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Now that our NICU journey finally seems to be settling into, as our neonatologist put it during rounds today, “just late-term preemie stuff” I finally have the urge to write about his birth.

I suppose it all kind of started the Thursday before he was born. I had what was supposed to be just another routine weekly NST scheduled and went in expecting it to go a lot like the two previous ones where we were in and out within an hour or so and told everything looked great.

Actually, that’s not entirely true. I hadn’t felt him move much that day so I think there was a part of me that sensed things might not all be completely well inside my womb. A bit of intuition perhaps, but for the most part I still thought everything was fine.

That day he failed the NST. The nurse looked at his strip and said it didn’t much resemble his previous ones and she decided to do a biophysical profile. She didn’t seem overly concerned and though he needed a bit of prodding he passed the BPP fairly quickly. Part of me felt uneasy over it because I could tell she was in a rush, she even mentioned to one of the other nurses (after he passed the bpp) that she was like, “Oh no, right at the end of the day!”

But he passed and the nurses all seemed happy and the woman in the room next to me, her baby had also apparently needed some prodding in order to pass its BPP after failing the NST, which I knew because the nurse that had “massaged” her baby into moving around was the same one that came in and massaged my belly and got T to do the requisite breathing/moving to pass.

I went home still somewhat uneasy but calmed a bit by the fact that I had another NST scheduled for Tuesday, and over the weekend I felt the baby move a bunch.

Until Monday. Monday he was again pretty quiet. I felt occasional kicks or punches and thought I felt him “breathing” in the morning but by nighttime, when I normally felt him the most, he was so quiet. I did my kick counts and even after eating sorbet and chocolates, drinking cold water, and getting into a position he normally hated and would make him kick me to move, I only got about 7 or 8 movements in an hour.

I was pretty freaked out and called my OB’s emergency line and the nurse told me to go to triage just to be safe. I felt terrible because it was already 10:30pm by then and Paul had to work the next day but he insisted on going with me so off we went.

Once we got there I was hooked up to the monitors once again. Since I wasn’t having contractions (at least not ones that I noticed) I didn’t have to take off my underwear this time. After awhile of being monitored the nurse told me that a) the baby wasn’t exactly passing the NST because he wasn’t having enough change in the heartrate to qualify as accelerations BUT that he did have good variability which was a good sign and b) I was in fact having a few contractions.

They decided to have the on-call OB come in and do a BPP to be safe, she came in and T passed with flying colors and didn’t even need any massaging or coaxing. In fact, as soon as I had gotten hooked up to the monitors he started kicking and punching away. I was both relieved by this but worried about the fact that even though I could feel him moving, he wasn’t getting the proper accelerations.

The on-call OB told me everything was fine but that I should keep the NST I had previously scheduled for the next day, Tuesday. This probably should have been a red flag to me that even though everything was fine right now that maybe things were heading in the direction of being not fine. But the thought did not occur to me. Or it did and I was in denial. This will be a recurring theme of how we got to T’s birth on Wednesday.

Anyway, the next day I went in for my scheduled NST which was to be followed by an appointment with Dr. MFM’s associate Dr. MFM2.

After about an hour of monitoring, the nurse told me not only was he failing the NST, she wasn’t seeing any variability. His heartrate was just steady at about 150bpm even though I could feel him moving around. I asked if she could let Dr. MFM2’s office know that I was still at the ante-partum testing clinic which she did and came back and said that was fine because Dr. MFM2 was actually running behind anyway. At that point she began the BPP, which he passed fairly quickly, but she said she wanted to maybe monitor me for awhile longer if Dr. MFM2 was still running late.

When she returned, Dr. MFM2 was with her. They compared my current strip with the previous ones, including the one from the night before in triage (they had run down the hall to get it from them). Again, I should have picked up on the obvious signs that things were headed in the wrong direction, I picked up on concern but I didn’t quite get what it meant.

