Circumcision

Just stashing these here.

http://www.cps.ca/english/statements/fn/fn96-01.htm#PREVENTION%20OF%20UTI

Prevention of UTI
Chessare¹¹⁶ developed a model for decisions concerning circumcision of newborn male infants to prevent UTIs. In the model, the probability of having a UTI in the first year of life was considered to be 4.1% for an uncircumcised boy and 0.2% for a circumcised boy,³³ and the likelihood of renal scarring as a result of a UTI was considered to be 7.5%.⁴⁷ The probability of minor complications was set at 21.8%, which is a much higher incidence rate than the rate of 0.19% reported by Wiswell and Geschke⁹¹ or of 2% to 10% estimated by the authors of a recent review.⁹⁰Chessare stated that the rate of minor complications has no effect on the preferred choice. Major complications were not included because they are relatively rare. All possible outcomes were ranked from worst (e.g., circumcision followed by renal disease) to best (e.g., no circumcision and no later UTI) on a scale of 0 to 1. For the set of values assigned to the possible outcomes, the highest expected benefit was obtained from the choice not to circumcise. The choice would remain not to circumcise even if none of the infants circumcised had complications as a result of the procedure and would change only if the probability of a UTI in the first year of life was 29% or greater. The possible reductions in the risk of penile carcinoma and of HIV infection were not considered in this model.

Thompson²¹ interpreted the published data by considering a hypothetical cohort of 2000 newborn male infants, half of whom were circumcised and half of whom were not. Given an incidence of UTI of 0.1% in the circumcised boys and of 1.0% in the uncircumcised ones during the first year of life, he calculated that there would be nine more UTIs for every 1000 newborns who were not circumcised. Thus, 99.9% of the circumcised infants would not experience a UTI, whereas 99.0% of the uncircumcised group would not have a UTI. Given a complication rate of 0.2%,⁹¹ Thompson estimated that, whereas 9 boys out of 1000 circumcised would benefit from circumcision, 12 would have moderately severe complications. At a complication rate of 4.0%, 41 boys would have moderately severe or worse complications. He concluded that the potential benefit to 9 in 1000 boys would be more than offset by the rate of moderately severe or worse complications, even if this rate was as low as 0.2%.

 

Better:

http://www.circinfo.net/urinary_tract_infections.html

In 1982 it was reported that 95% of UTIs in boys aged 5 days to 8 months were in uncircumcised infants [Ginsburg & McCracken, 1982]. This was confirmed by Wiswell in 1982 and a few years later Wiswell and colleagues found that in 5261 infants born at one US Army hospital, 4% of UTI cases were in uncircumcised males, but was only 0.2% in those who were circumcised [Wiswell et al., 1985]. This relatively captive population in Hawaii was said to be more reliable than the rate reported for hospital admissions [Wiswell, 2000].

…

Wiswell then went on to examine the records for 427,698 infants (219,755 boys) born in US Armed Forces hospitals from 1975-79 and found that the uncircumcised had an 11-fold higher incidence of UTIs [Wiswell & Geschke, 1989]. During this decade the frequency of circumcision in the USA decreased from 84% to 74% and this decrease was associated with an increase in rate of UTI [Wiswell et al., 1987]. Reviews by others in the mid-80s concluded there was a lower incidence in circumcised boys [Roberts, 1986; Lohr, 1989].

The rate in girls was stable during the period it was increasing in boys, in whom circumcision was in a decline. In a 1993 study by Wiswell of 209,399 infants born between 1985 and 1990 in US Army hospitals worldwide, 1046 (496 boys) got UTI in their first year of life [Wiswell & Hachey, 1993]. The number was equal for boys and girls, but was 10 times higher for uncircumcised boys. Among the uncircumcised boys younger than 3 months, 23% had bacteremia, caused by the same organism responsible for the UTI.

…

Premature uncircumcised boys had an 11-fold increase in risk of UTI and circumcision eliminated the risk of recurrence of UTI in a study in Augusta, Georgia [Cason et al., 2000].

..

Wiswell performed a meta-analysis of all 9 studies that had been published up until 1992 and found that every one had observed an increase in UTI in the uncircumcised [Wiswell & Hachey, 1993]. The average was 12-fold higher and the range was 5- to 89-fold, with 95% confidence intervals of 11-14 [Wiswell & Hachey, 1993]. Meta-analyses by others have reached similar conclusions.

Let me conclude this post, which serves only to provide me a place to find this info again, by noting that a UTI could literally kill my son.

(there’s more, too)

Theodore’s Journey Part IV

So I started keeping better track of things on the Carepage, and now I’m going to start a new blog just for Teddy’s stuff, and will link here when I get it going.

I did want to write a post on the emotional side of all of this. This is very stream of consciousness. I’ve made no attempt to filter, to put in order, or to make this make sense.

I remember, less than a month ago, being told by Dr. Auron (neph here in DM) that he probably had posterior urethral valves and would need surgery at about 6 months in Iowa City and I was pretty upset about that. I would cut off my right arm with a dull pocketknife if we could go back to that plan.

In the last month, I’ve gradually stopped crying during medical procedures. I’ve found my voice again. I learned how to change diapers with four different cords directly in the way. I somehow was completely OK with surgery on my newborn… 3 times. I had over a week where I cried – in front of strangers – every day. Then I had times when I was genuinely feeling OK, and then I’d see something in the hallway on my way to lunch that would just trip that trigger and I’d be sobbing. I’m honestly still like that. I’m reminded of The Replacements – that scene before the first big game, the coach and the Keaneau Reeves character are talking about how they’re like ducks on a pond – calm on the surface, but under the water, those feet are churning. I’m OK on the surface, but if you delve down even just one fingernail deep, I’m really not that great.

