Cute Siblings

We're spending some time with parents while daddy's on a business trip. I'm behind on posting (again!) but with the newborn lifestyle, even when baby's sleeping there isn't much time for blogging.

So, for now, enjoy some new pictures. :)

While I'm still Brand New!

Miss Annika had her newborn photos taken today by our friend, Andrea, and we got some beautiful pictures of the sweetest newborn around (not that I'm biased or anything). It was a lot of fun to watch, and Andrea's so talented and captured a lot of great photo memories that really are so like our Anni.

Another "super-mom" plug, she did all of these with another 3 kids ages 4 and under in the house at the time. :) Here's a sampling of my favorites, Enjoy!

If you want to see more photos, I also posted them to my Facebook profile.

Birth Story

Today was (one of) my original due date with Annika. (Maybe TMI, but there was a 2-day discrepancy between the dates I had and the date my doctor went by, due to cycle length)

So, before I forget, I thought I'd mark this day with Miss Anni's birth story. :)

Where did we leave off? I think I'd updated on here once I'd been officially diagnosed with severe preeclampsia on Thursday, September 30. After initially deciding to hospitalize me for the duration of the pregnancy, my OB reconsidered and sent me home on strict bedrest, taking my blood pressure 3 times daily and coming into the hospital/clinic every other day for a non-stress test.

On Friday, Sue, James' mom drove down to stay with us for the next few days. Shortly after she got here, my blood pressure went up past the limits my doctor had given me, and we headed into labor and delivery. After being in triage for a couple of hours, having labs redrawn, etc. they decided it was just a fluke bump in BP and sent me back home. Saturday I was scheduled to have a NST at L&D which I went to as planned. During that visit I was on constant BP monitoring and the doctors decided the numbers were consistently higher than they wanted them to be, so I was put on a blood pressure lowering medication and sent home again. All went as planned, and in fact my pressure numbers did drop a bit after a couple of doses of the medication. We were settling in on Sunday for another week of bedrest, and even had a clinic visit scheduled for first-thing on Monday morning. Just before we headed to bed on Sunday night, I had my blood pressure checked again. It was high again, very high--148/98--and I called the on-call doctor as directed. She directed us to come in again and the plan was to hospitalize me at that point.

After arriving in triage at about 11pm, we realized it was a VERY busy night in L&D. The until was swamped and during the course of the night they were laboring not one, not two, but three mothers due to deliver twins! Needless to say, the pregnant lady not having contractions was a bit low on their priority list. We sat in the triage room for the next several hours--various residents, doctors, and lab techs were in and out. Labs were run again, and I was put on the monitors both to check on how baby was tolerating the high blood pressure and keeping tabs on my blood pressure. It dropped a bit again once I got into the hospital, but it still wasn't low.

Finally, the attending physician came in and conferenced with us. Even though I appeared to be stable at the time, she told us, she was recommending we proceed delivery of the baby--that night. After the roller coaster of the previous five days, it was not a shock, we had been anticipating the arrival of our baby sooner rather than later, yet we'd had the plans changed so many times it hardly seemed real.

It was now about 2am on Monday morning, and I'll be honest, I was quite nervous about beginning labor without any sleep. I was curious however to see what kind of progress my body had been making on its own, if any. I'd been having frequent Braxton-Hicks contractions during my whole third trimester and I was favorable for so long with Lydia I was hopeful that maybe we'd have some progress. Unfortunately, not so much this time. When checked after being admitted I was a fingertip dilated, not effaced, and very posterior. Great--not good conditions for beginning an induction five weeks early. At that point I was prepared for a long journey. My IV was started, and by 3:30am the resident had placed the cervical ripener, Cervadil, given to hopefully start the induction process. It takes 12 hours for the drug to work, so we were in a holding pattern until the next afternoon as long as my condition remained stable. Thankfully it did, but wow, that was a long 12 hours! Contractions, albeit mild ones, began almost as soon as they inserted the Cervadil. They were fairly regular at about 7 minutes apart and definitely noticeable, especially since I wasn't allowed to leave my bed except to use the restroom. I was again hopefully when the resident came in to check me that because I'd been able to feel the effects I would have made a lot of positive progress. And I'll tell you, it is a sad day when you're hoping someone will tell you it's time to start Pitocin!

