes

Feeding has been a struggle for us since Giovanni was born. I knew going into this that breastfeeding would be difficult as I have gestational diabetes, hypothyroidism, asymptomatic PCOS, and infertility working against me, all barriers to successful breastfeeding. I was determined to try my best so I can do what is best for my son. While in the hospital after his birth, I was not producing much colostrum. I was actually siphoning drops of it off of my nipples with a 1ml syringe. The nurses and lactation consultant told me that three drops of colostrum would raise his blood sugar 20 points, so I made an effort to get what I could. I was using the hospital pump as well, and I would only get a few drops with that. It actually became quite frustrating as I would pump for 20 minutes and at times I wouldn't even have enough to suck up with the syringe as it would all just get lost in the chambers of the pump parts. With each pumping session I was only getting 0.1ml. (Yes, you read that right.) By the day of discharge, I was producing .6ml which is considerably more than a few days prior, but not enough where I was comfortable feeding Giovanni. Without going into great detail in this post about all of the problems I had with the hospital regarding my discharge, I will just say that I was in no way comfortable being discharged (another whole long post) as I didn't feel that my son was getting enough to eat. Needless to say, my concerns were ignored and I was discharged against my wishes. Luckily, while I was battling with the hospital to keep him until we knew he was getting enough to eat, I called my pediatrician and setup an appointment for the following day.

The next morning I went to the pediatrician and all I could do was cry. I knew that Giovanni was hungry and there wasn't anything I could do. I had originally asked the hospital about supplementing with formula but they told me not to as it wasn't necessary. By the time we saw the pediatrician it was almost 24 hours since his last wet diaper. I knew something wasn't right. His weight had also dropped from 6lbs12oz down to 6lbs1oz. The pediatrician was quite concerned and had us feed him 2 ounces of formula right in her office. She told us that if he didn't have a wet diaper by 7pm that night, that he would have to be readmitted to the hospital. Needless to say, we never had a wet diaper so Giovanni was readmitted back into the hospital...our local one though, not the medical center. For the next 24 hours we worked with the nurses and lactation consultants to determine what the problem was. They determined that his mouth is unusually small, therefore he wasn't latching properly. Because of this, my breasts were not getting stimulated enough to signal my body to produce milk. I then started a routine of pumping for 20 minutes and then feeding him, and I was doing this every 2 hours. As you can imagine, this left me with very little time to sleep which made recovering from my 3rd degree tear and spinal fluid leak very difficult. Within 24 hours Giovanni was peeing and pooping regularly and put back on 4 ounces.

For the next couple of days I was following this same schedule but I became worried that he would lose interest in the breast. As much as I didn't want to have to use it, I gave into the nipple shield that the hospital gave me. He struggled with it but seems to now be getting the hang of it. While it would seem that this would solve some problems, it actually has created more. Now, instead of pumping and feeding, I am putting him to the breast for 30-40 minutes (using both sides), pumping right after he is done, and then feeding him what I pumped. After all of this is said and done, I have very little time until his next feeding since I can't let him go more than 3 hours and the clock starts when he starts eating, not when he finishes. And to top off this routine from hell, I started having severe stabbing pains in my right breast a couple of days ago. I couldn't stand it any longer so I called my MFM. Since I called on Friday they told me to go to urgent care so I didn't have to suffer through the weekend. Turns out that I have developed mastitis and I am now on antibiotics for 10 days. I am still in a ton of pain but I am trying my best to stick to the routine. While all of this is so much to handle, learning the he was up to 7 pounds as of his last appointment with the pediatrician on Wednesday is making me even more determined to keep this up.  

I never expected things to be easy, but I never expected them to be so difficult. If I could just put him to the breast like most other women do, things would be so much easier. I have to admit that I cave a few times a day. I end up crying my eyes out from a combination of no sleep and seeing how frustrated my son is, and all I want to do is to switch him to formula. It would just be so much easier. While I understand that many women opt for formula and their kids are just fine, I feel like I owe it to him to keep trying. I am working with a lactation consultant at my local hospital, who I go and see again tomorrow, and I am also considering hiring a private consultant but they are just so expensive. I am praying that this gets easier. I am hoping that once he gets a bit bigger that his mouth will be large enough to latch without the nipple shield although I am worried that he won't latch as he only knows how to eat with the shield. One day at a time I guess...

Tuesday, September 4, 2012

The Birth Story

 I apologize for the delay in sharing this. Motherhood has been keeping me quite busy. So without further ado, here is the birth story of Giovanni Luca... 