Dr. MFM2 said to stop monitoring me but she wanted me to come back for another NST tomorrow and she marched me over to the schedulers office to book the appointment before taking me across the hall to her office. She said she wanted to do a quick ultrasound herself and said everything seemed to look good. She went over my most recent labs, etc. and said that it seemed like from the perspective of my health that I could probably still make it to 37 weeks. She caveated that by saying, the baby or my cervix could change that, but as far as my pre-e/lupus was concerned it looked like things were still chugging along. I clung to that and ignored the obvious concern everyone was having over the NSTs. In fact, as she was leaving she mentioned that if I didn’t feel the baby moving regularly in the morning that I should just come in early (my appointment was scheduled for the afternoon). She also mentioned that a passing BPP was a good indicator that the baby would be fine for at least the next three days.

I didn’t think much of that comment, but again, in hindsight, it should have been obvious where things were headed.

I felt the baby move pretty normally in the morning, but towards my appointment time he started to slow down again. In my head I started wondering, does he just not like this time of day? Maybe I’m scheduling these appointments at the wrong time?

Ah, denial, it ain’t just a river in Egypt.

By this visit I was pretty good at knowing what was a passing NST and what wasn’t. And even though most of me was still convinced that he was just going to fail the NST and pass the BPP like he had the other three times he failed the NST, part of me must have known that might not be the case because I was upset enough to blog about it from my phone.

The nurse confirmed that the strip showed no accelerations and no variability. I confirmed that I wasn’t really feeling him move at all. At that point she went to go talk to Dr. MFM who came over to look at the strip. Someone, I forget if it was Dr. MFM or the nurse, mentioned that I had gotten steroid shots a couple weeks earlier. Which, say it with me now, should have been a big flashing warning sign.

It was agreed that I definitely needed a BPP, but I think at this point Dr. MFM was already pretty sure I was delivering that day. The nurse asked me when I had last eaten. I thought she was asking because sometimes babies move more/less depending on when you ate. She asked me when I had last had anything to drink, including water. That was when I knew she was asking because there was a chance I was having the baby that day.

But I was still in denial. Still clinging to hope that he’d pass the BPP and I’d go home and all would be just fine.

The BPP did not feel like the others though. It felt like they knew I was going to fail it from the get go, whereas the other times were always approached as though he would pass. The other nurses had never bothered to set timers. This time the nurse made sure she was finished with her other patients before she came in because she said once she started my BPP she couldn’t stop. She set thirty minutes on her iPhone and began. I think he moved once during those thirty minutes.

When the timer beeped, she said she was going to go get Dr. MFM again. I think this may have been the point where she told me that she didn’t know this for sure, but she had the feeling that Dr. MFM would probably want to admit me and that I might be having the baby that night. She said she was speaking out of turn because the doctor had not told her this, but she didn’t want me to be blindsided if he did in fact come in and say this to me. I heard what she said but still couldn’t believe this could be happening, I was still oddly convinced I was making it to 37 weeks and I was only 34w5d so this couldn’t happen now!

Dr. MFM came in a few minutes later and said that he wanted to admit me and that he was glad we had made it this far into the pregnancy. I was in disbelief. I asked if this meant I would be induced and received another shock when he told me that with the strip the way it was he didn’t think the baby could tolerate labor and I should have a c-section. I think he could see in my face that I wasn’t prepared to hear this because he then hedged and said that they could give me some IV fluids, monitor me for awhile longer in triage and see if things improved, and if they did that I could try an induction. He said I would either have a c-section that night or be induced that night and have the baby by the next day.

I started tearing up as he was leaving the room. And eventually was in full-blown, sobbing tears. A nurse brought me some tissues and Dr. MFM’s two nurses who had seen me along with him during the whole pregnancy tried to comfort me. I think one of them hugged me. I was handed a box of tissues. They were telling me that this was a success story, that we had made it so far, that the baby would be just fine and how proud of myself I should be that we got this far. They said they would come visit me and the baby tomorrow. But I couldn’t stop crying.