I have yelled at God nearly every day. I have taken comfort in a sermon I heard once about how God was big enough to withstand our fury. I’m not going to hurt His feelings. I can be furious with Him and trust in His care all at the same time, and I’m not even going to try to explain that one. I have said, countless times, that His plans suck. He needs to come up with something better. But down inside, I still trust that He knows what He is doing.

You know, my mom had kidney failure at the age of 50 after 46 years of battling diabetes. But she was 50! Teddy was 1 week old. ONE WEEK. What kind of a God would do this to a one week old? Yes, I’ve asked that question. And I’ve meant it, to a certain extent, even though my personal beliefs do not include a God who “does things” to people. Again, I don’t try to explain that.

I trust that God knows what it’s like to watch your child in pain.

I sent this email to my uncle (a minister):

I am really struggling with this one. For the past 6 months, I’ve been trying to memorize Psalm 139. (Mommy brain makes it a challenge, lol, but I’ve nearly got it down now.) It has the verses about “For you created my inmost being; you knit me together in my mother’s womb… My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be.”

And I read that and I sit here and wonder how God could do this to a tiny baby. How, when he was knitting together MY baby, could He have decided to give him only one kidney, and then to make that one not work right? What did we ever do to Him that He feels we have to go through all this? What did my three year old do to deserve to be away from her mommy for weeks at a time, shuffled around on a makeshift daycare schedule of friends and family? What did my 7 year old do to deserve any of this? And mostly, as I watch them take away my baby for two surgeries, as i watch them poke him and stick things in him, and cause him pain several time daily, I wonder what HE ever did to deserve this. He is not even 3 weeks old, and his whole life has been pain.

I know Gods plans are based on a much broader view of things. I have such a limited perspective. I know all things work to His glory. I have received email from people I don’t even know that they heard about his story and it touched their lives and that God is working through Theodore to change them…and that is great, but doesn’t actually help much. Because it still leaves me wondering how this is at all fair.

—

And, yeah. I mean, it’s great that Teddy is touching the lives of others. It is. But surely God, who created the Earth from NOTHING, and made man from dirt, could have come up with another way to reach those people. I mean, don’t tell me He is THAT lacking in creativity.

Do I sound angry? I am, and I’m not. I am mad, like I was mad when we had our second miscarriage. I was furious, at everyone and noone. I’m not as furious as I was at that time, but there’s a lot of emotions in there that come out most easily as anger.

—

Here’s where I indulge my petty side. When I was dealing with our second miscarriage, I had a few friends who were also PG and they felt a little uncertain about me dealing with their healthy pregnancies. And I was really OK. I went through a period of being insanely jealous of those people who just breeze through pregnancies without any hint of worry that something might go wrong. I still kind of hate those people, and it’s not even their fault.

This time, I’m having more trouble. I don’t know who all reads this blog, but yes, it’s possible I’m going to be talking about you here in a second. It’s not you, it’s not personal. It’s nothing you do, can do, can stop doing, etc. It’s me and I just need to work through it.

So, yeah. I have several friends who are PG and going to 20 week ultrasounds and hey! everything looks GREAT!  Oh, my, God, I can’t even begin to explain how that makes me feel. I am OF COURSE happy for them. I would be happy for people I hate reporting that news, too. Don’t misunderstand. But I also kind of die a little inside every time. I have friends with happy, healthy newborns who, again, I am of course super happy for. But, yeah, I also can’t help but think “dammit, why can’t that be ME?” I had SUCH a hard time while we were inpatient with this. Walking to lunch, I’d pass someone with a baby in a stroller and want to scream a little. Looking at the other NICU parents, some of whom had that same shellshocked look I’m sure I had the first week, but knowing that most of them were there only for a few days or a week while their premature but otherwise perfectly healthy baby grew just a bit stronger. You get to go home and stay home and forget about this, I couldn’t help but think. I would kill to be you.

No, I’m not the first person to have a baby with an illness. I’m not the first person to have a baby in the NICU. I’m not the first person to have a newborn with kidney failure. (though, in the grand scheme of things, we are among the few there.) I know that. (And I’m surrounded by friends – close friends and not so close – who have dealt with NICU babies and babies with health problems, and etc. and I’m sure each of them has gone through similar emotions.)

—

So I have a post percolating about Star Wars and God and all of this, working with the “All the days ordained for me were written in your book before one of them came to be” and my view of omniscience. It should be a doozy.

Nephrology Research – transplants

http://www.lpch.org/clinicalSpecialtiesServices/COE/Transplant/KidneyTransplant/adultKidneys.html

Adult Kidneys transplanted into babies do the best of any transplant, ever. Have to have lots of extra fluid to increase blood volume for at least 12 months after. IV and gastric tube.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1358172/

Tends to go really well.

 

http://www.advancesinpd.com/adv90/64treatment90.html

Has a lot of issues (not with survival, but just… it’s complicated).

 

http://www.uofmchildrenshospital.org/Specialties/Transplant/Kidney/index.htm

Walks through transplant process. U of M has a great transplant program. Also “The hospital stay for a pediatric kidney transplant patient at University of Minnesota Amplatz Children’s Hospital averages between one and two weeks.”  Wow. Short.

 

http://cjasn.asnjournals.org/content/5/1/18.full

More stats

 

http://www.childrenshospital.org/clinicalservices/Site2202/mainpageS2202P0.html

Boston also has an excellent program

 

 

From my reading, a transplanted kidney will last 15-20 years. Sigh. This is going to be a long road.

