by Abby Howard, Jamie's mom
As you may have read, I had preterm labor off and on since 28 weeks. My doc put me on modified bedrest/ restricted activity until 35 weeks. I also had a few hospital stays for stopping contractions and monitoring, as I was effacing and slowly dilating. She said after 35 weeks, we would let nature take its course; she would no stop it any more if I went into labor.
After reaching 35 weeks, I got out of bed, so glad to be up and about again. My baby stuff was basically all ready, I had that done by the time I was 6 months pregnant! But we went grocery shopping, I did quite a bit of cleaning that had had to wait while I was in bed, and I even made some fudge one day (which didn’t come out right!) One day, I was driving to the Post Office to mail a package and some letters, when a guy rear-ended my car. As a precaution, I was taken by ambulance to the hospital to have me and the baby checked. My contractions got as close as 3 to 5 mins for a while, but then spaced out again, so no baby yet. An ultrasound was done to make sure the baby and placenta looked all okay. Then I was sent home again. I did see a chiropractor/massage-therapist the next day for the whiplash.
Friday morning, Dec. 1st, I woke around 2 am with contractions about 6 mins apart. This lasted for the next 3 to 4 hours. Around 5 am, I called the birthing center at the hospital, and talked to the nurse about what was going on; she suggested waiting it out a bit longer, it could progress or it could slow and even stop. By 6 am, the contractions were starting to double up---two right close together, called “couplets”, but they were still only 6 to 8 mins between sets. I called the doc this time, and she suggested going in to be checked. We did. She found I was still only about 3 cm dilated, which I had been early in the week, even before my accident. She suggested trying to rest, and see what happened. I was tired, and since I was on the monitor, I stopped timing the contractions and I fell asleep for a few hours. The contractions spaced out to 10 or more mins apart, so they sent me home, declaring it was just false labor.
Saturday, Dec 2nd, I was aware of some contractions, but decided that timing them would drive me out of my mind, so I pretty much ignored them. My back was killing me, but I was reasonably sure that it was largely due to the whiplash from my accident. I was also sore in front where the seat belt had tightened across my abdomen in the crash. There were weekend flea markets in the next town, and we decided to take my mom, and go bargain hunting. All the walking we did actually felt good to my sore back, as well as gave me some relief from the sciatica in my hips and legs.
We came home for lunch around 1 p.m. After eating, we put Eric down for a nap, and I felt like taking a nap myself. I felt slightly nauseous, and did not finish my own lunch. But when I lay down, I could not get comfortable. My back and side hurt so much (my left side where the seat belt had tightened the most). I tried different positions, but nothing worked. I began to realize that there was a pattern to the pain---these were contractions again. They started in my back and wrapped right around to my front, and they were 3 to 4 mins apart. I decided to wait and see how it went; I did not want to go to the hospital and be told it was false labor again. But after half an hour, the pain was intensifying to the point where I was crying real tears each contraction. My husband was really worried and insisted I call the doctor. When I called, she said, “Just come on in, I’ll meet you there.” She didn’t even talk me through a few contractions, to see how I was handling it.
My mom had gone to Ames to mail her film for development, so we asked a neighbor to listen for Eric who was still napping, until mom returned. We grabbed our bags and a towel (in case my water broke), and hopped in the car, praying this was the real thing.
Finally, this is it!:
We arrived at the hospital around 3 p.m. I could hardly walk, and had tears streaming down my face. A nurse met us at the door, and helped me into the nearest room. By now, I knew the routine by heart: go pee, get undressed, put on a gown, climb into bed, and have the monitor belts strapped on. I was having trouble breathing through the contractions, and began to get tingly all over. The nurse said I was hyperventilating, and really worked with me to calm down. I’m not sure, but I wonder if the pain was intensified due to the whiplash trauma I had in my back already. I just wasn’t able to deal with it as well has I had in my previous labor with my son Eric two years before.
A few minutes later the doc came in, and did a pelvic exam. Oh my gosh, that had to be the most painful one yet (I’ve only had not quite a hundred this pregnancy already!). I screamed. But the good news, I was up to 4 cm now!!!! The doc said it looked like this baby was coming, probably before midnight. I laughed and cried, and the contractions, which still hurt like crazy, didn’t seem so bad. We did discuss pain relief, though. The doc said that giving me an epidural or narcotics this early could actually slow things down, and she really did not want that to happen. Her best suggestion was the hot tub. Sounded good to me, so the nurse filled it, and soon I was in it. Ahhhhhh! It was wonderful. I could still feel the contractions, but the warm water melted the edge of the pain away. Plus the water jets felt like a massage, right were it was needed. I highly recommend the Jacuzzi, if your hospital/ birthing center has one! You just have to keep drinking water while in it, to prevent dehydration.
