Sweet V is here!

TL;DR Miss V was born Saturday, October 11, 2014 at 3:40 AM. She weight 8 lb 6 oz and was 20 inches long. She was born vaginally without complications.

I was hesitant to share the birth story here because I'm pretty much the only person on Earth who cares. I mean, V doesn't even care and it's her birth story. But I decided to do it anyway because like most people, I had a well-established idea of how birth was supposed to go and, obviously, it did not go that way - close, but not quite. And therefore I'm beginning to think that it's important to share birth stories - real birth stories - to help encourage flexibility and realistic expectations. Birth will probably not go as planned, and that's okay.

Disclaimer: I work in the medical field so I'm not super sensitive to what information might be regarded as too much information. Read at your own risk.

On Thursday, October 9th, at 40 weeks, 2 days pregnant, I had an appointment with my OB. Since I had gone beyond my due date I decided to ask her how she felt about stripping membranes (where the clinician applies gentle pressure to the bag of water to help stimulate uterine contractions). Since the cervix was favorable (2 cm and 80% effaced), she thought it was a good idea, with the condition that if I did go into labor, I didn't tell the OB on call that she did it (apparently, ushering patients into labor when one is not on-call is generally frowned upon). If you're ever considering having this done, there's some scary stuff out there on the interwebs about how painful it is etc. etc. but I did not find this to be the case. Uncomfortable yes, painful no. That part comes later.

Around 11 PM that evening, contractions started. They were irregular at first, but settled into a pattern (about every 6-7 minutes) around 3:00 AM Friday morning. Here's where my sleeping stopped.

Contractions continued to the point where OMP decided to take the day off from work. Unfortunately, they began to slow down. I called my sister-in-law (a labor and delivery nurse), who recommended walking to keep things going. So walk we did. We went on a nice little hike on a nearby nature preserve, stopping every so often so that I could hunch over for a contraction. People totally were not looking at us funny.

Her advice worked, and by 2 PM contractions were regular and getting closer together. Other labor signs happened (I'll spare you), and around 5 PM things were regular and strong enough that I called my OB, and was told to come in.

5 PM on a Friday. In a major metropolitan area. Yeah.

So after 30 minutes of traffic, some aggressive driving, and several obscenities, we arrived in antepartum. They tell you to fill out the paperwork ahead of time, which I did, but I somehow still had a ton of paperwork to fill out when we arrived. Which is super fun at all times but especially when your uterus is doing the equivalent of the strongest man in the world competition.

We adored all but two of the staff members at the hospital. One was the records person (I'll talk about her at some point...), and the other was the antepartum nurse. She wasn't awful, per se, but I got the feeling that she didn't believe that I was in labor. She acted like she was doing me a huge favor. She hooked us up to a NST and monitored for a while before she came in to check my cervix. Except when she went to do so, my water broke. Told you I was in labor. V showed her what's up.

Unfortunately, I now found myself with my water broken, awaiting an epidural on the Friday before a Holiday weekend, which means higher than normal amount of patients are in L&D for scheduled C-sections. The antepartum nurse asked me if I wanted an epidural and mentioned that it might be a bit of a wait because anesthesia was really busy at the moment. Oh yeah, and contractions might be a little bit worse now that the water is broken. Understatement of the century.

Cue horrifyingly bad contractions that were basically constant. OMP stayed with me for a while, but eventually had to run out to the car to get the overnight bags. While he was gone, every important person decided to come into the antepartum room and talk to me. So here I am, basically unable to think, blindly handing my birth plan to the OB on call and trying to figure out what my L&D nurse wanted me to do with the piece of mesh she was handing me (spoiler alert, its underwear). Good news! A room had opened up! She said something about a wheelchair but I was already on my feet, backside exposed to the world (those gowns really are horrible...), walking down the corridor mid-contraction, my nurse chasing after me.

All together it was about 2 hours before I could get the epidural. The anesthesiologist was amazing. My nurse was amazing. Epidurals are amazing. After having one, it is beyond me why someone would refuse it, but if you do, I give you all the credit in the world. Labor sucks.