Theodore’s Journey Part III

After surgery, his numbers improved a little, but not the dramatic improvement they were hoping for. By Tuesday (the 6th), everyone pretty much gave up.

His morning labs didn’t look great that morning, and when the perinatology team did rounds, they didn’t have much to say. The nurse said she had seen the nephrology team in the hallway, so we waited for them to stop by. Like 2 hours. They were all still talking to each other. And as much as I wanted to think I was being big-headed to believe that they were talking about us, I just kind of knew they were taking about us. And that they were talking about us for such a long time probably meant they weren’t saying “hey, things are looking ok.”

Turns out, they WERE talking about us, and no, they didn’t think things looked OK. They thought things looked pretty bad. He is making urine, but the kidneys aren’t actually filtering his blood. Not only were the toxins building up in his blood, but his electrolytes were starting to get all out of whack. This could lead to a whole host of bad things, including poor growth, lack of appetite, etc., in addition to just making him a pretty sick little kid.

His blood needs to be filtered. The bad stuff needs to come out. He needs dialysis.

She did throw us a bone that maybe, given time, his kidney will start working again, but then pretty much made it sound like it’s just as likely that his kidney will turn into a flock of geese and migrate south for the winter.

That night, he had so many tubes, I was not able to hold him, even for feeds. Asshats.

He had surgery Wednesday to install the PD catheter. That surgery went well, and they also installed a broviac line in his chest to do IV stuff and also blood draws. (He was blowing through IV sites about once a day, and he’s apparently very challenging to install an IV in, meaning that they blew out at least one vein with every IV placement attempt.)

The next few days, it was on again/off again with whether the broviac line would draw. We’ve finally figured out the trick, though – prop up his shoulders and turn his head.

On Thursday, they also installed a Picc line in his foot. That took about 3 hours. Sigh. They use that to give him bicarbonate (baking soda) to reduce acidosis.

He was on and off gavage feeds, and then he was on no feeds, and then he was on teeny tiny feeds, and then they finally let him go back to all breastmilk, as much as he wanted, on Friday. However, they were still pumping him pretty full of nutrition via IV, so he wasn’t all that hungry. They started backing that down a little over the weekend, and he’s eating better at this point (Monday).

I actually started sleeping in our room at Rossi House with the big kids, wanting to fill them up on mommy time before they had to leave, and Randy spent most of the days and early mornings with Theodore.

Sunday afternoon, Randy and the kids left to go home for the week. I’m settling in for a quiet week hanging out in the NICU, being in the nurses’ way. (And I don’t care at all.) I have his Christmas stocking kit that I’m hoping to work on, and a book that I’m sure I’ll finish before too long. I’ve got knitting. I’ve got some movies. I’ve got rhythm, I’ve got music…

I think that brings us up to date. I might post later on about how crappy I think all of this is and how I seriously don’t get it, God. He’s just a Baby.

Theodore’s Journey, Part II

Saturday and Sunday (3rd and 4th) are kind of a blur. He did get to go back on breastmilk, but from a bottle. Damn, that was hard. Particularly because when babies fuss, my solution is boobies. Boobies are my one-stop baby soothing shop. They are my only parenting trick. (OK, also babywearing and babywearing while bouncing on the birth ball, both of which were clearly out of the question.) I had to have a nurse show me how to feed him, and I actually had to get help figuring out how to get him to suck on the pacifier. Yeah, I’ve never done either of those before.

They had planned to watch his numbers with that catheter in. They did another ultrasound. Showed the same thing as all the others (severe hydronephrosis in left kidney, hypoplastic right kidney. Ultimately, they decided they’d probably need to do surgery to correct, not the valve at the bladder, but the narrowing in the ureter at the kidney exit. (I think they’d like to correct both at some point, but only wanted to do one thing at a time.) They decided to do it Monday morning, then Sunday around noon, Dr. Cooper decided to just do it that day. At 3. Or 5. Or 7. We kept getting bumped, but they did eventually get him in.

He also explained to us that Theodore would need to be circumcised. There is a slight increase in the risk of getting a UTI with intact foreskin. But with only one kidney, and one kidney that is just barely holding on, keeping him from getting a UTI is a pretty big priority. Apparently, foreskin was something we just didn’t need to take a risk with.

And Dammit. I was not upset about the surgery. It was needed, I was surprisingly completely OK with surgery on my week-old premature infant. But that circumcision. Randy said it’s not the end of the word, and I was like – you know, I know that, but for the love of all things holy, what ELSE do I have to give up? I know, ultimately, foreskin is not a huge deal, but it felt like (and still does feel like) it is. I still cry about it every time I think of it.

I am trying to tell myself that it’s just like a C/S – if it’s needed, it’s needed. It’s the UNnecessary use of these medical procedures that is a bad thing. Using the procedures when there is a medical need is a good thing. And my response to myself is “yeah, yeah.” At least they did it while he was under a general, and they gave him stitches and everything.

So… surgery went well. They cut out the narrow part in the ureter and sewed the two ends together. Kidney started draining right away. He installed a stent inside the ureter, just to hold it open while it healed (so the scar tissue didn’t form a blockage). He installed a nephrostomy, which is a drain tube leading from his kidney that comes out his back and looks like a little tail. Both of those should come out after two weeks. He also had an epidural, which I guess they’re starting to give to babies to help with pain post-op. They also gave him morphine.