During the 12 hours letting the Cervadil do its thing there was a change-over of the residents. I really liked the woman who was on during the night, I wasn't so much a fan of the daytime resident. There was nothing really WRONG with her per-say, we just didn't really click. She came in around 4pm to check me and pretty soon dashed my hopes of having a Monday baby. Per her exam I'd progressed to about 1cm, effaced to about 30%, and was still very posterior and high station. Needless to say, not the progress we were looking for. The resident tried to be empathetic, but I'm fairly certain she's never been a laboring woman herself. Her condolence: "don't get discouraged, cervical ripening can be a slow process, this might take days." Um yeah, thanks for that--very helpful! The only nice thing I can say about the woman was that when I complained that I was afraid that between no sleep and not eating since dinner on Sunday night that I'd have nothing left when it came time to really labor she shocked the whole room. She informed me that she always lets her cervical ripening patients eat--yep, not just jello or broth, but meals from the cafeteria. That information would have been nice to know all day, but I wasn't complaining, I just wanted my food STAT. Once she left the room the nurse brought me the menu and the phone and confided that she'd never seen a doctor let someone eat before, but by all means go ahead and get something. I still think that was perhaps what allowed me to get through the next 12 hours.

Anyway, back to the induction process, since the Cervadil had been so ineffective it was decided that we should try the other drug used for cervical ripening, Misoprostol. The best news about the new drug, it only takes 4 hours for each dose. It was about 4:30 or so when the new drug was placed. We went back to what we'd been doing all day, trying our best to rest. About 6pm, Sue brought Joshua and Lydia in to see us, it was nice to have them visit and helped take the strain of the process off a bit. I felt more relaxed and confident after their visit. At 7pm the staff changed out again, this time for the better. Not only was I assigned a nurse that I really clicked with, but the resident from the previous night was back on (someone I found out later is a good friend of one of my friends) and it was almost time to see what progress, if any I'd been making.

8pm arrived and with it good news. Not only had I made progress, I'd made good progress. Although I was still quite posterior and she was still very high, I was now dilated to 4cm and 60% effaced! The downside was that because she was ballotable (not fully engaged) rather than being able to break my water and let nature take its course, I would still have to be started on Pitocin.

In all fairness to Pitocin, I've never labored without it, so maybe it's just that labor is wicked, but Pitocin is evil stuff. My body does really weird things while on Pitocin. First of all, it doesn't seem to get the message that no matter if my body is making progress, it needs to show up on the monitor, or the staff will just keep cranking the levels. With Joshua the Pit level was so high that by the time my body got the message and contributed it's own labor I was hyper-contracting and he went into distress. For awhile with Lydia, even though I was feeling intense contractions, on the monitor they were showing up as negative (or dipping/inverted) contractions. This time was no different, though I could feel the intensity progressing the monitor was showing barely any contractions of significance. They got closer together, but to someone not experiencing them, they didn't appear to be actively making progress.

The rest of the evening passed as pleasantly as any labor can, I think. While uncomfortable, the contractions were still manageable, so we got comfy. In fact there was a period where the nurse, resident, and I were swapping birth stories. I gained new respect for the resident, who I discovered was a mother of four pre-school aged kids, the last of whom was born this spring in a flurry that the attending physician barely arrived in time for. The nurse and the doctor had working at each others deliveries, both earlier this year, so they were comfortable together. I was able to share that once things had gotten going both of my previous deliveries had gone FAST! Though it was just a conversation at the time, it turned out to be one of the most important bits of information I shared all night.

Monday crawled to an end, and I realized that all of my kids would be born on Tuesdays, and I was hopeful that they would all be born during the wee hours of the morning (Joshua was 3:08am, Lydia 12:29am) but I thought it was actually most likely that my doctor would deliver this baby as well sometime after she came on duty at 7am. I started feeling a lot of pressure around midnight, and while it didn't really feel like the pushing sensation I was familiar with, I asked to be checked. During the past four hours of being on ever-increasing doses of Pitocin I'd moved from 4cm to 5cm, but was unchanged other than that. At that point I realized it could still be a long process and I began to really think about my pain relief options.

