02 Feb

IUGR what?

When we found out we were expecting, we started referring to our baby as The Peep. We had made the decision to not find out the baby’s sex until it was born, so using  The Peep made it a bit easier. I was trying to avoid assigning gender roles to a baby so early on, and honestly, we (I think it was more me, but T went along with it) liked the idea of the surprise – there are so few good surprises anymore, right? Everything about becoming a mother has been a surprise of some sort, now that I think about it. I imagine that’ll only continue as our girl grows up.

I went for my 38 week checkup on Monday, January 19. At my prior checkup, I was told that I’d be having an ultrasound, and an exam to determine the baby’s positioning. I headed to my appointment at 3:30 pm, and around 4:00, everything changed. While I was waiting for my ultrasound appointment, I heard the secretary tell another patient that Dr. F had been called away on a delivery. I figured I’d at least have my ultrasound and reschedule my checkup, or just wait until week 39. The technician started the scan and immediately informed me that The Peep was frank breech, which meant butt down and face down, as if she was looking at my back. All of that kicking I had been feeling was indeed her feet, or more likely her knees & feet, as they were crossed. There I was, laying on the table, wondering if it was too late to get her to turn, wondering how much more it might hurt to try to deliver her, and then the technician told me that the baby’s body was measuring small. Too small. I think I had a minor heart attack right there on the ultrasound table. The Peep’s head was measuring at term, but her body seemed to have stopped growing somewhere around 32 weeks, and her estimated weight was around 5 pounds. The technician did a procedure called a biophysical profile and said that the baby “passed” all of the tests, but that she wanted to call over to Dr. F, who was at Labor & Delivery, to get his opinion. After I got the ultrasound goo off of me and had a good long pee, the tech gave me the CD of my ultrasound images and the few prints she could get, and sent me over to L&D to talk to the doctor.

I toddled up to the fourth floor of the hospital from the professional building, figuring I’d have a chit chat with Dr. F and we’d come up with a game plan for getting the baby to turn, or we’d schedule a c-section for a date closer to my due date, which was hovering between January 31st and February 2nd. I arrived at L&D and the staff escorted me to a room. Dr. F was on a phone at the desk and waved at me. Once I was in the room, two of the nurses introduced themselves, and one pulled out a gown. “Put this on, put your clothes in this bag, and we’ll be back.” I was in shock and asked, “What’s going on?”  After a few seconds and some looks that passed between the nurses, I asked, “Am I having my baby today?” The nurses realized that I was not clued in and replied with, “Let me get your doctor.” Dr. F came in a few minutes later and explained that between the frank breech presentation and her size, he felt it would be safer for both of us if she were to continue to grow on the outside. He wanted to do a c-section immediately to get her out.

“I need to call my husband. He’s at work, 2.5 hours away. Is this an emergency? Can we please wait for him?” “No, we can wait. but get him here soon.” Dr. F and the staff left me alone to make my phone calls. T and I agreed that unless it was an emergency, I would BBM him, so the minute the phone rang on his end, he knew something was up.  I could hear the noise of a busy restaurant kitchen in the background when he answered.  “Hi sweetie. We’re having a baby today.” “What?” I could hear the surprise in his voice.  “Dr. F says the baby’s body is too small and they want to get it out now. I need you to get here.” I heard him yell, “Guys, I gotta go. I gotta go now.” That was 4:20 pm. T  ran home to snag his passport, dropped our housemate off at the restaurant, switched cars and was across the border and was at the hospital with me in Jackson by 8:00 pm.

I called my parents, family and friends, and T took care of calling his parents, so that all of our closer friends & family were in the loop. While we waited for T to arrive, the nurses hooked me up to a fetal monitoring system. I had sensors on my belly, held tight with wide elastic straps. One was monitoring if my body was having contractions, and the other monitored The Peep’s heart rate. Thankfully I didn’t have a single contraction – had labor started, a c-section would have commenced immediately, with or without T and I would have likely been totally knocked out for it.

The anesthesiologist came in to see me and explained the options of an epidural vs. a spinal anesthetic during a c-section. I don’t honestly remember the difference now, but at the time, he was very precise in his explanation, and didn’t mind that I asked a million different questions. Dr. F was concerned that the surgery would be longer than a normal c-section due to my tummy tuck, which would mean an epidural instead of a spinal, but the anesthesiologist was thinking spinal was the way to go. I guess with the epi, they can always add more juice if you need it, but with the spinal, it’s harder to increase the dose if a surgery goes longer than planned.  I think – it’s all very confusing to me even now! He was also very concerned about when I last ate. Since I had NO IDEA I’d be undergoing major surgery that day, I had lunch while I was en route to my appointment!

During this time, there was a shift change with the nursing staff and the nurses I had been dealing with came in with the new nurse to do their hand off. This is where they introduce themselves to the patient and then the departing nurse briefs the new nurse on the situation. That was the first time I heard the phrase IUGR. Intra Uterine Growth Restriction. I had read a little bit about it when I was reading everything I could get my hands on during my pregnancy. IUGR was mentioned, but there was little detail and it never crossed my mind that it could be my reality.

A little bit after T’s arrival, our nurse informed us that our c-section was set for about 10:30, and that they’d come in around 9:30 to get me  ready. They were waiting until 10:30 due to digestion – there was concern that if they had to totally knock me out for surgery, I would aspirate the contents of my stomach into my lungs. Nobody wants chicken tacos or a bean & cheese burrito in their lungs.