The big kids went home with grandma and grandpa and Aunt Kelly and had a sleepover for two nights at Aunt Kelly’s house. They seemed to be OK, but when they came back on Tuesday, Wally was kind of quiet and withdrawn, and Genna was soooo clingy and upset and sad and unable to cope with anything.

Everyone hoped that the kidney would drain and then start working right and we could go home. I actually let myself believe that a little. Yeah… hadn’t learned my lesson about that yet.

Theodore’s Journey… Part I

I’m going to have to piece some of this together from IM’s and Facebook posts, because honestly, the last week is somewhat of a mishmash of bad memories all piled together.

So… I had Theodore on Saturday, 11/26. He peed in the hospital, we were all happy. I asked the pediatrician on staff if he would please call Dr Auron, the ped nephrologist in DM. He said he didn’t think that was necessary, and based on looking at his U/S records, the right kidney had “no concerns.” So we went home super happy, on Monday.

We had a GREAT week. I mostly sat on my butt like a good little girl, knitting and nursing. I played Zelda on the Wii with Wally every day. Took some naked baby pictures. Hung out.

Friday morning, we had our consult with Dr. Auron. At 8:15,we showed up, they collected urine (just think, I felt terrible they were sticking a bag on his little wiener) and we chatted with Dr Auron a bit. He said that he suspected he had either urethral valves, or reflux. Both are easily correctable, sometimes they adopt a wait-and-see approach and just monitor for a few years, but he suspected that our case would need surgery sooner rather than later since the hydronephrosis was so bad, and since his right kidney appeared to be nonfunctional. When a kid only has one kidney, they tend to want to act sooner just because it’s so important to keep that one kidney working. So, he thought probably surgery at 6 months in Iowa City. At the time, that seemed terrible.

We went to ultrasound, then blood draw, then to radiology. I forget the name of the test they did, but they essentially put in a catheter (which, at the time, seemed terrible) and then filled his bladder with contrast dye and took an Xray video. Kind of awesome, but I was holding his head and arms down (again, at that time, this seemed horrible) and couldn’t see the monitor from where I was.

Then we went home. Two hours later, Dr Auron himself called back. He wanted us to come right back and have another blood draw, but this time with a transport nurse doing it. (I didn’t know it at the time, but it’s apparently pretty easy to damage red blood cells when you do a blood draw, and then that can mess up some of the results – the very results that we really needed to have accurate.) He also said that his creatinine was really high, and based on that and the other blood work, and the protein and other things in his urine, he was pretty sure that his kidneys had shut down.

So that was a bad phone call.

So we packed up and left again. Sat in Path lab for an hour waiting for transport to come down. They poked his head twice and a few other places, as well, but finally got it. Then they sent us up to Dr Auron’s. He kept thinking he’d have time to stop in and talk to us between appointments, but he didn’t, and we ended up sitting around until 4:30 when the clinic closed. But the whole time, nurses kept checking on us, and I ran into Dr. Auron in the hallway once, and they all had Sympathy Face on, and we just kind of knew that things were going to be pretty sucky.

Dr Auron had us come into his closet-like office so he could show us the Xray and ultrasound pictures on his computer. I don’t remember what he said, to be honest. He teared up a little. He felt soooo bad for us. He said that he’d want to admit us to the NICU and put in a catheter, because it appeared that, in addition to the narrowing of the ureter at the exit from the left kidney and the defective valves at the entrance to the bladder, he also had a narrowing of the urethrea, and maybe that was making it hard for his kidney to drain appropriately. He hoped to put in a catheter and maybe that would be all he needed, just help peeing.

Honestly, at the time, I remember thinking that that didn’t make a whole lot of sense, but I also wasn’t in any position to ask questions. Well, I was, but all of the other alternatives were more horrible, and the catheter seemed the least terrible option, and I was willing to go with it.

So, up to the NICU (with the same transport nurse who did his blood draw). Everyone up there was so super nice. They got me some water. The transport nurse rounded up some pads for me (I didn’t have any, since I was not planning to spend the night when I left the house that morning). And they spent the next several hours doing terrible things to my poor kid who was STARVING and then told me that he couldn’t have breastmilk. Sigh.

I spent those hours with my finger in his mouth, stroking his head and shielding his eyes from the bright lights while they put in a few IVs, did more blood draws, and tried several times to put in a catheter. When they couldn’t get it in, Dr Auron decided that he needed to go to Iowa City. I don’t actually recall anyone telling us this directly, only overhearing the nurses talking about it. Someone gave me papers to sign.

I’d been resisting a pacifier, but they had just told me he couldn’t nurse, and he was going to be in an isolette for the 2 hours to Iowa City, so I ended up deciding it would be OK, because I didn’t want him to be upset during the ride.

So, there went two of my sacred cows… breastfeeding and pacifiers. And, cosleeping, at least for a while.

Randy went home to pack. Apparently, there was some back and forth with his parents about his needing them to come to our house and drive him to Iowa City. (I told him not to drive himself.) He finally got on the road about the time I was arriving in Iowa City in the ambulence. Theodore slept the whole time.

Once we arrived in the NICU, there were approx 3,000 people in his room. I sort of got the impression that they wanted me to just step aside and wait, but after a quick trip to the bathroom, I squeezed in and resumed the head rubbing that ended up becoming my main way of providing comfort over the course of the next week. I don’t remember what all they did to him. Labs, and monitors. Someone tried and failed to get in a catheter. Then Dr Cooper from urology (who I do like, but is also kind of on my shit list) retracted his foreskin. Sigh. It was over before I knew he was doing it, and while I understand why he did it, I think the least he could have done was SAY SOMETHING ABOUT IT. Then we would have had to have a conversation about it, which is probably what he was trying to avoid. He actually said “trust me, some day you’ll thank me for that” to Theodore. I wanted to say, “I’m sorry, really? You’re a UROLOGIST. Surely you know that it’s a rare male who has a foreskin that doesn’t retract on its own before he reaches adulthood. How is it possible that I know more about foreskin than the head of ped urology at UIHC?” But I was really too tired and upset to work up much more than a few head nods. It was 11 or so, I think. My phone apparently doesn’t keep that many text messages, so I can’t look it up.

