blank'/> A LITTLE BIT OF LACQUER: November 2013

November 12, 2013


Hey ya'll! Just a quick post to say I need to take a quick blogging break! My Step 2 CK exam (for our medical licensing boards) is in exactly 2 weeks and I'm slightly freaking out. Just slightly. As much as newborn babies are supposed to sleep Liv isn't a fan of it so I don't feel like I've had nearly enough time to study... when she does sleep I use that time for basic humanly needs like emptying my bladder and napping myself, but for these next two weeks, nothing but Qbank (practice questions)! All about priorities ladies and gents... hope you guys understand! Be back soon! 

November 6, 2013

Night Out in Camo

Hi all! Just sharing a simple night out look from when N and I went dancing a couple weekends ago! These (crappy) pics were taken as soon as we got back to our apartment... my hair is messed up, I'm missing an earring, and N clearly couldn't focus the camera... all signs point to a great night out!

November 4, 2013

Liv's Birth Story

Happy Monday everyone!! A shiny new week to get things off on the right start. Can you tell I did? I finally was able to go the gym this morning and feel like a new woman! My OB finally gave me the ok to get back to heavy lifting, so that's just what I did in the gym! It took a while because Liv's delivery was not the smoothest of deliveries and holy hell did my body take a beating. I actually thought that for this edition of Med School Mondays, I'd share with you all Liv's birth story, from a medical perspective. I know a lot of you are interested in OB and neonatology so hopefully you'll enjoy the read, and for those of you not I hope you'll enjoy anyway! {I also warn you that this is sort of long as far as my posts go, if you just want pictures, scroll down to the bottom!}

I got home from work Friday feeling great - I was still walking to and from work everyday even at 39 weeks - and this day was no different. I didn't, however feel like going out like N and I had originally planned. Instead, we ordered pizza, cuddled on the couch, and watched movies, who knows when we actually fell asleep. At 4am I awoke to pretty strong contractions. I tried to go back to sleep figuring they'd subside, but they continued getting stronger. By 6am I gave up on going back to sleep and got in the shower, washing my hair and just letting the hot water hit my back, which seemed to be bearing the brunt of the contractions. I walked around the apartment letting my hair air dry, and decided that this was the real thing, so I definitely needed to do my hair ;) I also knew I shouldn't call my midwife yet - she was only going to tell me to walk around and continue laboring at home which is what we tell all of our patients. I woke N up around 7 and he started actually timing contractions for me as I straightened my hair in between contractions. They were already lasting almost a minute at this point and coming every 2-3 minutes (aka the real deal). For the bad contractions I just had to curl up completely bent over on the bed with N rubbing my back, for the really bad contractions I had to run to the toilet and vomit the pain was so intense. By 9 I had had enough and N called the midwife. I made him call a cab first because regardless of what she said I was in labor and going to the hospital (it was the pain talking). By the time she called us back I was already right outside of the hospital, and she was about to tell me to "wait it out"- I had to break it down for her that I had most definitely waited it out and was at the hospital - she had me come right up.

Waiting at OB triage was surreal - N and I had both done our OB rotations at the hospital I was delivering at and it was so weird to be on the other side. I wanted to use my I.D. and just let myself in, hook myself up to the toco (the tocometer, which measures contractions and fetal heartbeat), you get the idea. When they took me into a triage room I politely waited for the nurse to ask me questions before I answered (in between contractions of course), instead of being the med student douchebag who rattles off the whole history because we already know what they're going to ask. I did have to laugh though when she looked at the tocometer and remarked "wow, you're having real contractions!" "Uh, yeah... I know" was what I really wanted to say. My midwife came and checked me and I was 4cm dilated, which was quite the change because less than a week earlier I had a cervical exam in the office and I was still zero and floating (meaning my cervix had not dilated at all and the baby's head was not yet engaged and still "floating" up higher). Instead of sending me home (which we do to a lot of women who are still in early labor), I got a labor room ASAP.

I was completely open to an epidural all my pregnancy. If you learn anything working on the OB wards it's that birth plans are silly (and I mean no offense, having a general idea of the way you want things to go is great, but they rarely go as planned and that's no reason to get upset) and there are a million primips (women having their first baby) trying to go au natural, a very large proportion of whom ask for the epidural eventually. I have so much respect for the women who do do it naturally, but just as much respect goes out to the women who do it at all. I definitely wanted to see how much my body could take, but was not at all against a little pain relief. I got my room around 10am, asked for the epidural around noonish, and got it around 1pm, which was really fun. The most painful part is the burning of the local anesthetic they use to numb the area, and then of course the fact that you need to remain completely still with an arched back as you're still being hit with contraction after contraction. I'm pretty petite as you may have observed, and apparently have very tight ligaments, so after attempting to place the epidural in the normal space, she had to remove the needle and place it one space higher. Another injection of local anesthetic and another insertion of the huge needle and we were set to go.