I intended to get an epidural during the course of my labor with Joshua, but was barely dilated when I started discussing it with my nurses, and they convinced me to try a narcotic first. During the couple of hours the narcotic was in effect, I progressed VERY quickly, and by the time I was sure I couldn't tolerate the pain any longer I was 8.5cm dilated and being headed to the OR for a probable emergency C-section. (That didn't happen, but that's a story for another day.) With Lydia, when my induction began I was already 5cm dilated and 80% effaced. Because Lydia was also ballotable, I was on Pitocin for a few hours, but because I was able to be up and walking around I was able to get through the contractions. When I finally felt like it was time for some pain relief I was 9cm dilated and pushing just a few minutes later--too late again! So this time I wanted to be more intentional. After delivering two babies without an epidural, it wasn't that I thought I couldn't do it, it was just that I wasn't sure I wanted to. I also knew that things would probably go very quickly at the end, so I wanted a plan. I debated asking for the epidural back and forth, but finally settled on asking for a dose of narcotic pain relief. The plan was for me to get the narcotic right before my water was broken, and I figured it would be fully in effect during transition and pushing. Given my history, I was doubtful labor would last more than a couple of hours after my water was broken, so I'd have some relief, but not more than needed.

It was a nice plan in theory, however nothing over the past couple of weeks had gone as planned, so I'm not sure why I thought that would! After being checked at midnight, I was pretty much on my own through the next few hours. The nurse popped in and out, but I didn't see the doctor again. The contractions continued to intensify slowly, but nothing noteworthy seemed to be happening. I tried to rest as much as possible and James was dozing on the couch. The monitor continued to show only little blips of contractions and I'm sure everyone thought this would drag on for a very long time. I know I was starting to...

At 4:21am I had another contraction just like the hundreds I'd been having over the past 24 hours, except...during the peak of the contraction I felt something like a rubber-band popping internally. It happened twice and my contraction instantly intensified tenfold. I wondered if my water had broken (it had been broken by the doctor in both of my other labors), but there was no fluid gush, drip, or leak. Just the weird internal popping noises. I told James what had happened and went ahead and paged the nurse. During the next contraction my water began gushing. During the midst of that contraction a nurse I had never seen before walked into the room. She calmly informed me that I should get up and go to the bathroom and she'd change the bed. Um, yeah...about that, I was pretty sure I wasn't going anywhere. At this point the contractions were coming nearly one on top of the other and they were INTENSE. To her credit she seemed to figure that out pretty quickly and backpedaled on the request for me to get up, she just put new padding down. She was not, however, taking me seriously that this was going to happen fast. I requested a doctor so I could be checked, because I was pretty sure I was transitioning and was starting to get the urge to push.

Though there are some very great nurses, I'm always surprised that they seem to think they know better than the mom, especially if the mother has had a child before. When I told the nurse I was starting to feel like the baby was coming quickly, she told me that contractions always intensify right after water breaks, but they'd settle down and come more slowly after a few minutes. She was obviously not getting it! I asked for my doctor and my nurse again and was told my nurse was assisting with a delivery in the next room. At this point I knew whoever was there or not there this baby was coming SOON. My body was starting to push unbidden and I felt the incredible urge to join it. The nurse was still taking her sweet time until I mentioned that Lydia had been born 45 minutes after my water was broken. That got her into action, she then paged the doctors again and started trying to prevent me from pushing. She checked me and told me I wasn't complete. That was very concerning to her, much less so to me, I knew it was only a matter of minutes (seconds?) before I would be--but she was very insistent I couldn't push. Again, I always wonder, have you done this??? There's nothing else you can do when you get to that point. Finally after what seemed like hours, but was really only minutes the doctor and nurse arrived. The nurse kept protesting that I wasn't complete--the doctor re-checked and I was in fact complete. It all happened in a blur after that. I knew she was coming and I didn't think it would be long. I pushed a couple of times and then could feel she was crowning. The doctor was scrambling to get her second glove on while she was born. And then it was over. There hadn't been time to get the bed transformed, the doctor wasn't gowned up, and the attending didn't even make it into the room until after Annika had already arrived. The best part of the whole labor--no tears--what a great thing!!! :)

At 4:43, just 22 minutes after the first "popping" contraction, Annika Caroline joined our family. You all know the rest of the NICU story, it wasn't what we had hoped and planned for, but we survived it, and couldn't be more pleased to have Annika as part of our family. We are in love! Happy Due Date baby girl, I'm so glad you're here snuggling with me. :)

The Fog

Annika came home last Friday (10/22), so we've spent our last week in the fog that envelopes all households with a newborn. We've been keeping a low profile as Annika's immune system is very immature, she's had respiratory problems, and in general we've just been really tired!

