Baby Story: Baby H comes home (Take 2)

To mark Baby H's official 2-week birthday, I'm writing today about Baby H's official homecoming! After an initial 2 nights in the hospital, a short night at home, and another night in the hospital, Baby H was finally able to come home for good!  In total she was in the hospital for 5 days, just like her big sister.

Unfortunately, we started having some challenges with Baby L (I guess I should probably stop calling her a baby now that she's a big sister!  She'll always be my baby...and I can promote her to just L) and some jealously for Baby H, particularly at bedtime.  When Baby H would cry, L would yell, mimicking Baby H, and at bedtime when I would read her books, she would look at Baby H and squirm out of my lap to run around and create general havoc.  So G and I have started to dedicate one on one time time with L daily to make sure she knows she's still loved, and at bedtime, we remove Baby H from the living room during stories and only bring her back in time for bedtime kisses and hugs.  It seems to be working mostly ok, and within a few nights, L even asked to kiss Baby H right before bed.

Baby H, just chillin' on the sofa while daddy is playing basketball

It's so interesting the ways in which the two girls are alike, and the ways in which they are different.  For one, Baby H has very very different eating patterns than L did - and it took me a few sleep-deprived nights to figure this out. For nursing a baby, I have a very strong let-down, meaning  my milk comes to the baby very fast to start.  L used to take it like a champion milk guzzler, and she would finish eating within  10-15 minutes.  She  only needed one side per feeding, and she ate frequently - maybe every 90 minutes to 2 hours during the day, and then every 2-3 hours at night until she started sleeping through the night.  Baby H struggles with my let down, and she only nurses for maybe 3-5 minutes at a time before she needs a break.  And her breaks are anywhere between 10 and 30 minutes.  And she needs to eat 3 or 4 times before she sleeps for 3-4 hours - she  is a serial cluster feeder.  So now that I've reset my expectations at night that feeding her is going to take about an hour each time I wake up, but then I'll get a longer period of sleep, nights have gotten a little easier for me.

L was terrible at burping and also had some minor acid reflux as a newborn...H is a champion at burps. Sometimes I don't even have to pat her back, I just sit her up and she'll let out a belch loud enough to make a grown man blush!

Baby H, passed out in between feeds

Another way the girls are different is how they are pacified.  L never took a pacifier, despite many efforts and many different kinds of pacifier.  L, however, needed to be swaddled to get any kind of decent sleep because her moro reflex was so strong - and she was pretty content to be snuggled up, even if she could figure out how to break out of most swaddles.  Baby H loves her Mam-branded paci, but prefers to be swaddled arms-out...to the point where she wakes up in the middle of the night angry that she doesn't have access to her hands.  We still swaddle her arms in at night because ours it's easier for me to feed her and she sleeps better, but I can tell she doesn't love it.

H is NOISY. She's a noisy eater (G has commented that she sounds like she's choking the whole time) and a noisy sleeper. She grunts and sputters and sometimes cries both while eating and sleeping, so I've had to adjust my mommy radar so I don't wake up at every little sound she makes. This was surprisingly easy for me since I can't nap with H during the day like I did with L...so I'm usually pretty exhausted by bedtime.

The girls are similar in that they both hated their first few baths, but then started to relax into bathtime...which is great, because seriously, what is cuter than a naked baby relaxed and cheerful in the bathtub??

They both also hate diaper changes and clothing changes. I've known babies to cry as soon as their diaper was soiled - and NOW L will ask to change her diaper after she poops, but as newborns, both Baby H and (then) Baby L were perfectly content in their poopy diapers, and both would cry bloody murder while I changed them.  Oh, and both of them projectile poop towards me mid-diaper change, despite my best efforts to avoid getting pooped on.

Because of her time in photo therapy, Baby H takes a bottle and formula without any issue.  All the things that breastfeeding mommies write about nipple confusion and preference for bottles turns out (in my case) not to be true - Baby H nurses just fine, other than the cluster feeding (which is the same for her regardless of breast or bottle).  This is a huge relief for our family since it took L forever to get onto a bottle, and also forever to get her onto formula.  This will also make going back to work, and eventually back to Basra, much less stressful for me, knowing that my baby can drink formula without any issue.