The nurse would have me get out to pee, and monitor the baby every half-hour. Things were going really well. Once or twice, they also checked me for dilation. Around 4 p.m., my mom and son had come over, after Eric woke from his nap. He tooted around the hallway, playing with the toys there. He enjoyed peeking in to see me, and opening and shutting the curtain was a lot of fun for him. I was happy that he was around. With my mom there to watch him, and my dear husband sitting right near me on a stool, handing me my water glass and offering me moral support, it made a great family atmosphere. I was the only patient in there at the time---it is a small-town hospital, so I had both nurses, plus the doc sitting around the corner, ready and waiting.
Around 5 p.m., they started my IV; I had to have antibiotics, being GBS positive. They gave me a different one than I’d had during preterm labor, plus it was a stronger one, so it should give better protection, in case the bacteria had built up against the other type of antibiotic I’d had previously. I was still allowed in the hot tub, just had to keep my arm out of the water.
Around 6:30 p.m., they got me into bed again for my next check. The antibiotic had had time to take effect, and if I was dilated enough, the doc said she would break my water, if it didn't break from the check. I was about 6 cm, so she broke it. Right away, I noticed the increased intensity of the contractions. I could feel the pain/pressure in my pelvis as the contractions were pushing the baby down. The doc thought it would still be a little while, so she let me get back in the hot tub, for pain relief. This time, I preferred to sit in the tub cross-legged or with my legs folded under me, so I could lean forward, but still feel the water jets against my back. Not long after, I told the nurse I felt sick. She brought a trashcan, but I didn’t feel like getting up to lean over the high side of the tub, so I puked in the tub! (Yuk, but it was only water in my stomach anyway). They thought I must be in “transition”; the doc did a check as I knelt in the tub. She said I was still only about 7 cm, but she would check again in 10 mins. I was 100% effaced.
By this time, the contractions were coming “piggy-back”, for lack of a better word. I was getting three! contractions right on top of each other, with no real break in between. The first one would barely finish and there was the next one; and then the next one. Then I’d have a break of a couple minutes, then would come the next set. It was quite an experience; I’ve never had them stack together like that in my two previous deliveries.
I puked a few more times, then the doc decided I should get into bed. She checked me, and said I was at 9 cm. This baby was surely coming soon. My doc sat right on the foot of the bed, my husband held my right hand, and the nurse was on my left, monitoring the baby with a hand-held device. I found that I preferred to lie on my left side. I felt too weak to sit up, and my back just hurt too bad. I hung onto the bed rail with one hand, and nearly yanked Truman’s hand off with the other hand! The contractions were coming hard and fast, and I was moaning and yelling, and even kicking, with each one. Being out of the warm water, they felt like knives in my back. I asked for a narcotic, to take the edge off, like I’d had in Eric’s delivery. I had already told the doc I did not want an epidural. The doctor and nurse were just great; they kept calmly telling me that I was doing just great, I was in control, I was going to have this baby soon. They almost made me believe it, though I hardly felt in control! Making noise helps me release some of the pain, but it was disturbing Eric, so mom took him out of the room.
The doc told me to tell her if I felt the urge to push. The second nurse set up the big mirror so I could watch the baby be born, which I thought would be cool. Two more nurses showed up, as it was time for shift change. Truman told one of them where our Polaroid instant camera was, so she agreed to take a few pictures of the baby coming out.
They had barely given me the narcotic Nubain through my IV, and I was in the middle of a hard contraction, and suddenly I wanted to push really badly. Through my moaning, I said, “caaannn I puuusshhhh?” The doc said, "if you want to, go right ahead." I tried, though I didn’t feel like I was doing it right, but suddenly the doc says, “there’s the baby’s head!” The Nubain never did have a chance to work for my relief!
The nurse called my mom, and she brought Eric back in the room to see the baby be born.
Truman was so excited. He was holding my right leg for me to push against him---I was still on my left side. The contractions were still coming in sets of threes, so I just kept pushing with the next one. My eyes were squeezed fast shut with my effort, so I wasn’t looking in the mirror! Another push, and the head was out. Oh, no! there was a loop of cord around the baby’s neck! So I had to pant through the next contraction. But, thank God, the cord was really loose, so the doc pulled it out of the way, clamped it, and let Truman cut it! He was so pleased.
Then they let me push a couple more times, long pushes, and the rest of the baby was out! He felt so long! I thought he would just keep coming and coming, when would he be all the way out?