Eventually, they did get the catheter in (had to use some other type of tube – a feeding tube, maybe?) and a whole mess of people – some of whom had been woken up at home to come in and see him – had different things to say to me, none of which I recall. At some point, Randy got there and hung out with me for a half hour or so, then they all found a hotel. Genna woke up once they arrived around midnight, and didn’t go back to sleep for a few hours. I ended up going out to get dinner at about 2:30 am. Surprisingly, the fried cheese balls under the heat lamps in the overnight cafeteria were delicious, but I only ate about half of them.

Nearly throwing up whatever I was eating became somewhat of a theme for the next 4-5 days.

I eventually fell asleep in the NICU room.

 

—–

Also, ultimately, I’ve heard that they suspect his right kidney was fine, but the reflux on that side is much worse than the reflux on the left, and they think that it might have just been completely destroyed in utero by the reflux. Among the things I think people need to explain to me, I think someone needs to explain to me how at 33 weeks, Dr Drake still saw a perfectly healthy, appropriately sized right kidney, but at 34 weeks, Dr Mandsager could not see a right kidney at all. That one is a mystery to me. Ultimately, no, it doesn’t matter, but I want to know anyway.

Last, I’ve noticed something about docs here in the NICU. They make the decisions. Parents are told after the fact. That is not how I am accustomed to doing business, and ultimately, they are going to have to realize that. They are not in charge. I am still in charge here.

Theodore Joseph’s birth story

This is a bit of an emotional one for me.

I really haven’t blogged about the stresses of this pregnancy. At our 19 week routine ultrasound (due to the MTHFR), they discovered that the left kidney had hydronephrosis (swelling) and there was a two-vessel cord. Dr Drake recommended coming back in 4 weeks to follow up and see if the hydronephrosis went away (sometimes it does).

So over the course of the next several months, we watched it get slowly worse.

Then at 31 weeks, the fluid level dropped to 8 (low normal) and Dr. Drake became very concerned. A week later, it was still 8, and she said we’d need to induce at 34 weeks.

We switched to Dr. Mandsager, who saw us at 33 weeks for a BPP and NST. Fluid still 8, he was not concerned. He could not find a right kidney at all, left kidney was worse still.

Weekly BPP and NST. 34 weeks showed a right kidney that was small and underdeveloped with no blood flow. Fluid at 4. Dr. Hwang says we need hospital birth, no later than 37 weeks, baby will be in NICU, baby may not make it, baby may need dialysis or transplant. Ped Nephrologist is out of town until 12/2.

34 and a half weeks showed a small right kidney that did have blood flow and fluid back up a bit. 35 weeks had normal fluid. 35 and a half weeks (day after Thanksgiving) showed fluid back down to 2. Mandsager wants me in hospital overnight for monitoring. I declined, and left AMA.

Seriously. I was NOT going to stay. I know 2 is low. Really low. I needed to come home. I needed to sleep in my own bed with my kids. I needed them and me to have a night together. I needed to sit and drink water like nobody’s business. I just needed to.

Next morning, fluid was still at 2, but they let us go. They let us go. And though I knew in the back of my mind that they were going to call us back, I still let part of me believe that we were really fine, that we were going to get to have a nice weekend together and worry about the next ultrasound on Tuesday.

And then they called and said we needed to come in right away for an induction.

And then I asked to talk to Dr. Mandsager about that. I just wanted to know why. What specifically were the concerns. Wasn’t he concerned about pitocin induction on a baby with a 2 vessel cord? What made induction preferable to waiting another few days? And he just would not answer my questions. I explained to him that I needed his help with this because I was starting to feel like i was not getting good care from his office – it’d been 2 weeks since I’d seen any actual doctors and now he wasn’t answering my questions on the phone, could he just please help me understand. And he said that I should go find myself a new doctor.

Yeah, asshole, keep it up – I really want you at my baby’s birth now! Jerk. God, I hate him.

The funny thing was, we’d been preparing for an early hospital delivery since 32 weeks. I’d been packed, had bags packed for the kids. Was trying to adjust mentally to the idea. We’d been talking about it. And then when everything looked so good that Monday before Thanksgiving, we let ourselves think it would all be OK. Maybe I’d get to be back with Cosette at home after all! And even Saturday morning… they let us walk out of there. They let me go home.

I just wasn’t ready to go have a baby.

I’ve always loved being pregnant. Loved it. Even through all the ups and downs with this one, I love being pregnant. I was walking around on Friday (the day before I delivered) thinking about how much I loved being pregnant. I’ve never ever hit a point in any pregnancy where I’ve been “sick” of being pregnant. Even with Wally, who was born at 42 weeks. I have, however, always hit a point where I’m “ready.” Just – ready. And I hadn’t yet hit that point with this one.

I just was not ready.

So, we called the IL’s to come get the kids, called my sister, called Cosette, crying the whole time, and headed to the hospital. Crying. Up in the elevator. Crying. Waiting in the waiting room. Crying. Another couple also waiting to check in, so happy, I think I was stressing them out.