L is finally warming  up to Baby H

We're slowly settling into a routine with the two littles.  I took Baby H to the doctor a few days ago, and she has a clean bill of health - her eyes will still be a little yellow for a few more weeks, but otherwise no need to return to the doc until her 2-month vaccines.  L warms up to Baby H a little more every day, kissing her on the head, gently touching her face, and giving her fist-bumps (with a little help from mommy).  We've even been able to have some company over - my boss and his family, our friends who introduced us to Miss J, and our friends from L's swim class have all come over to meet Baby H and love on L. 

It's been a great two weeks with Baby H, and we're excited to see her and her big sister continue to grow together!

Baby Story: Baby H's Time in the Hospital

Our newest little nugget!

I'm not going to lie, our first night with Baby H was rough.  Unlike BrightPoint. Royal Women's Hospital in Abu Dhabi (recently renamed NMC Royal Women's Hospital), Mediclinic policy is that babies 100% "Room-In" with the mothers. The hospital doesn't even have a nursery for babies to go to - unless the baby is in the NICU, it is in the room with the mother.

According to the World Health Organization, "Rooming-In" is better for the babies, and supposedly better for the mothers - I strongly disagree with the second part of that statement.  When  I gave birth to Baby L, I lost over a liter of blood, my hemoglobin was below 5g/DL, and what I needed more than anything was uninterrupted rest.  So the nurses at BrightPoint took my baby to the nursery for 2 hours until she needed to eat so I could sleep.

Fortunately, with Baby H, I still lost a liter of blood, but I had boosted my iron ahead of time, so my hemoglobin was around 7.5 g/DL. I was also in labor a lot less time, so even though the labor was harder, I was "less tired" - but I still could have used some uninterrupted sleep, which Baby H was not having at all.  She fussed all night, to the point where I had to start "tuning her out" because she wasn't hungry, her diaper wasn't poopy, she was just making fussing sounds because she didn't like being out of the womb (sorry, kid).  Between that and the nurses coming in and out to take our vital signs all night, I got maybe 3 or 4 hours of sleep in the wee hours of the morning.  I'm pretty sure that this is how post-partum depression starts, by sleep-depriving a new mother immediately after giving birth to her child.  I'll come back to this later, but I'll hop off rant for now.

After our rough night where neither of us got much sleep (G reports that the pull out sofa bed was extraordinarily uncomfortable), G went home to pick up Baby L and Miss J and bring them to the hospital to meet Baby H.

Baby L is a little apprehensive of Baby H. We're sure she'll get over it, it's just going to take some time.

I mentioned in my post about the induced labor that we weren't able to have a birth story photographer because the hospital policy is only one extra person in the delivery room.  This also worked out pretty well because Jo, my new favorite photographer in UAE had also just had a baby almost 3 weeks prior to ours, so a 4-5 hour birth story would have been tough for me to ask her to do.  Instead, I asked her to come do a fresh 48 the morning after delivery, and I'm so glad I did because the photos she took were beautiful!  She also took some great shots of the whole family on the hospital bed, something I forgot to do with Baby L because of all the trauma of both my blood loss during her delivery and her treatments for possible infection. This is not yet the full gallery, but
she sent me a sneak peak so I could share with friends and family.  I just love the way that Jo captures naturally happy moments in our family - even when she poses us, it doesn't feel horribly staged, we're just having good time being ourselves.

Our beautiful Baby H, bright eyed and bushy tailed even though Mommy was exhausted

Making  sure Baby L still gets some love from Mommy!

First family photo

I think Baby L was actually playing peek-a-boo with Jo and her camera!

Super Dad with his new baby girl

Jo stayed with us for a few hours and it was also fun to catch up with her about her birth experience and how things were going with her newborn as well.