The doc put the baby on my tummy, and I hugged him to me, and laughed and cried. I was so glad it was finally here, I did not even ask if it was a boy or girl. (The u/s had said boy, but we were hoping it might be wrong, we really wanted a girl, after two boys.) It was 7:31 p.m.
The doc suctioned the baby’s nose, and a couple seconds later, he cried. What music to my ears! Then I looked up, and saw our family doctor, who we also wanted as the baby’s pediatrician. They whisked the baby into the warmer, and started doing all the tests, Apgar scores, and all the stuff they do soon after birth. One of the nurses gave us the instant pictures she had snapped. She took four, two as the baby crowned, one after his head was out, and one after all of him was out. I really like having these pictures (NO video for me!), it is kind of cool to look at them and see what it was like, especially since I was concentrating so hard on pushing that I forgot to open my eyes and look in the mirror!
My husband went to peek at the baby in the warmer. A minute later he announced “It is a boy!” My doc repeated, “It is a boy? Well, congratulations! You did a good job, Abby.” Then she added, “I wasn’t really looking at that part, when he came out. So what is his name?”
“Jamie Welles Howard.” Truman and I said it together.
The pediatrician and one nurse were busy with the baby. Then they informed us that he wasn’t breathing as well as they wanted to see, so they were taking him to the nursery. Truman went to watch them through the window---there wasn’t enough room for him to be in there while they were working. Before they left my room, they told us he weighed 4 pounds 15 ounces, and his Apgars were7/7.
A few minutes later, the doc asked me to push the placenta out---that is a kind of weird feeling. Then my doc checked my perineum, and declared that I had no tearing at all! I was amazed and very pleased---I had torn badly with Eric, which caused me trouble for a long time afterward. I was also happy to hear that I did not poop while pushing this time! The other wonderful thing I was so happy about was having my own doc do the delivery. She had given me care all through this pregnancy, and it was so nice having her to do the delivery, instead of getting some “new doc who is on call for the weekend”….
Afterward:
The nurse who had done the majority of my care in the afternoon came and hugged me good-bye and congratulated us once again. Her shift was over, and she was going home. I think her partner had left already. My new nurse came and helped me clean up, and changed the bed, and checked my “vitals”, etc. I knew these nurses quite well by now, after all the time I had spent in L&D to stop preterm labor! They are such a great bunch of ladies!
My mom stayed for a bit to talk with me. She told me it was so awesome watching me give birth! She gave birth to eight children herself, but had never watched someone else give birth. It was especially nice for her to be there for her own daughter! Eric had also watched as the baby was born, his eyes as big as saucers. He did not seem at all upset---just very curious. He pointed and asked, “What dat?”
I gave mom a list of people to call to let them know about the baby’s arrival. Also, I instructed her how to e-mail my e-groups friends to let them know, too. It was getting close to Eric’s bedtime, so she had to take him home to take care of him.
After a bit, I was left completely to myself. Everyone was off doing something else, and I began feeling lonely. So I hoped out of bed, and went out to the nurse’s station. My doc was sitting there at the desk. My husband was standing at the nursery window, and the pediatrician and some other people were still working over the baby.
We could hardly see the baby, but they said his breathing was labored, like gasping for air, and they were concerned he would give up in his effort. The decision had been made between the doctors to transfer Jamie to a big hospital about 20 miles away, where they were better equipped to take care of him. We agreed. My doc said that I had to stay at least until midnight, then she would release me early to go to the other hospital. I would not be transferred as a patient, so I would not get any further care or food once I was released, but I could stay in an empty room at the other hospital for the rest of the night.
The transfer team arrived and stabilized Jamie, then prepared him for the trip. Then they brought him to my room for us to say good-bye to him. I finally got to stroke his tiny cheek and check out his toes---yes all ten were there! He had an oxygen tube and various wires for monitors taped all over him, poor baby. They assured us that they would call later to let us know how he was doing after they got him set in the other hospital.
Hours later, we still had not heard back from the other hospital. One of the nurses called and finally got hold of someone who could tell us what was going on. Jamie was stable and doing fine. Several other babies were brought in to that hospital shortly after Jamie, including a set of quads! The staff was so busy, somehow we hadn’t been called.
It was now so late, we decided to sleep where we were, and leave after breakfast in the morning. I took a long hot shower, then we both actually got some sleep. The following morning, we had to fill out papers for the birth certificate and social security applications. Finally we loaded the car with our bags, plus all the freebie stuff they gave us, and we were off to see our newest family member.