On Tuesday, August 21st, my husband and I arrived at the medical center at 7:30am for our induction. Going into this I did not know what to expect as the consensus was split whether I would deliver vaginally or have a c-section. I knew that it could potentially be a long process and that I would just need to go with the flow. Around 10am one of the residents came in to insert Cervidil as my cervix was still high, hard, and completely closed although I had been 100% effaced since 32 weeks. They told me that it was going to be 12 hours before they could remove it and assess my progress. Around 4pm the contractions started, and while they were between 4-5 minutes apart, I was having periods where they would just stop only to restart again, so we couldn't count them as "regular contractions". At this point I was still comfortable enough to move around so I decided that I wanted to get on the birthing ball. I can't even tell you how much this helped to ease the discomfort of the contractions. I stayed on the ball for a couple of hours and even fell asleep on it as I propped myself up on the bed using a bunch of pillows. At 10pm the doctor came in to check my progress. I was so excited to see how much I was dilated. Much to my disappointment I was only a fingertip dilated. I started crying as I was just so frustrated not to mention hungry as I couldn't eat after midnight the night before.

It was decided to attempt to place a balloon catheter in hopes that it would help to dilate my cervix. They gave me some pain meds and started to insert it. The doctor tried for a good 15 minutes to get it in but I just couldn't take the pain. Even though they couldn't leave it in place for more than 5 minutes, it managed to get my cervix to dilate 1-2cm. They then decided that we would start Pitocin in hopes that my body would respond. This was started around midnight. The Pitocin brought my contractions to 1-2 minutes apart but again I would be contracting consistently and then all of a sudden they would just stop for 5 or so minutes. After more pain meds and 7 hours, the doctor checked my cervix again. I was positive that we had made substantial progress but again to my disappointment I had only progressed to 2-3cm. Around 7am on the 22nd it was decided the next nest step was to break my water. For some reason I just didn't want to do this as I really wanted to wait for my MFM to stop in and see me as she would be making rounds within the hour. They really didn't want to wait but also gave me the option of getting an epidural and trying the balloon catheter again. All I could do was cry as I didn't know what to do. I was only 2-3cm so I didn't want the epidural as I was so afraid of being bed bound for a long period of time. Very reluctantly I agreed to have my water broken. I don't remember the exact time but the doctor came in with the little plastic hook that looked much like a knitting needle and broke my water. As soon as I felt the gush of fluid I knew that there was no turning back. I was an emotional mess as I was getting quite uncomfortable and the constant gushing of fluid was getting to me. I suddenly noticed that the contractions were intensifying and soon they became unbearable. Anesthesiology came in to talk to me about an epidural. They told me that it would help me to relax and labor conmfortably but I explained to them again that I was nervous about getting it so early as my cervix was minimally dialted. The anasthsiaologist was fine with me waiting. After he walked out of the room I only lasted another 20 minutes or so as the pain was to the point where I just wanted to die (and I was screaming) so at this point I didn't care. I let them start the epidural. I don't remember much about the epidural process except how hard it was to stay completely still during my contractions. The nurse that was there was absolutely amazing and really helped to make the process a little easier. I had noticed that they were taking a long time to get the epidural started so I started to become nervous. I don't remember their exact words but I was informed that they had "overshot" the needle and that caused a spinal fluid leak. I was told that there was a 1% chance of this happening but I was lucky enough to be that 1% I guess. Once the epidural kicked in I was able to lay back and relax. Soon after the epidural the doctor came in and asked when I had last been checked. I can't remember the exact amount of time but it was around an hour since the last cervix check. I wasn't expecting much at this point but when she said the words "you are fully dilated", I almost died. It was time to push!

