Okay, so I haven't posted in a while, but life has been so busy! I am really trying to blog more because I just have such great material! I have also been inspired after watching the movie Julie &Julia (a must see). I am going to back track a bit since I have been itching to put these stories down so here I go again...
Date: February 6, 2009
Time: Too Early At 8am!
Now, I am sure that 8am isn't all that early, but after only sleeping 90 minutes, 8am is painful. I had deliverd a baby around 4am that morning to woman who was 39 weeks along as well as her birthday! Let me not forget to mention it was also her sister-in-law's due date. This was baby#9 and she hadn't ever birthed early much less on her birthday! She was concerned upon going into labor because her sister-in-law was also using my services and stirring up as well. She finally decided to call her sister-in-law (Joanne) at 5am to tell her of the birth. *Now two weeks prior, Joanne had pulled an all-nighter false labor run. I had assured her that all was well and baby would come eventually and it's all a part of the job! She had been concerned because she knew this would be her biggest baby yet! Fast forward two weeks and you can imagine her envy of wanting to see her baby NOW! Besides, it was HER due date!* I made sure my client was stable and finally drifted to sleep only to be awakened 90 minutes later which brings us to an early 8am when the phone rang! It was Joanne's husband saying that Joanne had been laboring for a bit and her contractions were 3 minutes apart and intense! I, half aleesp, assured him that all was great and to call me when her contractions pattern out and become intense. Needless to say he hung up confused and later told me that in his mind he was thinking "that's why I am calling you now!" I immediately came to and called him right back saying I was on my way! I waited to alert everybody to come until I had evaluated Joanne to verify she was in labor. As I walked in through the back door, Joanne was in the spa in the box with her eldest child Yolanda pouring water on her back. It was the sweetest thing. I quickly realized her intense contractions and called the students. They, Joanne's sister and mother were on her way. Her mother was coming from her son's house taking care of her daughter-in-law who had delivered with me just a few hours before! As I was preparing my equipment and for staying I notice a small bottle of castor oil on her night stand. I then told her how I just knew she was determined to NOT go another day without holding her baby girl.
Hours went by and after very intense contractions (mostly in her back) and hardly any cervical change at 6cms, they asked me if I would consider breaking her water to help progress. I knew the baby was in a bad position (posterior' face up') and offered to do some positional excercises before rupturing membranes so we had a better chance of locking baby girl in a better position. After those excercies, I thought and agreed to break waters. I know, I know, intervention! But I had much to consider...From what I know , this baby consistenly wanted to stay posterior, and there was Joanne's history...She transferred to the hospital with her eldest which after being posterior for a couple of days, turned and came vaginally and her second was several hours yet. This was Joanne's first with us, but I should have known that baby #3 would follow the same as her siblings births!
Note** We have discovered for ourselves that third babies are the most unpredictale, but for us for this year, that meant most challenging!**
I decided and felt in my gut that we should carry on with breaking her water. I had Melody "pinhole" it since the baby's head was somewhat high to help guide her head down and make sure it was in the right position. As she did this, water GUSHED out. Now, we were expecting more baby less water, but that water kept pouring out and as it did, Melody felt the baby's face! We immediately repositioned Joanne so that we could get baby out of the pelvis and readjusted. And that's exactly what happened! PTL! Baby turned and went head down. Now , Melody said she didn't think the baby was over 8lbs as we had suspected and that she wasn't exactly sure of head position, but we were fine with that as long as it was head presenting and not face! The thing was that her water kept gushing and it seemes as if she had lost over a gallon and it was still flowing! I have never seen so much water. Finally the word polyhydramnios came out of our mouths and we set back and wondered if this was it UNDIAGNOSED.