After Jo left, we got the bad news that Baby H's blood type came back, and she had ABO incompatibility jaundice.  Essentially, she inherited G's blood type which was incompatible with my blood type, and my immune system created antibodies that would break down Baby H's red blood cells faster than her liver could process.  This is apparently very, very common, and the most typical treatment for newborn jaundice is light therapy, so Baby H was going to have to spend 24 hours in this special light box, with only breaks for feeding and diaper changes - I was crushed because it meant I would only have very limited cuddles with my little one.

Baby H in her light box

Let me tell you, 24 hours in the light box for a new mom and baby is hard.  My milk hadn't come in yet, and Baby H was HUNGRY. With jaundice, it is really important that the baby eat to help clear out the bilirubin in her system (the toxin from the breakdown of red blood cells that causes the yellowing of eyes and skin for jaundice).  G took Baby L and Miss J home, then came back to spend the afternoon with the baby and me so I could get some more sleep - we decided that he would not spend the night since there wasn't much he could do other than suffer on the mattress. He'd be more helpful to me with a good night's rest.

It was a struggle from the start - Baby H wanted to eat all. the. time. And getting her to settle back down on the table without crying was really difficult. By around 10pm, I finally had my first crying breakdown, and I called the nurses to help me with the babe - the nurse took the baby from me, telling me to calm down since my being upset would also make the baby upset.  She advised that formula might help her sleep, and reassured me that all babies struggle with phototherapy.  Intellectually, I knew this was the right answer - I had even just listened to a podcast and posted a NY Times Article on Facebook from economist Emily Oster that discussed this very thing, that there is no conclusive data that formula is bad for your baby or that "nipple confusion" is actually a real thing.  Emotionally, it was hard to say yes - Baby L had 100% breastmilk until she was 6 months old, and I wanted to the same for Baby H - but I also really really wanted to sleep, so I signed the formula consent, and the nurse fed the baby and put her down.  And I got 3 glorious hours of sleep.

At 2am, Baby H woke up and I changed her diaper...and after an hour of unsuccessfully trying to put her down, I called the nurses again.  More formula, and they settled her, and I got 3 more hours of much sleep.  It was amazing.  The nurses were somewhat shocked at how much Baby H could eat -she finished all 60 mls of formula both times, and that was after draining the colostrum in both my breasts. She was a big baby! And at this point I realized, that "rooming-in" doesn't mean you have to go it alone as a new mom - it just means you need to ask for help.  I still don't like the 100% rooming-in policy because I don't think most moms KNOW that you can ask for help - so I wish that new moms were told after being wheeled to the maternity ward postpartum to call for help.  Not just that the call button is on the hospital bed, but please use it and actually call for help.

The next morning, we got Baby H's initial results at 10am.  We could take her off the light table, but we had to wait until 4pm to confirm her bilirubin levels wouldn't rebound.  So I finally got the cuddles I was hoping for, and we hung out and took some passport photos.  This one was my favorite, but the passport photo people said we should probably use one of the more neutral-looking ones.

Baby H, looking super duper Asian

The nurses took Baby H's blood in the afternoon, and the doc came back with the results - they were just barely in the acceptable range, so she recommended we stay another night.  At this point, I really, really wanted to go home, so the doc scheduled us to return the next day, and warned us that we might be due for a second round of photo therapy if Baby H rebounded.  The hospital had promised discharge would go quickly, but it still took forever - we didn't get home until around 8pm, and we had an appointment at noon the next day with the pediatrician.  Had I known discharge would still take that long despite the doctor's promises, I would have stayed the extra night, but hindsight is 20/20.

Baby H ready for her first car ride!

It was, indeed, amazing to sleep in my own bed again.   But alas, as I'm sure you can from above, we ended up back in the hospital for another round of photo therapy, from 3pm until 11am the next day.  Her skin had yellowed, and her bilirubin levels were just into the therapeutic range.  She was only 3 days old,  bilirubin levels peak around day 5-7, so while the doc was on the fence about re-admitting her, and I told him I wanted to do it just to be sure. Day 2 was even harder, because now Baby H knew when the eye protection went on, she would be on the light table.  And unfortunately, my night nurse this time around was not has helpful as the previous nurses - she was unwilling to feed the baby for me, or really even hold the baby to help me settle her, she just sort of stood next to me watching me and advising me to try things that I had already shown her didn't work.  I finally asked her to just leave. I was on my own - but at least this time around I had the tools (and the previous good night's sleep) to help me get through the night.