Jamie’s progress:
They said his lungs were just a bit immature. We were surprised, as he was born at 36 weeks gestation. We thought he would be like Eric, who was born at 35 weeks gestation, and had no trouble breathing at all. But my doc said that every baby is different, and this was not unheard of for a 36-weeker. He was breathing on his own, not on a ventilator machine, but he needed supplemental oxygen, and he was making a lot of effort to breathe. His doctors were a bit concerned he might get tired of trying.
The first day, they kept him in an oxygen tent. It was warm and humid in there, and the air in there contained about 30% oxygen. The nurse allowed us to wrap him up and hold him for a short time, with a tube blowing extra oxygen around his face. They also ran a bunch of tests, which turned out fine. The most important one, perhaps, was that they tested him for GBS, to make sure he didn’t somehow get it from me. They were concerned that might have something to do with his breathing problem. Thankfully, the results on that were negative, though they gave him antibiotics to be on the safe side.
By the second day, they had put Jamie on CPAP. I don’t know what the letters stand for, but this is an apparatus that supplies air with extra oxygen (about 25%) right to the baby’s nose. He no longer had to stay in the tent. However, Jamie hated this thing, and kept trying to take it off! But his breathing was less labored, and he was making definite progress. The doctors still did not want to feed him yet, as they feared he would choke if trying to eat and breathe at the same time. He did have a temporary IV line to give him fluids and electrolytes. However, I had already begun pumping to get my milk to come in, and they hoped to give it to him soon.
On the third day, Jamie was weaned completely off supplemental oxygen---he was breathing normal room air---21%, and his respiratory rate was now quite normal. He was no longer gasping to breathe. They decided to try giving him my colostrum, but they tube-fed him to start with. They allowed me to do some “kangaroo care” with him, holding him skin to skin on my chest, under a cover. That was pretty cool! Or I should say, warm!
By the fourth day, Jamie was quite jaundiced. Though jaundice is normal in newborns, it is more of a concern with preemies---low-birth-weight babies cannot tolerate as high a level of bilirubin before it would become harmful to them. So they put him under “bili-lights” for 24 hours. We did attempt putting him to breast for a short time, but he spit my nipple out---it was as if he didn’t quite know what to do with it!
The fifth day, we tried putting him to breast again. He did a little better this time. He did latch on and suck for a little bit. But breastfeeding is hard work, and he got tired quickly; this is not unusual in preemies. We gave him the rest of his feeding with a special bottle designed for feeding preemies. That evening, they moved Jamie from Level 3 care to Level 2. That was a sign of his good progress, and we were very excited. He was still in an incubator to help him regulate his temperature, but they felt sure that soon he would graduate from that too. The nurses kept saying that he might be able to come home in a few days, but they couldn’t promise exactly when.
On the sixth day, they put him in a crib at room temperature. He did just fine. We did more breastfeeding, and he did very well. He was quite eager as he rooted and latched on. He took most of his feeding from the breast. The lactation counselor gave me pointers, and she said it was just a matter of time---as he matured, he would be completely breastfeeding before we knew it. We could always supplement him with some pumped milk in a preemie bottle at the end of each feed, to make sure he was getting enough. The fact that I had been through this same thing with Eric two years before convinced them that we would be able to handle it.
Then they told us that it looked like we could take Jamie home that night! We were so surprised and happy! He had passed his car-seat test---done on all preemies to make sure they can tolerate sitting in it for long periods and continue breathing okay. We did want him circumcised, but the obstetricians who would do it were quite busy, so it didn’t look like it would get done. We said that was okay, we could arrange to have our doctor do it later. It was Friday, and we wanted Jamie to come home; we didn’t want him to have to stay over the weekend just because he hadn’t been circumcised yet! So the nurse practitioner in charge came and checked him out, and formally released him. We were so relieved. And it was so nice to have him with out any tubes or wires attached to him anymore!
We dressed him in a cute knit outfit, which was way too big on him---but that really did not matter! We took his picture. And off we went. We decided not to call my mom who was home taking care of Eric---we were going to surprise her! …which we did.
Once home, Jamie continued to progress. He got better and better at breastfeeding, and before long we no longer had to supplement with a bottle after nursing. By nine days old, he had regained his birth weight. A few days later, we took him to our doctor to be circumcised. He did very well, hardly cried at all. One reason we had him done was that his foreskin was deformed, so we felt it would be better if it was not there at all. At least that way he wouldn’t have to live with a birth defect.
He has continued to nurse well and gain weight at a good rate. He is a good baby, and we are so happy to have him. It was quite nice to have him home for Christmas 2000---what a great gift!