9:30, then 10:00 came along, and then the nurse came back. Turns out an emergency c-section case came in; They were finishing up with that patient, and would get the OR cleaned and come back for me in a little while. Finally, a little after 11:00, they came in. I figured it was go time, but we were given the option – go now, with a tired doctor and tired nurses, or we could let Dr. F & crew have a long nap and be their first case in the morning. I opted to be the first case in the morning – I’d much rather have a fresh doctor cutting open my innards and handling my baby than a tired & fatigued doc. Surgery was scheduled for 6:30 am on Tuesday morning. T and I hunkered down for the night. I was starving and they allowed me to have a popsicle and a cup of orange sherbet, which was the best popsicle and sherbet I have EVER eaten. Ever. T was able to stretch out on this chair that opened into a bed, while I attempted to sleep in the hospital bed with the monitors strapped to my belly. If I moved wrong, it’d stop sensing The Peep’s heart rate and a nurse would come in to adjust things. T slept, and I dozed on/off for a few hours, but was wide awake from about 4:00 am onward. I sat there and listened to my baby’s heartbeat and knew that I’d be meeting her in a matter of hours. I also found myself praying.

Around 5:15 or so, staff started swarming around me. They increased the fluids being pushed in my IV & put these ridiculous yellow traction socks on me. The yellow indicates that I was a post-surgical fall risk & I wasn’t allowed to do much of anything without help. I had to drink a shot of awful gunk that was supposed to help cut down on acid in my stomach. It was like a liquid sweet tart and it made me feel horrible. T got suited up in this head to toe surgical outfit – cap, suit and shoe covers. We headed to the OR. I sat on the table and the anesthesiologist was there, attempting to insert the juice into my back. It took him a few tries, and at the same time, I was feeling woozy and getting the cold sweats from the crap they made me drink earlier. T wasn’t allowed in there yet and I wanted nothing more than to hold his hand. It took the anesthesiologist a few tries to get the damned epidural placed right, but eventually he did. I was laid out on the table, all Jesus-like, and the blue curtain went up. There were people everywhere – surgeons, nurses, technicians, and pediatricians. They all introduced themselves to me and the seriousness of our situation was starting to become real: There were as many people there to care for the baby as there were for me. There was a real risk to her health and survival and there I was, trying not to lose my shit. T was finally brought in and he was able to sit to my left, behind the curtain. They kept tapping on my chest & belly to see if I was numb enough, and when I was, they got the show on the road. I couldn’t feel a thing, but I could hear and smell everything, especially my blood and the burning skin smell of the cauterization tools. Dr. F gave us a minor play-by-play as he went along, and announced when he was getting ready to pull the baby out.

T: “You know, we never did settle on a boy name.”
me: “I know… I just want William in there somewhere…”
Dr. F: “I see girl parts. Dad, do you want to stand up and see your baby?”

T got to watch as our little girl emerged from my belly, butt first. He sat back down next to me, and we both said, at nearly the same time, “We have a little girl!” I looked at him, and said her name. He nodded and we both sobbed joyful tears. At the same time, the baby had been taken over to a table to my left and was being vigorously rubbed down by the nurses and that’s when I finally heard her howl. It was the most amazing thing to hear. I kept asking how much she weighed, but nobody had any answers yet. T was invited over to cut the cord and they delivered my placenta and set about closing up my belly. I was feeling kinda funky. I was nauseated but elated and then nauseated again. They pushed something in my IV and holy moly I was flying and fully elated and babbled a LOT at T and Dr. F. I was wheeled into recovery and a minute later, The Peep  was brought to us. That’s when we found out she was 4lbs 9oz. So tiny!  We called T’s parents via BBM video call and introduced them to their granddaughter. I started to get feeling back in my legs. It was slow and gradual, and my right leg came back long before my lef. After the hour in recovery, we were rolled to our room. The movement made me incredibly nauseous, and it took quite a while for me to feel somewhat okay.

The hospital stay itself was pretty low key. We learned that The Peep weighed 80 grams over the cutoff for the NICU – had she been 80 grams lighter, she would have gone to the NICU regardless. All of her tests – apgars, hearing, blood work & labs, weight checks, were done in our room. With the exception of the car seat challenge, we had her with us the entire time. She was in her little bassinet, or with one of us for the entire hospital stay.

T’s parents arrived from Florida on Tuesday night and came right to the hospital to see the baby. That was when we realized that all of the clothes and things we have and brought for her were way too big. The Peep spent most of her hospital stay in a diaper, the hospital issued wrap-around cardigan, and the hospital standard swaddling blanket. She was perfectly content.

I can sit and watch the baby for hours. I marvel that we made her & that I carried her for nearly 38 weeks. It’s surreal now that she’s on the outside. My body doesn’t feel empty, and I keep expecting to feel the baby kick. I am wearing regular clothes and only slightly swollen around the incision site. I suppose that’s a side effect of having a small baby – I didn’t get huge. Dr. F commented a few times during the c-section that my tummy tuck had my abdominal muscles pulled really tight, too.

I get tired pretty easily, and find that I can’t stand still for super long. I still have some post-surgery edema going on in my feet, calves & thighs. The skin on my legs hurts from being stretched due to the swelling. Most of the time, though, it doesn’t feel like i just had major surgery  and had a baby. Just the baby part feels real.

I’ve been doing some research, as Dr. F mentioned that my placenta was sent to pathology. It seems that IUGR can have a variety of causes, and some are totally unknown. I’d like to know if there was a reason. Some of the research I have found indicates that it’s possibly related to the malabsorption my body does due to my having had weight loss surgery. The Peep’s pediatrician and my sister-in-law were both shocked to learn that I was not considered high risk and that I wasn’t monitored closer throughout my pregnancy. My age alone – I turned 43 the same month I found out I was pregnant – should have made me high risk, not to mention the weight loss surgery part. I appreciated Dr. F NOT treating me like I was a delicate flower, but I sometimes wonder if he should have taken a closer look. I’d really like to know more, especially if we decide to try for a second child. Up until everything started happening the day before The Peep was born, my pregnancy was very easy.

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