And I knew it needed to be done. I wasn’t ever really NOT going to do it. I just needed a few minutes, you know? I needed questions answered, I needed to know my perspective was being considered, I needed respect, and I needed to just cry for a bit. And I did.

Our nurse was so super. We walked in and she came in and was all chipper and “how are you guys today?” excited and then she turns and sees that I’m not answering her because I’m trying not to start sobbing again, and Randy said we were not so great, and she just seriously switched off the chipper and said she had no idea what was going on, but what could she do for us. She got Mandsager in the room for us before anything else, and he was much more respectful face to face – and I was calmer, having had my chance to freak out and get it out of my system. I hate talking to people with cry face, but I had gotten myself under control at that point, at least.

And then, you know, I just got over it. I just needed that space, and then I flipped on that switch, and said, Alright, we need to do this, let’s do it.

I did ask him about amnioinfusion, where they pump saline into the uterus to cushion things. It can be indicated when low fluid is causing the baby’s heart tones to be nonreassuring. Often, this is caused by cord compression, and putting more fluid into the uterus can provide enough cushion to get heart tones looking good again and avoid a C/S for fetal distress. I’m ALL FOR THAT. I had been reading about this and had several studies printed out that said, hey, it’s effective, it’s safe, and it’s cheap – absolutely do it. But Mandsager, in talking to Cosette, totally poo pooed the idea, and actually said that Mercy didn’t do it. (I asked our nurse, who said that was BS and that she herself had done it before.) So while we were there, I asked him about it and he said it was something we could consider. I pushed on that one, because I know what ‘we could consider that’ means – it means, I’ll come up with a reason for saying no later. The nurse listened in on this conversation, more on that later.

I also handed him the birth plan we never got to discuss. He read it. He said it looked fine, and nothing should be a problem. After he left, we gave it to the nurse, who also read it. I told her I usually want to be kind of left alone, I don’t want to be counted at – ever, and once I hit active labor, it tends to fly. She said she never counts at moms, it’s annoying. She read through the plan and said “you’re my kind of mom, this is the type of birth I love.”

She was literally a gift from God. I don’t know how else to explain it. She was what God sent me to say “Hey, I’ve got this one.”

So, they wanted me to put on a gown and I asked if I couldn’t just wear a Tshirt. Sure, she said. (awesome) Mandsager came back to check my cervix. Um, he is NOT GENTLE in the slightest. Just… ow. Decided while he was in there to break my water, something I found amusing, all things considered. Hoping that would get things started. Yeah, nothing came out. They kept asking me if I was feeling anything coming out, and I would guess that at most, a few teaspoons came out the whole time.

So Kim, our doula arrived, and they got the monitors on. I had started having really regular contractions, but not too strong. They got the pit started, and the antibiotic (I had tested GBS pos). I told the nurse I was hoping they would have forgotten about that. She said it’s her job to NOT forget things like that, but it’s not her job to make me to do it. “You don’t have to have the antibiotic if you don’t want it. Just let me know.”  I mean, really? AWESOME.

Ultimately, knowing we might have a long haul ahead of us with the baby, I decided to do the antibiotic, but it was nice to be able to make the decision. I need those little things, you know?

Also, she let me put my undies and sweatpants back on, and I kept them on until just before the baby came out, despite the fact that taking them on and off for cervical checks (just a few) was a serious pain for the nurses. Bless them for that.

Sooo… then started a long period of waiting for something to happen. Contractions got closer and stronger, then they’d turn down the pit and they’d get more spaced out and less strong. I had an obsessive need to watch the monitor – for baby’s heart tones, and also to judge the contractions. It was so dang important that they be strong. The nurse kept laughing at me, because I was like “come on, let’s bring on the ones I need to concentrate for. The uncomfortable ones. I want to be groaning here!” But seriously – let’s get ‘er done, eh?

I also kept commenting that it was just wrong. This not how you have a baby. You don’t go to the hospital and wait for labor to start. Ridiculous. The whole first part of my labor was just stupid. I posted on FB that I was bored, and I was. My sister came and hung out with us until 8 or so.

I was sooo tired, I tried to lay down for a while, but could not get comfortable with the monitors jabbing me. The nurse came in because the baby had a few small decels and she was concerned. She started talking about going ahead and starting the amnioinfusion, because her preference would be to start it before anything got too serious so that it’s all in place and maybe we prevent things from getting serious. She said she’s done it herself several times, and it’s worked pretty well most times. If nothing else, she agreed, it is something to try to prevent a C/S for nonreassuring heart tones, and if you can prevent a C/S, then so much the better. I told her I’d try getting back up and we could watch for another hour or so and see how it looks and go from there, she agreed that was a good plan. Then he never had any more decels, so… awesome.

Our first nurse went off shift at some point, but she hand selected our next nurse, who was just as awesome. Then she went off, and chose another nurse for us, who was studying to be a midwife. Yeah. Super awesome. All 3 nurses hung out with us and chatted or just stayed in the room, quiet.

Eventually, I actually had to focus on contractions, and made everyone be quiet during them. They were close together and stronger, though not terrible. I told the nurse I was ready for terrible. Geez, already. Randy called his mom, she asked about how far apart they were, he told her 2 minutes, she said it would be soon, he said probably not, she told him she knew more about having babies than he did. Ha. I have to say, my husband knows more about having babies than 70% of American women and 95% of American men.

Early on, I felt a lot of pressure and definitely felt the head moving down. I got all excited and asked to be checked. Yeah. She would not even tell me what it was. (later found out it was 2. Yeah.)