As Joanne kept laboring, she was feeling more and more pushy. We gave her the go ahead to push minimally with each contraction and as she did, her hubby brought out the laptop to research this polyhydramnios. It wasn't long before he closed it and said, "I don't need to know about that right now." When, Joanne reached 9.5 cms we, she really had the urge to push and did so for almost 45 minutes. I had her stop to rest so that she could renew her energy. After resting for about 20 min, her pushing was involuntary. We set up for delivery and being that she continued pushing for another 45 minutes, I knew this baby was posterior (face up)! She was pushing for a long time for a third timer! As her pushing came to an end, Kayla Rose was born looking up at Daddy! It was a wonderful moment, but an alarming one for me. What happened to our 8lb baby? She was tiny and young looking. She breathed and cried and nursed right away. But the first scary moment occurred shortly after nursing. While Daddy was holding her, Kayla stopped breathing and as we stimulated her cry, she began to spit up what we originally thought was mucus but resembled the colostrum. As she stabilized, we put her in the bath with momma. It was a sweet moment for them, but I wasn't comfortable yet? How was there so much water and so little baby....this must have been polyhydramnios. Melody and I began to research... This baby was tiny and appeared to be a young gestational age. After her bath, I performed her newborn exam and dated her to only be 34 weeks along and her color was looking pretty ashy. How was this possible?? She was born on her due date with sonograms confirming! We were open and honest with all involved when we discoverd that this was more than likely polyhydramnios and that the baby needed to be examined! How did I miss this? I kept thinking to myself. Melody got on the phone with a CNM and I read more. Was this baby SGA(small for gestational age), IUGR(intrauterine growth retardation), or was it Esophageal issues indicative of polyhydramnios? Something wasn't right but I could not put my finger on it. Kayla continued to choke and spit up and as others wanted to chalk it up to transition, I knew something was wrong. Both Melody and myself knew this baby needed to be seen right away and the CNM urged Daddy to take her in. The family did not want to take Kayla anywhere if it was unnecessary, BUT this WAS necessary according to my heart and gut! IT was Friday afternoon at 5pm, no one would be available, We urged them to take Kayla to Cooks Children's Hospital in FW and Daddy made the executive decision to go! I had called the ER to let them know of Kayla's arrival. Being I hadn't slept and the inability for all of us to be in the exam, I opted to go home and sleep before rejoining at the hospital and all agreed we would part for now (6pm).
At 7:30pm, I had called to see if there was any news. I was praying that all would be fine, but my gut told me different. They had said that the ER was waiting for them and rushed them into the exam room. The Dr. felt there wasn't anything to worry about and would do an XRay and test and probably send them home. I hung up humbled and with a heavy heart thinking I made them go for nothing. At 9pm, I received a phone call from Daddy saying that I was right. "How am I right?" I asked. Kayla has esophageal atresia and needs to have surgery right away and on the way up to ICU....NO! I sat there blaming myself wondering what I could have done to prevent this...so far, nothing! I told them I would be at the hospital the next day.
The next morning I received a call from Joanne's mother stating time of surgery and saying that Kayla's rectum was perforated...Great! another thing I missed! She reassured me with the fact that Kayla had gone through 2 Drs that missed the diagnoses. Kayla's surgery that afternoon would fix her esphogus ....poor baby! Her esophagus was not attached to the stomach and had formed a pouch, thus her spitting up since birth! We went to the hospital and I was blessed to have seen Joanne and Kayla just before surgery. That little 5.6 pounder was a fighter but I hated seeing her all tubed up! Joanne was doing so well for just having given birth, I was proud of the way she handled it all...with grace!
After 3 some hours of waiting, Kayla made it through surgery and was on her way for recuperation. She was supposed to be in the hospital for a month and that miracle baby was out in two weeks. I call her a miracle baby because we had heard of other babies born with the same problems who had longer hospital stays and who did not survive. According to the Doctor, there is a small window to perform the surgery and if it's not done then, life would be compromised! Kayla Rose is a happy, beautiful baby who survived and though she still deals with a feeding tube and doctor visits, it does not bring her down, she smiles with grace over her life!
***How did I miss this....Esophageal Atresia can be detected by ultrasound after 28 weeks, Joanne's last sono was at 22 weeks. Joanne's fundal height measured right on and sometimes under her weeks. What I thought I palpated as part of the baby's back was indeed all of it and what I thought was forehead was possibly her whole head! I had also palpated for fluid level wich had minimal thril.
***How was this a God thing: Had I caught this beforehand, we would have had to transfer Joanne out of care. Being in the hospital and having her labor stall with little progression would have caused a nurse to break water without the same caution , hence face presentaion would have occurred and Joanne would have likely had a c-section. With the problems arising, Kayla would have been transferred to Cooks and gone through surgery in one hospital while her mother was recovering at another! In our ignorance, Joanne was able to have her homebirth, spend a precious first few hours with her daughter without being tubed and tied to a NICU bed, and spent every moment with her daughter even just before and after a serious surgery.
Thank you, Lord for ignorance and the grace you showered us in this situation!
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