independence day

I did want to put the birth announcement up here first, as this is something of my Primary Address when it comes to the internet, but something was weird with the wireless network at the hospital and my computer couldn't connect, blah blah blah (now I'm just boring myself) and besides, everyone is on Facebook and Twitter anyway, right?  But just because I'm a completist when it comes to documentation:

Introducing:

Nina Qiao-Ying Walrath
Born July 2nd, 2012 at 12:05am
6lbs, 13oz
19 inches long

(Her Chinese middle name, picked out by my dad, means "witty" and "intelligent." We figured she'd have a lifetime of people telling her that she was "pretty"--I mean, not that we knew she would be pretty, though she is, but you know what I mean, people always tell little girls that--and we wanted to pick a middle name that would emphasize that there are more important things.  When it comes to first names, we don't make a big thing about choosing first names that have a lot of symbolism, we just go by the "like the way it sounds" school of baby naming, but so far as I can tell, Nina means "girl." So, you know, story checks out.)

Nina came into the world in her own way, which I am coming to understand is determinedly unique and certainly on her own timetable.  You remember I was admitted to the hospital for about 12 hours in what was first deemed to be active and then downgraded to a sort of meandering prodromal labor last week--and I spent the time since then doing exactly what I didn't want to do with the final stages of my pregnancy, which was puttering around, hyperaware of my body, and sort of obsessively cataloguing every squeeze and twinge and thump.  This is so annoying, I thought to myself.  If I was at work, I'd be busy, I'd have more to do than naval-gazing, and I wouldn't be so focused on every little thing going on all up in my junk.  This is a waste of time.

(She said with great PORTENT.)

Sunday morning--the day I turned 38 weeks--I woke up, and Nina, intrauterine, was still asleep.  I had gotten pretty accustomed to her sleep/wake patterns by this time, and usually she would perk up and start kicking around pretty soon after I got up myself, but this morning, she was a little slow to get going.  So I did the usual things they tell you to do.  I had some breakfast.  I had some coffee.  I started counting her kicks.  It wasn't that she wasn't moving around AT ALL--obviously that would have been very worrisome--she was meeting her minimum kick count, which I believe is 10 movements in 2 hours, but it was just different from usual.  She was just kind of pokey in there.

I know that decreased movement at term can be normal--there's just less room in there, after all, and who knows, maybe they sense when birth is imminent and quiet down to save energy for getting borned and all that.  But it was still a change, and though I considered long and hard just going about my day (see above: with the lack of my usual daily runaround, maybe I was just being too obsessive about what was going on inside) but in the end decided to just call my OB and get his opinion.

Sidebar: I cannot recommend my OB highly enough, by the way.  I can talk about it more with anyone who wants a recommendation, but his name is Dr. Brad Moore, here is the website for his office, and he is truly an excellent clinician and bedside doctor--and this is from someone who is well aware of the Pressures of Modern Medicine and therefore very forgiving when it comes to how other clinicians practice.  He is quite simply and unequivocally excellent, so get thee to his practice, pregnant ladies of Atlanta.  End sidebar.

Anyway, I called my OB, kind of apologizing for calling on the weekend about something that could be nothing, I'm not a hysteric, I swear, but he listened and he did take it seriously.  "Come on in," he told me, "we'll check you and check the baby.  You're 38 weeks, contracting, with advanced dilation, GBS positive and a history of fast labors.  If things are in line, maybe we'll just get in your antibiotics, augment you with a whiff of Pitocin, and have this baby tonight."

I think his intent had been for me to check into L&D right from the beginning (since he was on call that weekend he was already in the hospital, puttering around) but because my chief complaint was "decreased fetal movement at term" they sent me to triage first, where the nurse was very clearly of the opinion that I was a hysteric and should be sent home.  "The best outcome here would be to send you home," she told me brightly with one of those tight, forced smiles as she was doing the admissions paperwork, and after she got the phone orders from my OB that I should indeed be admitted to L&D, she made it clear that she disagreed in the way that people do without coming out and saying so outright.  "Well, you're getting admitted.  It's what your doctor wants, I guess..."  I don't begrudge her the sentiment--I don't like being on call for the weekend either, I guess--but I was also glad that I'd called my OB first and that the decision was not up to her.

The actual lead up to delivery was completely uneventful, much with with Cal and Mack.  I got my antibiotics, started some low-dose Pitocin, got my epidural (great stuff, by the way, though it's not an entirely pleasant process getting it placed, and fact that I'm pleased to be reminded of every 3.5 years just for the purposes of patient empathy) and then had my membranes ruptured with my second dose of penicillin hanging.  We were on our way.  At 11:56, the baby's head was at +2, all the players were in the room, and we were ready to push.