Round 2 of phototherapy

Even after the nurses took Baby L's blood for testing, I kept her on the light table as much as I could just to be sure. Her levels were back down, and we would be discharged in a few hours once things were sorted out with billing. We were scheduled to return in 1 week for a check-up - So Baby H will have that in common with Baby L, both of them spent their first 5 days of life in the hospital for some sort of treatment!

We got all packed up, and I came home to deliveries from my wonderful co-workers of flowers, more flowers, and chocolates! More on our first days at home in our next post!

Baby Story - Induced Labor

Warning! This blog post is very text-ey without a lot of pictures.  It’s also more a record of what happened for my benefit and for Baby #2, so if you’re more interested in baby pictures than in a gory labor and delivery story, wait for the next blog post. :-)

My most amazing midwife, Gabriela!

After the False Alarm one week before Baby #2 (aka Baby H)’s due date, I was ready and anxious to have the baby!  Literally every night, I would think that contractions were starting again, only to discover they were Braxton Hicks “practice contractions”.  I would go to bed hoping to go into labor naturally and wake up in the morning super grumpy that I was still pregnant.

My doctor (Dr. Shikha, who is fabulous!!!)  offered to perform membrane stripping a few days after the false alarm, but I held out for a few more days, and finally, we scheduled a membrane sweep for 09-May.  This was my due date based on my 12-week ultrasound, and slightly later than the due date calculated by my last period.  By the time we got to the day of the membrane sweep, I was so uncomfortable that I scheduled labor induction for 48 hours later — CTG Machine be damned.

The membrane stripping didn’t really do anything to progress labor - other than give me cramps and make me nauseous from the hormone release.  So after a day, we started to prepare for an induced labor.  Our instructions were to check into the hospital Labor and Delivery Ward (L&D) a little after midnight on the day of of induction. The midwife and nurses on duty took a few blood samples, hooked me up to the CTG for a few minutes to get a baseline for the baby, and then told me to get a few hours of sleep - we would start the procedure at 6am.

G - getting some zzz's before the excitement begins

At 5:30 am, a light breakfast was delivered to me, the midwife did a little more monitoring, and then she went ahead and ruptured the membrane - i.e. manually broke my water in hopes to kickstart labor. My belly was so big and stretched that the release of fluid was actually a huge relief, I felt so much lighter! I was instructed to walk around for a few hours, and see if things progressed.  So G patiently walked with me around and around the labor and delivery ward until finally I asked for an exercise ball to sit on because my back hurt from walking with my big belly.  

Waiting for something to happen...and yet...nothing

Around 8am, I’d had a few contractions, but still nothing regular, so the nurses and midwives began to set me up for medical induction.  I was given the option now for an epidural in advance of induction because it would be easier now than in between contractions. I originally was not going to use an epidural, but I also was originally not going to be induced - I figured if I was going to be strapped to the chair, I might as well have pain relief, so I agreed.  By 9am, drugs were flowing, and I was being induced!

My midwife, Gabriela, prepping me for my epidural

I tried to watch a movie but there were constantly people coming in and out to check this or that so eventually I gave up and tried to doze for a little bit.  According to G and the CTG machine, I was having contractions about 2-3 minutes apart, so I took that as a good sign - until I started to feel some of the contractions, like monthly period cramps. The midwife looked concerned and with the anesthesiologist permission, increased my epidural and checked my dilation - it was maybe 11am? And I was dilated to 4 cm.  I had started at around 2 or 3, so not much progress.

It was a busy day at L&D with 1 woman having already given birth before I started my induction, 2 more laboring at the same time as me.  At this point, there was an emergency C-Section thrown into the mix, and G and I could hear mad chaos in the hallways of people running around to tend to the patients - I think this was the busiest the labor and delivery ward had been since opening 9 months ago! I give this context because it sort of sets the tone for the rest of MY delivery.