I cried as they walked me over to triage. My NST appointment had been at 1:30pm. I think it was around 3:30pm when I was settled in at triage. I was hooked up to the monitors again and could see that his heartrate was still steady at about 150bpm and I still wasn’t feeling him move. The time was passing very quickly.

My IV was placed and fluids started, I had some blood drawn. Paul arrived. I called my parents and my sister. I sent out some texts to friends. Paul and I debated if he should go home and pick up some things because I thought things would still take awhile, but when the nurse came back and I asked her if he should go home really quickly, she said she didn’t think so because things could happen fast. Also, the monitor was showing I was having a ton of contractions though I couldn’t really feel any of them.

At 4:40pm the triage nurse came in with some consent forms for me to sign for a c-section. I didn’t realize that an hour had already passed and asked her if this was just a precaution, in case I needed a c-section. I thought I had only been there for a few minutes and that they were going to monitor me for awhile longer to see if anything would change. She told me no, I had been monitored for quite some time now including the time at the testing clinic and that it didn’t look like anything was going to change. She said they were trying to get an OR for my c-section and that Dr. OB was on his way over to perform it.

More shock. More tears. She very gently reminded me that this was what was safest for the baby, and I didn’t want to take any chances, right?

I’m glad she said that, because it made everything sort of click for me. My baby was in danger. Something was clearly wrong. Nothing was going as I envisioned it. I wouldn’t get to try to push. I was having a c-section. But it was clearly what was best for my baby. It helped me to accept what was happening.

I asked her when they were planning to do the c-section and she said 5pm. I finally looked at the clock and realized that was 20 minutes away. She said she wasn’t sure if it would actually happen at 5pm though because they were really busy upstairs.

But things did happen quickly. By 5pm Dr. OB had come by, my L&D nurse had come down and brought the blue surgical outfit for Paul, and I was told it was time to head upstairs to the L&D floor.

It’s weird, I have no recollection of the time between leaving my triage room and being upstairs where they showed Paul the daddy seat outside of the OR. I assume we must have taken the elevator, but I don’t remember it or walking through the hospital lobby to the elevator.

My nurse led me into the OR and talked me through what would be happening. I remember seeing a needle on the floor and being worried someone would step on it (even though no one was barefoot). I pointed it out to the nurse and she seemed surprised and was about to go pick it up when the anesthesiologist came in and stepped on it (he was wearing shoes). When he moved away she picked it up and tossed it.

The anesthesiologist was really nice, everyone was really, he told me what he was going to do and what I would feel. I would be having a spinal, I’d feel a pinch in my back when he put in the numbing agent and then I’d feel pressure and feel a tingle down one leg. It went pretty much as he described and as scared as I was about it being painful from some of the horror stories I’ve heard about how much epidurals hurt, it really wasn’t much more than a sharp pinch and a bit of uncomfortable pressure. The tingle went down my left leg and very quickly after that my legs started to feel very heavy and the nurse helped me lay down on the table. After that Dr. OB, another OB and another nurse came into the room. They set up the sheet to block my head from my abdomen and then I think that was when Paul was called in and told to sit near where my head was. I think he held my hand.

One of the nurses asked Dr. OB something and he said that he “wanted the team in the room for this one” and I knew that he was talking about the NICU team. For some reason, I wasn’t that worried though? I guess because I knew the baby still had a strong heartbeat.

At 5:44pm the procedure began, I was terrified I would feel something and I did feel a tiny bit of stinging which freaked me out but they said that wasn’t anything to worry about and they were right. The assisting OB told me that I’d feel a lot of pressure while she was pushing the baby out and it was quite uncomfortable but suddenly they told me he was out and I heard strong crying. Dr. OB exclaimed that he was crying, they asked Paul if he wanted to see and he hesitated to look over the sheet but once they handed him off to the NICU team, everyone encouraged him to go over and look which he did.