Miss Annika is doing well, lots of sleeping, eating, and pooping. Mommy and Daddy have been getting all the snuggles we can while trying to keep the big brother and big sister entertained as well.

Friends near and far have been so helpful, and even though we received such an abundant supply of meals while we were making trips back and forth to the NICU, we've continued to have people offer to keep us well fed--what a blessing!

Our biggest struggle since bringing Annika home has been transitioning from the bottle to the breast, but after getting a nipple-shield yesterday and deciding to breastfeed exclusively for 2-3 days, I think we've made a breakthrough and it's been 24 hours since she's needed to take any of her feedings by bottle!

Hopefully the next post won't be so long in coming and will be filled with cute, snuggly, newborn photos...and of course trick-or-treating pics as well!

On the 12th Day in NICU...

My baby got to try...bottle feeding for the first time! :)

Annika continues to improve each day, slowly but surely. As of today, she's down to room air (21% oxygen) again, on 2.5L worth of air flow on the nasal cannula. She graduated yesterday to an open-top crib instead of the isolette and she's been maintaining her body temperature quite well. She is being given a 3-day course of Lasik (a diuretic to reduce water retention) to eliminate the extra fluid she has from being on IV's for 10 days. We can see the reduction in the puffiness in her face, but the main goal is actually to help reduce extra fluid retention in her lungs. It seems to be working well, as her respiration rate has come down steadily over the past couple of days and except for occasional "episodes" she's staying nicely in the optimal range (20-60 breaths per minute). Because of the reduced respiration rate and longer alert periods, she was allowed to try bottle feeding starting last night, and when we were visiting this morning, I got to give her a bottle! :)

To follow up on my last post, I'm sure most of you heard the update either in person, or via Facebook updates, but we learned on Monday (I think, it might have been Tuesday...my days are running together) that Annika had a probable case of pneumonia on top of the premature lung disease from being born at 35 weeks without any steroid lung maturation. Sunday was a rough day, but we actually didn't become aware of the condition until she was starting to make progress again. Honestly, as rough as last weekend was, we feel very blessed that my Group B strep status was unknown when labor began. What seemed like an unnecessary precaution at the time (I've been negative with both other kids, and was again this time we found out later) turned out to make a huge difference in Annika's life. If we had known that I was group B negative, they wouldn't have started her on antibiotics immediately following birth. Without the antibiotics, the pneumonia could potentially have been even more serious than it was, and Annika could have had an even rougher start than she did. Though the journey still seems far from over, we've already starting to see God's hand working throughout the situation. Though it would never have been what we would have chosen, we can still see how much worse things could have been and how God has been keeping us and our daughter safe when we could not have done anything to protect ourselves on our own.

I think the hardest part for me is still that we're just not sure how much longer she'll be in the NICU. She's making progress on all the goals she needs to be, but I think it'll probably still be a week or two before she's ready to join us at home. It's just a bit frustrating, because everyone says she's doing well, but no one is able to tell us how long the rest of her progress might take. She's really setting the pace right now, so it's just really up to her at this point. I definitely want her to be healthy and as ready as she needs to be before we bring her home, but it gets harder and harder to leave her as she's more aware of our presence and also as we're able to do more and more for her. At the beginning it was obvious we couldn't care for her in the medical condition she was in, but now it seems like almost everything she needs we could do at home with the right equipment. However, they have protocol and so she'll continue teaching mommy a lesson in patience.

We finally got pictures of our whole family together (aren't the kiddos all just too cute?) and I just am so excited to think about our little family returning to "normal" though it may be awhile before that actually happens. In the meantime we'll treasure the time we get to spend with her and rejoice in each step she takes toward coming home!

Week 1

Well, I feel significantly better this Monday morning than I did last Monday at this time. I can't ever say I enjoy any part of labor, other than when it's over. However, I absolutely cannot believe my baby girl is one week old tonight. I don't think it's possible for someone to work herself more into my heart than Annika has this week. Not being able to hold her is incredibly difficult, as it feels like there's not any way to let her know how much I love her without doing so.

I apologize in advance, this may be a bit all over the place.

The first week has been rough, I never imagined this would be as hard as it has been. In fact, before last week, I guess I really never imagined the NICU being part of my story ever. Your entire perspective on everything changes instantly. Leaving the hospital without your baby is something no parent should have to do. I think perhaps I was even more poorly prepared, because while I knew that at 35 weeks she would likely have to stay, I saw it as more of a speed bump than a long term stay. After a week, I don't really know what to believe.