It was smooth-sailing after that. My new nurse came in and said that she was going to let me labor down as much as possible to hopefully minimize pushing time and risk of tearing. Based on my pain, they were a little concerned that the baby might be occiput-posterior (aka sunny side up, aka bad), so they gave me a special pillow to help encourage her to descend the right way. Basically, my nurse was everything my sister-in-law told me to look for, so I was pumped.

A few things happened here that I was not expecting. First off, I had the shakes like crazy. I guess its common with and without epidurals because your body is under so much stress, even though you can't feel the pain. I slept off and on but the shaking kept waking me up. Eventually, I started to feel nauseated. I mentioned this to the nurse, who immediately ran and grabbed an emesis bag. "Oh I don't think I'll need tha-" aaand vomit. Again, stress. Basically your body is being beat to a pulp but you're unable to feel any pain. It's the weirdest sensation.

Also, my left leg went completely numb, despite the nurse coming to turn me frequently. It stayed that way until sometime the next day. I knew I could move it, but it's so hard to do that without being able to feel it. This provided a good deal of comic relief at various points in the labor process.

Finally, the nurse checked me. Baby was in a good position and it was time to start pushing. OMP was somewhat surprised to be handed my leg, but he made for a great coach. I pushed for about 30 minutes and the nurse went to grab the doctor.

The doctor thought she was just coming for a "pushing check," but when she saw me she immediately gowned up. I pushed once with her in the room and was reassured that we were almost done!

Except...baby started showing some signs of stress (heart deceleration's while I was pushing). I pushed again and I saw a concerned look in the doctor's eyes. Likely cord compression, she thought. She knew that she had agreed to try to avoid an episiotomy (Oh yeah! one of the things I had written on my birth plan! I had forgotten about that...) but she was concerned about the baby and really wanted to get her out ASAP. Was I okay with it? Um...yeah, please do what you need to do to make sure she is safe! At that point I didn't care about anything, just that baby came out and was okay.

I didn't even feel the incision, pushed one more time, and BAM, Sweet V came into the world. The cord was only loosely around her neck, so the doctor was able to easily slide it off. We did skin-to-skin and waited for the cord to stop pulsing (hey! there's something from my birth plan) and basically, I died from love.

My folks had been in the waiting room since midnight, and were happily rewarded by being V's first visitors. My sister-in-law (who lives in a different time zone) got to Skype in and listen to me rave about all the great advice she gave.

And then finally, we all got to go to sleep. The next morning would bring more visitors, and eventually, we were able to bring her home.

As mentioned earlier in this blog, V did have a soft marker for chromosomal abnormalities. All of her testing came back perfect. Even her blood type came back to be A- (mine is also A-, so no Rhogam follow-up). In fact, when we did bring her home I had a full-on ugly cry when I realized how healthy and perfect she was and is. Of course we would have loved her regardless of her number of chromosomes, but in the moment I felt so blessed to have a healthy baby.

My recovery has been pretty good. I had a few complications post-partum. I had really heavy bleeding that required pitocin (the only pitocin I received), Cytotec, and some fluids, and they monitored me pretty closely for a while. I also had the episiotomy, which is still in the process of healing. But generally, I can't complain. I continue to feel like I did in the L&D room: I have a healthy baby, so whatever happens to me happens to me.

I am breastfeeding, but that is an entire post in itself! For now I will say that it was more challenging than expected, but we're starting to get to the payoff now.

...now being a full month later! That's right folks. IOU two follow-up posts, one about the challenges of breastfeeding and one all about V! But another time!

Showering Sweet V

Baby showers are not my strong suit. I have a tendency to be pretty socially awkward, and I have a difficult time in situations that require things like grace and good etiquette. If you're reading this and are thinking "No way, Erica, you're great in situations like that," then chalk that up to some serious acting. If you're reading this and saying "Yup. That is totally you," then ummm...you're right.