I sat on the birth ball some, stood some. I actually paced for a while, which is what I really wanted to do, but was so confined in my space, i felt super silly, particularly with everyone just watching me like a tennis match. Sat on the edge of the bed some. At one point, they lowered the foot of the bed and raised the upper part and I sort of half squatted over the edge, and laid back on the pillows between. I had a hard time making that be comfortable, but I was starting to get too tired to stand any more.

They turned down the pit, contractions spaced out. Turned up pit, they came back. I stopped caring whether they were “my” contractions or pit contractions. Eventually, the contractions got pretty strong. Actually, they started to hurt like pain. Like, not labor, but like… I don’t know… pain. In the front. I started breathing through them, and found a way to rub my belly through them without bothering the monitors too much. Again, I felt pressure and asked to be checked. 5. FIVE. That was at 8. I was literally thinking to myself that it took me 7 hours to get to that point, and several hours of that had been pretty hard work. There was no way I was going to make it.

I got back up to stand. At some point, I tried leaning on Randy’s chest and it was nice. I started having to give myself pep talks through contractions and actually ended up talking to the baby, too. “You can do this. We can do this together. Come on, baby. Let’s do this. We can do it.” It actually helped. I was sooo worried about him during this part. It was hard on me, and I figured it was hard on him. So I kept turning around to check the monitor, which was distracting.

At some point, I started moaning during contractions. And holding my crotch. Just felt right. Weird. Then I stopped having breaks. I mean, there were clearly times when the squeezing was stronger than others, but no time when there wasn’t tightness. Kim had been talking to the nurses about how, once I really start going, I tend to go fast. They were each prepared to deliver the baby themselves, lol. (I tried to bribe the last nurse to just go that route.) Anyway, she also had told them that I have this noise, apparently many women make it, that is the signal that things are really starting to happen. Randy calls it the Yeti call.

So I heard myself doing that noise, and tried to tell someone, but all I could do was nod. But everyone knew. Upon hearing that sound, Randy wisely suggested I should take off my pants. Good thinking. I stripped to just my Tshirt and hopped up on the bed. Next contraction, I kneeled on the bed and rested my head on the squat bar and it was SOOOO comfortable. The nurse called Dr M and then needed to check me (why, I don’t know) and wanted me to lay down after the contraction. I just didn’t. She even asked “are you still having a contraction?” and I said “no, I just don’t want to.” Then had another one and she checked me. She did not want me pushing because I apparently wasn’t complete. She also wanted me actually squatting, which I tried to do for her, but hopped back to my knees once the next contraction started as Dr M walked in. DURING this contraction, he insisted I needed to be on my back. Our nurse, bless her heart, told him she wasn’t going to make me (and she would had a fight on her hands anyway, lol) because he had already agreed to my birth plan, which said I wanted to be upright, probably squatting. Next contraction, kneeling, I reached down and caught the baby as he slid out (and said “hey, that’s a baby coming out!”) and all I can hear is Mandsager, across the room, throwing a fit like a four year old. “Well, I can’t do anything with you like that. THAT is why I wanted you ON YOUR BACK!”

FOR REAL. He actually SAID THAT. TO ME. As the baby was coming out and I was howling like a Yeti. I mean, I didn’t expect “wow, you are one powerful, strong woman” or anything, but REALLY?? And clearly, buddy, your assistance here is not needed. Look, there is a baby ON THE BED. You don’t even have your stupid gown on, you hack. I wish he’d just stayed at the far side of the room there. Asshat.

Anyway, I was so surprised to reach down and feel a head coming out of me. It was a whole head, too. Then I kind of stopped being able to process things, and also was distracted by the asshattery going on.

Then he clamped the cord immediately (against our wishes), pulled on the cord (against our wishes), pounded on my stomach (against my wishes and after I told him to stop), and got the placenta out pretty much immediately. He was REALLY rough with me checking things and was out of the room in about 5 minutes. I mean, good riddance, but that’s HARDLY good care.

The nurse was awesome, and we had a great time hanging out in the room with Theodore. She was in NO hurry to do vitals and did them all with him on my chest. He was reluctant to nurse but finally did a wee bit.

The rest of our hospital stay was kind of a downer, from “required” formula to bottles to tests and 90 minutes in the carseat, no cosleeping (ha, but I did a little anyway), pumping, yadda yadda. Stupid nurses and a pediatrician who I am now incredibly mad at. He didn’t see any reason to call Dr Auron (nephrologist) since he was peeing well. Sigh. I should have insisted, but I still hadn’t learned to just start expecting the worst and still was willing to believe any good news thrown my way.

We went home after 3 days and had almost 3 days at home together, living a normal life. I got to snuggle with all three of my little ones for 3 nights. And then life kind of fell apart.

Premotherhood Self

Because I can never make it to the mamas group hosted by my Midwife’s office, I decided to go ahead and write out some thoughts on this month’s topic. Our Pre-Motherhood Selves, the Woman apart from her role as mother.

This topic will bring in the theme of life-long dreams (what we dreamed of doing before we were mothers, and how we are or are not working to achieve those dreams at this moment in time), work/professional identity (what we may have “done” before kids or what we were training to do, and how that has played out in our current lives), and our holistic identities as women who have emerged from birth and early childhood parenting with…Some? All? None? of our former “identities” intact.

This is an interesting thing to think about. Here’s where I ended up – I’m not sure that my pre-motherhood self is relevant any more, just like my pre-marriage self is no longer relevant, and my pre-college self, and my pre-parents illness/deaths self, and my pre-ITP self, and my pre-miscarriage self. All of those life experiences make me who I am today. The person I was 8 years ago is not the person I am today, and the person I am today will never be the person I was 8 years ago. I carry that person along with me, as well as all of my other previous selves, and they inform and affect the person I am now, but I don’t think that isolating my personality/my self from any point in history is necessarily a useful exercise.