Annika is stable for now. She's still on the ventilator, which she's been on since Thursday morning. They've been able to adjust her settings lower over the past few days, but I haven't really heard talk of trying to take her off it for the past couple of days. I think it's mostly due to the fact that while she's holding pretty steady, she's not really making the forward progress the neonatologists would expect for someone of her gestational age and size. Though she doesn't seem to be in pain, she's fairly lethargic most of the time, and they feel like she's "sick." What they haven't figured out is if it's just the trouble breathing that's tiring her, or if she has some sort of bug that they haven't identified.

Yesterday we were there when they rounded, and the one neonatologist in particular seemed fairly puzzled and concerned. She was not re-assuring to a mother's heart. Their biggest concern is that they would expect a baby of her age to have started producing her own surfactant within the first 1-3 days following birth, and there's no indication that she's done so. Her chest x-ray is still very cloudy, she's still taking too many breaths per minute, which is making her oxygen usage ineffective on her own, and is working to hard to breathe. As a result they've started to investigate if there are other structural issues putting more stress on her lungs. Annika had an EKG yesterday, which didn't really turn up anything explanatory or terribly concerning. She has a few small, very common holes in her heart, but according to the cardiologist almost any baby would have visible holes at this age, just most aren't given an EKG because they close on their own in the first few months following birth anyway.

Today she has tests for liver functionality due to some bilirubin numbers that are atypical, and she'll also have another blood draw to see if she's still has elevated levels of antibodies that are usually indicative of infection. I never thought I'd be hopeful that my child had an infection, and it still concerns me, but if she has a bug that she's not getting antibiotics for, it might be a quick and "easy" solution.

The unknown is what's so difficult for me right now. If someone could tell me that she'll be fine and give me a timeline for when she's coming home, I feel like I could deal with it, somewhat regardless of when it might be. I've already mentally extended my "2 weeks at most" perspective I had before and during her birth. I'm trying to prepare myself for a long road.

Unfortunately, I'm also concerned about the doctor's concern. I don't know about all moms, but I can imagine all sorts of terrible outcomes. I know the statistics on 35 week preemies says they almost all do just fine, but yet all of us know that there are always exceptions to statistics and there's not a worse fear as a parent than the thought of losing your child.

We're trying to take things one day at a time, stay present for our kids at home, and make time for each other, but many times it seems that there's just too much uncertainty to find any "normal" in this stage.

We still cannot thank everyone enough for continued concern and support: calls, meals, offers to help with kids, and asking about how Annika is doing. Thanks for loving our daughter with us, even though most of you haven't yet met her. Thanks for loving us well too! Hopefully the next update can be more encouraging.

Welcome Baby Girl!

As nearly all of you have probably heard, we had our baby girl this past Tuesday. Annika Caroline made her (fast) entrance into the world at 4:43am, and weighed in at 4lbs, 13oz while stretching out to 18."

Though she did make it to 35 weeks gestational age, her lungs are not fully developed. So, the past several days have been a roller coaster ride of adjusting to being a NICU-parent. We're not sure how long this road will take. For the first three days it seemed that we were only moving backwards, with Annika ending up on a ventilator by Thursday morning. She's been holding steady since and today she's actually been making forward progress going down in both oxygen percentage and number of breaths the vent is taking for her. We're hoping that she'll continue to make forward progress, but no one can really tell us when or how that may happen. The kids are both thrilled to have a little sister, but a bit confused as to why they're not able to hold her much (they've both gotten to do so once before she was vented) or play with her, or have her live here at our house. All in all they're doing OK.

Her bilirubin levels rose steadily over the first few days, but she started to poop yesterday, and the levels were down today, so she's only on a bili-light now, and was able to retire the bili-blanket. Even though she hasn't been able to work on eating yet, she's receiving intravenous nutrition, and after initial weight loss, she's picked back up a couple of ounces over the past two days, so we're hopeful her weight is on the way up for good.

So, we're taking things one day at a time and hoping and praying she'll be able to join our family at home as soon as possible. Leaving her behind when I checked out of the hospital was one of the hardest things I've ever done in my life, for sure the hardest thing as a mom!

Thanks for everyone who has prayed for us and Annika, brought us food, called, taken care of the kids, or supported us in so many other ways, we couldn't have made it through this past week without it!