So when my parents offered to throw me a baby shower, and asked for my input, my only feedback was that I wanted it to be as comfortable as possible. Like a Barbecue. Everyone loves Barbecues. Even socially awkward people like myself.

Per usual, they absolutely knocked it out of the park. Sweet V's BaByQ was a huge success. OMP and I feel so blessed to be surrounded by such amazing friends and family.

Bocce, Build-a-Babykirk, and Baby Gift Bingo were all big hits. And OMP chipped in by making the favors - Sweet V's BaByQ sauce!

And I was struck by the sheer number of babies that were present. We're so excited to be bringing V into this group!

Any gal would count herself lucky to have such an amazing party thrown in her honor. But I was blessed by not just one, but TWO amazing baby showers, thanks to the sneaky girls at work!

Our Head Nurse sent out a message at the start of the week saying that we were overdue for a staff meeting and would need to stay late Wendesday night. Wednesday came and it was totally stressful. I had a complex patient at the end of the day and was beyond frustrated to have to stay late. Until I walked in the door...

And saw all this...

I was so overwhelmed with emotion. To say that I was surprised is an understatement. I am so lucky to work with such an amazing group of ladies!

Needless to say, V hasn't even arrived yet, and she is already so loved. I can't wait for her to meet all of these amazing people who have already given her so much!

Case Study: Babykirk and her Echogenic Focus

Ok guise. Let's talk about the baby.

Fun stuff first. OMP and I are thrilled to announce that Babykirk is a girl!

The Money Shot

Initially OMP had his fingers crossed for a boy, but now that the results are in, I think he's more excited than I am. When he was 13-years-old, his little sister was born. He's starting to relive the memories he has of her as a baby, and is getting more and more excited for this little one to make her debut.

Now to the nuts and bolts...

At our 12-week visit, OMP and I elected to have the Integrated Screen. This is a multi-part screening tool (blood tests as well as ultrasound measurements) to help to determine the relative risk of trisomy and other fetal problems. Our results were excellent. The genetic counselor estimated our risk of trisomy as being less than 1 in 50,000.

Our 18-week ultrasound, in addition to revealing Babykirk's...um...ladyhood, looked promising as well. All of the fetal measurements came back as normal. Ten fingers, ten toes, one magnificently beating heart.

Or so we thought.

A few days later, I got a call from my OB's office. The radiologist had reviewed the ultrasound images and found something known as an Echogenic Focus on Baby's heart. I wasn't to worry, but they did want me to come in for a Level 2 ultrasound ASAP.

Um. Panic.

Since I work in Pediatrics, I was vaguely familiar with Echogenic Foci and the significance of finding them on a fetal ultrasound. Basically, I knew two things:
1. It's not normal.
2. It's a "soft marker" that is associated with an elevated risk of trisomy, notably Down Syndrome.

Image from http://www.medscape.com/viewarticle/518149_6

I spent the next several hours voraciously researching Echogenic Foci and their exact significance. Luckily, I was somewhat comforted by what I read. Echogenic Foci themselves are harmless (our radiologist would later compare them to a "freckle" on the heart). They usually indicate a slight calcium build-up within the heart muscles. They are not associated with any cardiac problems - short- or longterm. They are only concerning because they seem to be more common in children with chromosomal abnormalities.

How much more common? The literature was vague. The general consensus is that although Echogenic Foci can be a normal finding, they can effectively double an individual's chances of having a chromosomal abnormality. Baby's initial chances? Less than 1 in 50,000. That means, at worst, the Focus increased those odds to less than 25,000, which is still pretty good.

So OMP and I went into the Level 2 ultrasound being cautiously optimistic. We prayed a lot. We asked friends and family to pray.

--- Just to pause for a second ---

If someone happens to stumble upon this blog because they've recently learned that their little one has an Echogenic Focus, first of all let me say that I'm sorry that you're dealing with this. I can honestly say that there is nothing more terrifying than thinking that something might be wrong with your baby.