The epidural seemed not to really be working - it was taking the edge off the pain, but I started feeling contractions very, very strongly. The midwives were not happy about it, and they tried to call the anesthesiologist, who was with Dr Shikha tending to the emergency C-Section.  The unit manager came in with one of the midwives because they didn’t like how the baby’s heartbeat looked, so they helped me roll onto my left side - which was horrendously painful for me at that time.  I don’t think the unit manager is normally on the floor, but it was all hands on deck in L&D!

My original midwife - an angel named Gabriela from the Czech Republic - came in boosted my epidural further. It seemed to help very, very briefly, but in the short period between with Gabriela left me to check on her other patient and come back, I was in pain again. G suggested maybe I’d made some progress, but I didn’t think I’d go from 4cm to ready to delivery in less than an hour.

When Gabriela came back she checked the insertion point of the catheter, and found part of it had slipped out. “Do you want to have it replaced? I’d like to increase your induction meds to help lengthen your contractions, but I know you’re in a lot of pain”.  I told her I was concerned that my contractions were too close together to re-do the epidural, and she offered to check my progress. Sure enough, I was at 8cm. Gabriela advised again, we could either re-do the epidural or try to deliver the baby, and I said let’s have this baby! And can we take the epidural out if it’s not going to help me?

Well, I had to wait for Dr. Shikha and the anesthesiologist to come out of that emergency C-Section.  In the meantime, Gabriela offered me nitrous oxide, which didn’t do much for the pain but definitely helped me relax in between contractions.  When the doctors came, I tried to negotiate removal of the epidural and she offered to give me a booster dose to help take the edge off while she fixed the catheter - again, it worked for a few minutes, but then wore off shortly after she left. Dr. Shikha advised me to rest as much as possible in between contractions, and let them know when I start to feel pressure to push.

Shortly after Dr. Shikha left for her afternoon appointments, I told Gabriela that I was starting to feel pressure, sort of like constipation.  She checked my cervix, and told me it was open enough, but the baby’s head position wasn’t quite where it needed to be - so she then started coaching me on starting to push the baby downward during my contractions. She helped me figure out where I was wasting energy by tensing up, and she helped me focus my efforts into the right muscle groups. She was hoping that by pushing the baby downward, the baby would naturally rotate into the correct position for delivery.  We did this for maybe an hour, and G was standing right next to me holding the laughing gas mask for me to take a few breaths to relax in between - I have a tendency to continue clenching my muscles even after the pain has subsided, and I really needed to conserve some energy. I couldn’t breathe the N2O continuously though, because it made me really dizzy, so G would count 3-4 for breaths for me and then take it away.

After about an hour of this, I needed a break, so Gabriela and G helped me roll to my side to just rest and breath without pushing.  I could feel the baby’s head moving downwards, and I think while I was on my side, she rotated to where she needed to be on her own.  I was so tired, I felt in that moment “This is how women end up in emergency c-sections - they just can’t push any longer!”, and after all the pain and struggle, I really didn’t want that to be me.  I quietly started squeezing my abdominals during the contractions while on my side to see if it helped move the baby, and when I felt I had energy to push the way Gabriela wanted me to, I told her I was ready to move back to sitting.

At this point Dr. Shikha happens to walk in - apparently Gabriela called her while I was resting on my side to tell her I was very exhausted.  Doc took a quick check of my cervix and announced that I was ready - we’d have a baby in 10 minutes, so the nurses needed to help her scrub in!  After that, there was an insane flurry of activity, and then Dr. Shikha started talking me through it.  “Ok, Kim - chin to your chest, deep breath in, and hold your breath for a long push.  When you can’t push anymore, quick breath, then push again.  Goal is to do three pushes per contraction”.

G and the nurses getting ready for Baby H!