Everything is a bit jumbled, but I remember Dr. OB saying something about jade colored meconium and I remember hearing his Apgars were 7 and 9. Paul came back with a look on his face I will never forget, shock, amazement. I think he said, “This is crazy.” I could see on his face that he was in love, this was the moment that Titus became real to him. Dr. OB asked what time he had been born and a nurse replied 5:49pm. I couldn’t believe it was only 5 minutes from when the procedure had begun.

I asked Paul if the baby was okay and he said he looked great. A nurse brought him over to my head, he was all swaddled and looked so tiny but perfect. She told me to kiss the baby and put his soft little lips to mine and then just as quickly he was whisked away to the NICU. The doctors asked Paul if he wanted to go and he hesitated but I told him, “Go! Take pictures!” and he ran off after the team.

The anesthesiologist noticed that my blood pressure had immediately plummeted after the baby had been born and said he was giving me something to bring it back up a bit so I didn’t get nauseous. He also gave me some Zofran for nausea just in case. At the end of the procedure he also gave me some steroids since I was on pre.dnisone.

The team started talking about random things, the anesthesiologist’s son being home from college, some hospital politics stuff I didn’t totally understand. They reassured me towards the end that the chatter meant everything was going well, that it was silence that meant something was wrong. I heard stapling and Dr. OB told me they were using staples. Finally the sheet was brought down, they moved me from the table to a gurney and I was wheeled out of the operating room to the recovery room.

I saw my dad in the hallway as they wheeled me. He seemed surprised to see me, I told him I was fine and that the baby was fine and Paul was with the baby. The nurse said he and my mom could come into the recovery room once she had done a few things in there first. Dr. OB was in there and on the phone gave a detailed summary of the c-section.

When he was done he talked to the nurse about what kind of pain meds I could have. They wouldn’t give me the standard kind because they were worried about my kidneys. I asked him how my placenta looked. He said it looked okay but they had sent it to pathology. He said that there had been some jade colored meconium in the fluid, which was old meconium and generally meant the baby had been in some distress for at least a couple days. Hearing that completely validated the c-section for me. It suddenly all made sense. The NST/BPP’s that he failed a little bit more each day. The fact that he always hiccuped a ton and in the past two days I hadn’t felt any hiccups at all. The lack of movement. Something HAD been wrong with him and while I’ll never know what would have happened if I had tried an induction or waited a few days longer, I’m glad I don’t know. Because it could have been catastrophic.

I was sad that I couldn’t see him and hold him and be with him right away, but I knew he was okay. He was down the hall with his daddy. He had been born screaming. And later the doctor came in and told me his lungs were good and he was regulating his own body heat. Paul came back and showed me pictures and videos of this adorable little guy with giant feet and a full head of hair. I couldn’t believe that that baby had grown in me for the past 35 weeks.

I didn’t get to cuddle him until almost midnight that night, they wheeled me into the NICU and put him on my chest. It still felt like a dream, but a great one.

I think for the first few days after his birth, I was still in total shock. It was all so surreal. Everything had happened so quickly, I never had time to process what was happening. That plus the pain medication and sleep deprivation (from pumping and being woken up constantly for vitals) just made me wonder if it was all a dream. Even the fact that it was a c-section, it didn’t feel like I had just had a baby and because my uterus was contracting sometimes it still felt like there was a baby kicking inside me. I didn’t want to touch or look at my stomach for the first few days because it made me sad that there was no baby in it and no baby with me. But for the most part I was just numb and in disbelief.

I’ll be honest, the fact that he’s still in the NICU still makes me feel some days like this is all a dream. I don’t exactly feel like a mom yet and I’m guessing I probably won’t until he’s home and we get to do the “normal” thing. Being awake in the middle of the night because of a crying baby and not because I need to pump. Not having to go to the hospital every day to visit the baby, which makes me feel more like I’m visiting the hospital’s baby than MY baby. Not having to ask nurse for permission to do certain things for the baby. Having to call someone for updates about how much my baby ate or pooped.

I don’t really know how to end this since I guess it’s not really over until we bring him home. So I’ll leave you with this cute baby picture for now.