I finally started getting some pain relief and was actually able to chat with N, we called our parents so they could come, and watched some college football. I felt something weird down there and was really hoping I hadn't wet myself now that everything was pretty much numb - we had the nurse check and it was my mucus plug (ewww),  and shortly after at 2:30 I SROM'd (aka - spontaneous rupture of membranes, meaning my water broke on its own). My midwife checked me again but I was only 6 cm. So we hung out some more, watched some Scandal on the laptop. My contractions hadn't decreased in intensity, frequency, or duration since the epidural (which is sometimes a concern) so there was no need to add pit (pitocin, an artificial oxytocin that stimulates stronger contractions). Around 7pm I got checked again, this time by the new midwife who had just come on. I was 8 cm, but she thought baby's head might be in the OP position (meaning occiput posterior, so the back of her head was against my back and her face was up - which is the wrong way - we prefer to deliver babies in the OA, or occiput anterior, position). This explains why I was feeling most of my contractions in my back (aka back labor) - it also could have explained why things were progressing pretty slowly. So out came the bean. This is a huge balance ball like blow up that's shaped like a bean and wedges in between your legs while you lie on your side in an effort to spin the baby OA. By 10pm I was 9cm and baby was developing some caput (caput succedaneum, or swelling of her scalp), but I still wasn't 100% effaced. So we waited some more. By this time both of our moms were with us so we chatted and I dozed off here and there before the pushing had to start.

Finally around midnight I got checked again and it was time to push! We sent moms out and into the waiting room and the nurse and midwife got their waterproof gear on (it's really so that things are "sterile," but I'm convinced that its bodily fluid protection is wherein lies its real value). N and I had made a conscious effort all throughout my pregnancy to cut back on our cursing but I couldn't help but hype myself up in my head with a quiet "LET'S DO THIS SHIT!" With each contraction I pushed as long and hard as I could, and I kept doing this, until we realized we had been doing it for three hours. Towards the end of that three hours I had spiked a fever which granted me a diagnosis of chorioamnionitis (most often associated with a prolonged labor, which I guess I was having seeing as we were already on hour 24), and most concerning was that we were starting to see some late decels in baby girl's heart rate (decelerations are just slowing of heart rate - early decels are usually due to head compression which is normal, variable decels are usually due to cord compression and can be alleviated with change in maternal position, but late decels are due to fetal hypoxia which is never a good thing.) Antibiotics were hung and the OB was called because this definitely wasn't good. The OB came, saw the tracing, and immediately said "We're going to give this 3 tries with vacuum assist, but if that doesn't work we're doing an emergency c-section." I loved her no-nonsense approach and N and I totally knew this was where we were headed after seeing that tracing. She got the vaccuum, I pushed my hardest, and we could tell her head was going to come out, except it couldn't, I was likely going to tear, so instead she cut the biggest episiotomy I had ever seen (well, N had ever seen, thankfully I didn't have to watch that part), and with the next push we had a head. But then baby girl seemed stuck, and now we had a shoulder dystocia. They were amazing and did a quick McRobert's and applied suprapubic pressure (meaning they hyperflexed my legs practically up to my neck and pretty much sat on top of my pubic bone), and with the OB pulling and me pushing she finally came out. But there was no cry, and she was blue as can be, and my feeling of joy and relief for getting her out quickly dropped to utter terror. They suctioned her and rubbed her off on my chest as I cried and prayed that this little girl would actually be mine, and then she cried, and then I really cried, and felt my fears melting away with each one of her little shrieks. She pinkened up, the neonatologists took a look at her, and her and daddy headed off to the NICU so she could get prophylactic antibiotics given my chorioamnionitis. My placenta delivered with no difficulty, they repaired my episiotomy and cleaned me up, and I got to hang out with my moms until they brought baby girl back down. They eventually rolled her back in a few hours later, daddy strolling in like the man with his little pride and joy, and all three of us, for the first time as a family, got wheeled off to the elevator to head up to my recovery room. I felt like it was our little victory march. Little did I know we'd still have to battle my bladder not wanting to work (I had to stay an extra day or risk leaving with a foley catheter because I simply could not pee, a condition know as postpartum urinary retention, which added up to lots of painful straight cathing), but I made myself pee and got out of there darnit!

During our OB rotation I'd always ask the OB mommas how their labors and deliveries went, and there were always complications. They joked that it was the OB gods making sure they really knew all that could go wrong, firsthand. We definitely felt like a lot went "wrong," but so much went right. I had an amazing midwife, OB, and team of nurses. My labor nurse and I hugged and both teared up when we said our goodbyes. I had an amazing family by my side, especially N there through every second of it. And most important of all, we got what we all were really there for, a healthy little human being, who weighed more than any of us thought was possible, who was more beautiful than anything I could have dreamt up, who latched onto my breast almost immediately and took to breast feeding like she had already been practicing, who smiled in her sleep, who was ours, we got it. And I wouldn't trade that for anything.

November 1, 2013

Goodbye October!

Man, where did this month go? It feels like just yesterday I was welcoming September! Probably has something to do with a little girl who keeps me busy all day, a big exam coming up, and just a dash of sleep deprivation ;) 

Thank goodness for my phone and all of the annoying pictures I snap throughout the day; when I do get downtime I can look back and actually remember the amazing things that happen on a daily basis. I am constantly wondering how I got so lucky ❤️

I hope you all had amazing Octobers and are ready for November! Time for the holidays now! And if you haven't yet and want to, make sure to enter my LuckyPalmTree giveaway for some adorable baby gear, and my Dansko giveaway for a trusty pair of clogs
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