"We've still got four minutes to make a July 1st birthday!" Joe kidded, and my OB made a little jokey show of putting on his glove and gowns real fast.  Then we started pushing.

I should mention that up until this point, for the hours we'd been there, the fetal heartbeat monitor was looking really good.  Lots of good variability, perky, with a rate right in the normal range.  When the head was all the way down and we started getting ready to push however, the tracing looked a little more flat, meaning that the rate was still normal, but it wasn't quite as variable as it had been.  I assumed she just didn't like getting squashed.  But then after the first two rounds of pushing, it all kind of fell off a cliff.

Even in an adult, a heart rate of 50 in an adult is slow.  That's what Joe's heart rate is, and he's on beta blockers, for chrissake.  A heartrate of 50 in a neonate is...well.  Let's just say that if I was in the NICU and there was a baby with a heart rate of 50, I would be doing chest compressions on that baby.  After the first two pushes, that's what our baby's heart rate did on the monitor.  The nurse adjusted the Doppler, thinking maybe that the baby was so low down that it wasn't picking up, but no, it was picking up, and it was 50.  So my OB--in a way that was very calm but also very quick and decisive, and I'm convinced that it was this quick response that really saved us from those things we don't like to think about--busted out the obstetric vacuum, applied it to the baby's head, told me to push one more time quick, and pulled that puppy out of there.

Nina was born vigorous, with good tone, and she cried right away.  Her Apgars were 8 and 9.  As they were warming her up and drying her off, I heard my OB, from the region I like to call Down There, say, "Oh my gosh, look at this."  Which is not a thing that I like to hear from Down There.  Because when he delivered the rest of the placenta and cord, it looked like this:

(Let me just insert here that this is not a picture of our umbilical cord, it's a picture I got off Ye Internet, though ours looked remarkably similar, only tighter.  That is not to say that we didn't take pictures of this phenomenon, because WE TOTALLY DID, once the placenta and associated works were safely and discreetly deposited in the specimen basin, but they're on our "real" camera and I can't figure out how to get them off, because someone switched the settings so that all our photos from that day are in RAW format.  If someone knows a good strategy to batch convert them in Photoshop so we don't have to do them one by one, let me know in the comments section, thanks--I'll update with those photos once I'm able to extract them.)

In case you can't see for yourself, it was a knot.  What they call a true knot in the umbilical cord, which is pretty rare, and even rarer for it to actually get pulled tight enough to manifest with fetal distress.  The knot had probably already been there for months--Nina had probably tied it earlier in gestation when she was much smaller and there was more room to maneuver, and if you don't read about all the terrible things that can happen with a true knot in the umbilical cord, it's actually a little amusing to thing about her doing the loop-de-loop, then threading the needle while swinging her cord around like a lariat.  A little amusing, until she started to pull down on the cord on her way out and tightened that knot up but good.  Obviously we had no idea until after, it's not exactly something you screen for routinely without lack of other indicators for risk, and there's nothing you can really do to cause or prevent it.  We were incredibly lucky, and we know it.

I also do have to say this here, because these days, what my friend Veronica (also an OB-Gyn) has called "the fetishization of the natural" goes hand in hand with the demonization of the medical.  By no means am I saying that everyone should have the maximal interventions possible (Pitocin and epidurals and C-sections for everyone!) or that people's hearts aren't in the right places when they choose to have births outside of the hospital.  But if I were of the type to elect for a home birth (and let's be clear: I'M TOTALLY NOT) I would have, on paper, been the perfect candidate.  Multiparous with two prior uncomplicated vaginal deliveries, full-term with normal-sized fetus and an uncomplicated gestation.  But if this pregnancy experience has taught me anything, it's that you can't plan for everything, and there's always going to be things you can't expect.  And maybe because it's the anesthesiologist's credo (aside from vigilance), but I live by the idea of hoping for the best and planning for the worst.

This could have been bad.  It could have been catastrophic.  But it was not, and for that, and for our sweet baby Nina, we could not be more grateful.

Cal, upon meeting Nina for the first time in the hospital the next day, gave this assessment.  (Cal's demeanor is often overly serious--we keep telling him to lighten up, kid, for god's sake--and while we mentioned to him about the interesting little finding on Nina's umbilical cord we didn't really go into detail about what it could have meant; Cal's grave little pronouncements just happen on their own.)

"She's perfect." he told me.  "She's the perfect baby and we get to take her home with us."

Yes she is, and yes we do.  And we love her so much already.

Welcome to the family, Nina.  Now get ready to have some fun.