That being said, I'll remind you that this is just our story. It's ongoing. We still don't know how it will end. But I do hope that our anecdotal journey can be a comfort to you while you're weighing your options. We are still weighing them. We are still praying, trying to trust God, and are still hoping for the best.

--- Let's continue ---

First of all, our radiologist was awesome. She had that "I'm obviously the best doctor in the world and know everything" vibe which is exactly what you want in a situation like ours. The focus was still there, she showed it to us on the monitor. She began by saying that her eldest son had an echogenic focus on his fetal ultrasound. She says that she considers it a relatively normal finding, and that in certain populations it can occur in almost 40% of individuals. She told us that the focus itself was not a problem, and made the comment about it being similar to a freckle.

We were worried that the focus would double our chances. She disagreed. Given that every other screening test and "soft marker" was normal, she felt that it in no way affected our odds. In her words "you don't have a bad option here." She did not feel that further testing was strictly necessary. However, we had her blessing if we did want to pursue further testing like a cfDNA test or an amnio. It was up to us, but if it were her, she wouldn't worry about it. Actually, she kind of gave us the impression that she didn't know why we were there.

As of right now, we've done nothing, except maybe stop worrying. We did briefly consider cfDNA testing, and I might discuss it with my OB at my upcoming visit, but generally we feel very reassured. We've acknowledged that it's a possibility and have emotionally dealt with that. We plan to continue to pray (and would ask you to as well!), but otherwise, we're letting it ride. There's already so much love for this baby and, quite frankly, we're feeling pretty blessed.

Anyway, more to come on Babykirk's Echogenic Focus. As for now, on to more important things, like trying to find some baby-sized hot pink hiking boots...

Ovia Pregnancy: App Review.

Two posts, one day, ftw.

After scheduling my first appointment with my OB, I decided to download some pregnancy-related apps. I was looking for an app that would let me keep track of symptoms, check in on Babykirk's progress, and allow me to look up foods/medicines that might be unsafe.

I started out with "The Bump," because I had used its sister site "The Knot" for wedding-planning and really liked it. The best thing about The Bump - something that I was not initially looking for - is it gives you access to something called a Birth Club - a forum with all the other Moms-to-be who are due in the same month as you. Since I'm still in the "don't tell anyone!" stage of pregnancy, I've found it to be surprisingly comforting. Also, the "Your baby is the size of a..." section is pretty cute.

That being said, the app is otherwise pretty useless. Even their checklists are kind of stupid. Some are useful, like "Schedule your first ultrasound," but "Give yourself some 'Me' time?" Gross.

I tried a couple other "Can I eat this?" apps, but I didn't find anything worth keeping.

But today, a fellow Bump member recommended the Ovia Pregnancy App. If you find yourself looking for a pregnancy app that is comprehensive, cleanly designed, and easy-to-use, then look no further.

The front page presents a quick overview of your pregnancy to-date; complete with trimester, week counter, illustration of size of baby, and illustration of size of baby's handprint (awww).

Below that, it gives you a live feed of your "data." By clicking the "Add Data" button you can include updates on your weight, exercise, sleep, nutrition, symptoms, medications, and even blood pressure. Further along, you can also utilize a kick counter and a contraction timer (so cool). It allows you to set goals in all of these categories and gives you little updates (and recognition!) as you accomplish them

Also included in your feed are relevant articles and information about pregnancy and parenting. And...drumroll please...

Ya. It's basically like the holy grail of pregnancy info. The Food Safety Lookup has just about every food you can image, and allows you to search, rather than browse (good for very hungry pregnant women rummaging through the fridge at midnight). Pregnancy week-by-week provides enough information without being "too much." And Symptoms Lookup explains what the symptom is, whether or not it's expected, why it occurs, and what you can do about it.

Overall, I give the App 5 stars...or thumbs up...I don't know, I don't exactly have a functional rating system. I like it. You should use it.

** I also looked into "I'm Expecting," by Medline, "What to Expect," and "Sprout," by American Baby. They were pretty good, but not as comprehensive as Ovia.