Maybe my perspective on this is affected by my answer to this question: What did I dream of doing before I was a mother?

I dreamed of being a stay at home mom. I mean, really. I have always known that, ultimately, I would be a stay at home/homeschooling mom. I enjoyed the years we were married before kids – a lot. We had a lot of fun. But, ultimately, I wanted to be doing exactly what I am doing today. And maybe it’s that harmony, the peace of knowing that I’m doing what I was meant to do, that makes me not have that longing for some pre-child version of myself that I see many other parents struggling with.

Anti Kid Backlash

You know, some of the antikid stuff here lately comes from PARENTS and I’m tired of parents not waking up to this. (or owning up to it, anyway.)

By Antikid stuff I mean restaurants or stores instituting bans on children.

Yeah, that kind of stuff bugs me.

But ultimately, it’s a business owner’s right to decide who to do business with. (example: cake baker in Des Moines recently under fire for not wanting to do a cake for a lesbian wedding. Her right.)

But I am appalled at the behavior of other parents a good portion of the time, and shocked that all parents can’t see any correlation between parental actions (or nonactions) and these types of policies. Examples:

- Taking your kids to restaurants clearly not meant for kids. (upscale, expensive, no or teeny tiny kids menus, dark, candlelight, largely adult patrons.)

- Letting your kids run around at any restaurant (other than Chuck E Cheese or something), or be loud, or throw things, or otherwise disturb other patrons.

- Letting your kids touch fragile things at a store. I apparently know many parents who don’t see a problem with this at all. “They know how to handle breakables.” Yeah, that’s great. Actually, my kids do, too, and as long as I’m supervising, i totally trust them. Problem is, the store owner doesn’t know that, and can’t possibly know that, and can’t know that MY kids are OK with breakables but another person’s kids aren’t. It’s just simply considerate (polite) to not let the kids handle fragile things without permission from the owner of those things.

- Letting your kids roam unsupervised at a store.

- Letting kids yell, play with toys you have no intention of purchasing and that aren’t set out as samples intended for play, or pull things off shelves.

 

I see this kind of crap all the time. (except the first one, we haven’t been to a really nice restaurant in years and years) It baffles me, particularly when the very same parents then complain about our society being so “anti kid.”

I’m not saying my kids are perfect. If they are disruptive, though, I remove them so that they don’t bother other people. Because, guess what? Not everyone finds my kids as charming as I do.

PS, also tired of the reaction to these stories being shock and disbelief that a business owner might not want to do as much business as possible. It’s like when people are surprised that I won’t give them special discounts, because they are so certain that every business owner is just desperate for more business. I’m not wanting to turn down business, but unprofitable business is worse than no business. (And, in a restaurant’s case, if they believe they will get more business by not allowing kids, then they are making a smart business decision.)

Stockpiling

Alright, I’ve had it with the backwards slams about stockpiling.

You know, “we don’t feel we need to hoard food above our current needs, we prefer to donate any extra food we pick up for cheap (with coupons) to charity.”  The ones that use the word “hoarding” or the ones that imply that those who stockpile food/supplies are selfish.

Let’s set the record straight.

And while we’re doing that, let’s keep in mind that smart stockpilers don’t discuss their stockpiling. I’m not necessarily talking about myself here. (And, really, I’m only a wanna-be stockpiler.)

My family (Dh, me, kids) have plans for what we would do under nearly any scenario. We know where we would go. We know how we would survive in the city in our own home, and we know where we would go if we need to leave and how we would get there. I’ve scoped out potential sources of water. Where we could forage. We have thought through heat sources and energy sources. Etc. We even have (more tentative) plans for where we’d go if we needed to leave the midwest. We are building up our skills (shooting, food prep, etc.) and doing what we need to to get ready for pretty much anything. I believe if you prepare for the worst, then you can make it through anything else. If we’re prepared for total societal breakdown, then our area gets slammed by a tornado, we can surely survive that. Right? That’s the theory.

OK, so along with that comes something I see as FAR less extreme – keeping a good supply of food. It’s not HOARDING. It’s being prepared.

If you have a supply of food (and other necessities) that will last your family 2 weeks, then when you are hit by a major blizzard that keeps you trapped in your home without power for a week, you’ll be FINE. (even more fine if you have a source of heat that doesn’t plug in.) If you have a supply of food/necessities that will last your family for 3-6 months, then when you’re hit by unexpected job loss, at least you won’t have to worry about how you’re going to eat. (from a societal standpoint, this means that you won’t be taking food from the food bank and can leave that for less prepared families, yes once again proving that those who plan ahead ultimately end up getting screwed.)

What the stockpile of food/supplies also does is provides you with a way to bless other families, in a far more personal way. I have to agree with Glenn Beck here – charity is much more satisfying when it’s personal. (and it’s more efficient, too.) I know most people are more COMFORTABLE just giving stuff to the food bank, or the salvation army, or whatever, but how much more of a blessing is it for ALL involved if it’s more personal? Having a stockpile lets you take action when you learn that your sister’s family has been struggling with unemployment and is not sure how they’re going to buy groceries this month. Without busting your own budget, you can slip down to your stockpile and gift them with 2 weeks of food.

I just don’t see stockpiling as being selfish. (now, hoarding 80 bottles of BBQ sauce like they do on Extreme Couponing, yes, that’s what I’d call “hoarding” and would typically see as a bad thing.)