Somewhere around 9am I started pushing. I couldn't really feel the contractions through the epidural so the nurses let me know when I was having one. I did a series of three pushes with each contraction. They told me to push as if I needed to poop. I don't mean to sound immature but pooping during labor was one of my biggest fears (and no I didn't poop). Since I knew that I had to effectively push to get this baby out, I just went with the flow...even though I kept asking if I pooped yet. About an hour into pushing I was starting to feel the contractions again so I was able to tell them when I needed to push. Around 10:30 I noticed the doctor get up and walk out only to come back with my MFM. I didn't think much of it until I heard someone say how low the baby's heart rate was dropping. I started to panic as I just wanted my little boy to be okay. At just about 10:45 everything changed. His heart rate had dropped into the 60's and it wasn't recovering. My MFM just kept telling me that I needed to push and that we had to get this bay out right away. They hooked up the vacuum to his head but it wasn't working. All they kept saying is that I couldn't stop pushing as they baby had to come out now. I was doing push after push with no breaks in between. I could feel every vessel in my face rupturing. I then felt my MFM stick her hand in me to grab the baby while continuing to try the suction. At this point I tore but I didn't care as I was just so scared that he wasn't going to make it. The resident that was assisting ended up needing to cut me further as my baby was struggling. With one final push at exactly 11am, Giovanni made his entrance into this world. I only got to look at him for a brief second as they whisked him away to be evaluated. All I kept asking was "is he okay" and no one would answer me. Things were quiet, too quiet. Finally, after what seemed like an eternity, I heard him cry. It was the most amazing sound in the world. I didn't know at this point if they had to resuscitate him but I knew that he was alive. I made my husband go and be with him in the next room as all I cared about was my new little man. Turns out, that despite his initial rocky start, my little man was just fine!

He was a perfect 6lbs. 12oz. and 19 inches long.

I am absolutely in love!

At this point I knew that he was safe and that my husband was with him. The doctor informed me that it was time to deliver the placenta. I didn't know much about this part except that I read that it was fairly easy and that most women don't remember doing this part as it is so insignificant. My story is quite the contrary as I will never forget what happened. I am not sure at what point the doctor told me to start pushing but I remember pushing for quite a while. I don't remember too much after this point as things got a little fuzzy. I remember the doctor saying that I needed to push and push now, in the same manner she spoke to me when Giovanni was stuck and his heart rate was declining. It was soon after this that my entire body started to shake, almost like I was convulsing yet I was conscious. I was completely shaking from the inside out and that is when the nurse put oxygen on me. The resident and my MFM kept looking at each other and shaking their heads and my MFM kept telling me that I needed to keep pushing and that I couldn't stop. I vaguely remember hearing that my body was retaining the placenta and that they needed to manually extract it. The baby nurse asked me if I wanted to hold Giovanni but I said that I couldn't as something was wrong. I felt hot, nauseous, and shaky. My husband took Giovanni and stood by my side. The look on his face said it all. I have no idea how long it took but eventually they got all of the placenta out. It had broken into pieces inside of me. I had lost a lot of blood. I had also learned at this time that not only did I have a 3rd degree tear, they also had to do an episiotomy as well and this required quite a few sutures. As soon as they were done suturing me up I quickly sat up and demanded water. I was still violently shaking. I am pretty sure that my body was in shock. Within 10 minutes I sucked down three large pitchers of water. I suddenly felt quite faint and the nurse then put the oxygen back on me. I was listening to the conversation between the resident and MFM and they were going back in forth about giving me Magnesium. I begged them not to do it. I remember the nurse walking over with a syringe and putting something into my IV. I am pretty sure that it was Ativan as I quickly became semi-unconsious. I only half remember this part but they ended up giving me Cytotec to make sure that all of the placenta was out and they also did an ultrasound.

Shortly after things calmed down, I remember waking up and seeing my husband holding my son. I had a son. Me. I was finally a mom! For the first time, I was able to hold him and all I could do is stare at him and cry. I was too weak to hold him by myself so my husband had to help me. I remember looking down at this tiny human and thinking about everything that I had been through. It was like a movie going at high speed. All of the losses, the failed IVFs, the surgeries, and all of the complications before and during this pregnancy. It was all over. I suddenly realized that the chapter the never seemed to end was finally over. All of the pain I endured, the heartache, and every tear I shed seemed so insignificant now. All that mattered at this exact moment was my perfect little son. I remember rubbing my cheek across his head and feeling his soft hair glide across my face. I remember the smell of his skin. I remember the sounds of his squeaks as he laid there in my arms. It's over. It was finally over.

The next couple of days were difficult due to the fact that they drew spinal fluid when the did my epidural. I ended up developing a horrific spinal headache and was unable to care for my son the day after birth. I ended up needing an emergency spinal blood patch which couldn't be done until Friday as they needed to wait 24 hours as they had already restarted my blood thinner. I also have quite the story to tell about my discharge and how it ultimately led to Giovanni being readmitted into the hospital 12 hours after discharge but I will save that for another post as I really want this post to be just about his birth.

In the end I am a mom and it is truly the most amazing feeling in the world. My son is perfect, my family is perfect, my life is perfect. I am now complete.