I don’t think I ever got to 3 per contraction, but I did push that baby out at 3:27pm.  At the very end, I was pushing even without contractions because the baby’s head crowning was so uncomfortable, I couldn’t wait the extra 2-3 minutes for my body to help me. I’m not sure where the extra energy came from, but I imagine most mom’s who delivery naturally go through something similar - you just do what you have to do.  And then I found out why this baby - Baby H - took so freaking long to come out - she was 4.4kg, or 9.8 lbs - 2 1/2 lbs heavier than her sister!  And she wasn’t really any taller, Baby L was 51 cm vs Baby H’s 52 cm - so this little baby was all chunk! G even joked that her umbilical cord was twice as large around as Baby L’s, so she had access to a lot more food.

My gorgeous newborn! So chubby!

I was able to hold the baby for a few minutes, then after her cord was cut, the nurses and midwives took her for cleaning and checkup.  Similar to with Baby L, I started bleeding, but Dr. Shikha was already ready for it - and so I was given meds to help my uterus contract and my doctor called for help from another one of the L&D Ward doctors to control the bleeding while I tried to push the placenta out.  This actually took awhile because I was just so tired from pushing the baby - I felt like I had no abdominal strength left.  I think they tried to see if they could remove the placenta without me, but they were concerned with tearing, so eventually I was able to find some strength and push it out as well.  Gabriela told me later that it was huge 1.5kg, so no wonder I had a hard time! The doctors stitched me up, and kept massaging my abdomen (both of which were painful since the epidural had completely worn off by now) to stop the bleeding. I told G to take some photos of the baby, and he did, but then he came back to help hold my N2O to get me through this last part.  

Our gorgeous Baby H!  H for HEAVY at 4.4kg, or 9.8 lbs!!

When the docs finally finished, I still lost about a liter of blood - twice what I should have lost for a normal delivery.  The L&D Ward doc who was helping Dr. Shikha had to rush off to another delivery, along with some of the nurses and the other midwife. Apparently, with 5 deliveries in one day, L&D had also started running low on supplies, so Angie, the unit manager, was also running back and forth from the post-natal maternity ward with extra dressings and gloves, supplies to clean me up and a fresh hospital gown for me to wear that was specially designed for nursing moms.  Dr. Shikha wanted me to stay in L&D for a few hours to ensure I didn’t have anymore blood loss, and so they cleaned up my baby, put her in a crib next to me, and while she slept, G and I ate some food for the first time in hours. Gabriela also had another delivery to run off to, but told us she would be back because she still needed to do a lot of clean up and documentation for her report of our delivery.

After her other patient delivered, Gabriela came back to remove my epidural catheter and transfer me to the maternity ward.  I decided early on that if the baby wasn’t born before 2pm, we would not bring Baby L to the hospital, and it was a good decision - we didn’t get to our maternity room until 7pm.

I have to give a shout out to my amazing and wonderful husband throughout this whole ordeal. He was involved every step of the way, from walking with me in the hallways, to holding my laughing gas mask, to massaging the tight spots on my back when I was sore.  He held my hand when I cried, stroked my hair through the worst of the labor pains, and helped the midwives move me every time I wanted or needed to change positions.  Even Gabriela commented on how helpful he was in the delivery room, and I couldn’t be more blessed to have him as my husband and father of my children.  Even after delivery, when Baby H and I were in the hospital, he made it a point to spend extra time with Baby L every day to make sure that she still felt that she was special and loved.  

My amazing husband with our new baby girl

Compared to Baby L’s birth story - I would say I definitely felt more “beat up” and sore everywhere, but that is probably a combination of the epidural being less effective and Baby H being 30% larger.  On the other hand, I didn’t feel as physically drained / fatigued, despite losing the same amount of blood, most likely because (1) labor was only 8-9 hours instead of 17 hours and (2) I’ve been able to eat red meat during Baby H’s pregnancy and my iron levels were much higher.  I’m glad we induced when we did, if Baby H were any bigger, I think I would have likely ended up doing an emergency C-Section at the end of my labor .  Fortunately, now that we have 2 beautiful baby girls, G and I have decided the baby making factory is officially closed. ☺

Dr. Shikha with Baby H