The Drink

I'm a coffee person. I have often said that my blood type is Venti Bold. If you want a break down on why coffee is the greatest thing in the world, check out ilovecoffee or talk to my husband for more than five minutes.

Now that BabyKirk™ has come along, I've been doing some research into the effects of coffee on fetal development. Coffee is one of the few million things that you are not allowed to consume during pregnancy, because of course you and the baby will spontaneously combust and THE ENTIRE WORLD WILL END.

Coffee is an especially tough one for me because it has become so much more than a drink. It's actually a pretty significant part of my life. My morning routine legit doesn't exist unless I get a cup of coffee. At work, I perk up at just the though of my mid-morning joe. If I work nights, a quick stop at Starbucks is what gets me through the second half of my shift. So if this was something that had to go, I wanted to be sure that it really had to go.

I started out by browsing UpToDate. If you're not familiar with it, it's basically like medical Wikipedia. Really awesome, well-written, and well-researched medical Wikipedia. Subscribers only (sorry guys), it presents the lastest data on a variety of medical conditions, diagnostics, and treatments.

I expected to troll around for a while and maybe come across a link or two to some interesting studies on the topic, but to my surprise and delight, I stumbled upon a very comprehensive literature review titled "The Effects of Caffeine on Reproductive Outcomes in Women." Jackpot.

Turns off that coffee turns so many heads in the scientific world because of how accessible it is to the developing fetus:

Maternal caffeine metabolism declines significantly during pregnancy; the half life increases three-fold in the third trimester, reaching a t_1/2 of 11.5 to 18 hours. The fetus metabolizes caffeine very slowly, mainly due to immaturity of caffeine-metabolizing hepatic microsome enzymes and lack of CYP 1A2 activity in the placenta. Therefore, even low maternal caffeine consumption can be expected to lead to prolonged fetal caffeine exposure, particularly when the mother is a genetically slow caffeine metabolizer.  (Nisenblat, V, Norman, R, 2013).

This sounds exceptionally terrifying at first read, but the review goes on to explain that, despite the ready absorption, the effect of caffeine on the developing fetus is largely unknown. There is precious little literature on the effects of caffeine on human subjects, and the literature that does exist is of poor quality. Furthermore, there are a large amount of cofounders that have made studying the effects of caffeine difficult, most notably that the only women who consume large amounts of caffeine during pregnancy nowadays are typically doing other not-so-great things - like smoking, drinking, not accessing prenatal care - at the same time.

Poor evidence aside, the review did examine the effects of caffeine on a variety of reproductive outcomes. Here's the rundown:

1. Probability of conception (fecundability): Inconclusive, caution advised
2. Spontaneous abortion: More likely with >300 mg per day
3. Congenital anomalies: More likely with >300mg per day
4. Fetal Growth Restriction: Some good evidence that caffeine intake is associated with fetal growth restriction, but the range of concern varies between 200mg and 600mg
5. Preterm delivery: No significant association
6. Gestational Diabetes: Unclear (actually some studies showed that it was beneficial!)
7. Gestational Hypertension: Slightly increased risk, but no increased risk of preeclampsia
8. Post-partum depression and long-term effects on infant psychology: No significant association

Upon review, I feel that there is good reason to be cautious with caffeine intake during pregnancy. Given the outcomes, the most sensitive period (like everything in pregnancy) appears to be in the first trimester. After some consideration, my plan is to avoid caffeine entirely for the first twelve weeks. And then after, limit myself to <300mg daily. Although given the amount of caffeine typically found at your average Starbucks, that might be pretty difficult.

source: Huffington Post

Who knows? Maybe I'll start to like this whole decaffeinated tea thing.

Probably not.

**

Nisenblat, V., Norman, R. "The Effects of Caffeine on Reproductive Outcomes in Women." UpToDate. September 11, 2013. Published by UpToDate Inc. [0503-50.169.70.108-4E541A501A-6.14-178603391]