Welcome to the world, little one!
A lot has happened since I wrote my last blog post (and not all of it positive). While I may eventually write about my dad's sudden cardiac arrest, long ICU stay, and passing, now is not the time. Today, I want to share the story of welcoming our son into the world. Here I'll also add a content warning (CW) for birth complications and a NICU stay. Use your best judgment before reading.
David James Ledford Richard (named for my dad, David) was born on December 21, 2021 at 5:47pm. Here's how it all happened.
I went to the hospital at 6am on Monday, December 20 for a scheduled induction at 38 weeks for chronic hypertension. Though my blood pressure had on occasion been high before pregnancy, it was during pregnancy that it really started escalating. I had gone to the hospital on more than one occasion with high blood pressure according to my home cuff, only for it to be normal by the time I arrived. Prior to my induction, all of my most recent blood pressures had been normal so we were hoping for a relatively uneventful labor and delivery. I changed into my labor gown and prepared to get started.
To gauge our starting point, my cervix was checked and I was just at 1 cm dilated, so a foley bulb was inserted around 8am. I had worried a lot about the pain of the foley bulb insertion, but it really wasn’t a big deal for me, thankfully. Cervidil was also placed to help ripen my cervix. Unfortunately, it wasn’t long after that my blood pressure readings started to rise as my cervix began dilating (all my labor pain at this point was in my back). While I got some relief from sitting and bouncing on the birthing ball, being up in that position made my blood pressure higher. After a few hours, the doctor and nurses told me it was no longer safe for me to be up out of bed, so the ball was out from that point forward.
Soon after, my blood pressure reached a critical level and I was officially diagnosed with preeclampsia. I was started on a magnesium infusion to prevent seizures along with a blood pressure medication while I continued to have contractions (all in my back). My husband Kevin was such a great support to me during all of this, pressing on my back with each contraction to provide counter-pressure and helping me pace my deep breaths. I got some Tylenol (I was still mostly managing my pain), but shortly thereafter developed a bad headache from the magnesium infusion.
Every hour, the nurses would do a magnesium check to make sure I didn’t develop magnesium toxicity. During this period, my contractions were getting more and more painful, but the foley bulb still wasn’t coming out, indicating that my contractions weren’t adequately dilating my cervix. The OB came in and recommended we start Pitocin and also asked about my plans with respect to pain management. I had wanted to avoid an epidural if possible, but also knew that I might need one eventually, so we talked about timing and options. The doctor noted that breaking my water might also help to increase the frequency and intensity of my contractions so if I was thinking of getting an epidural, I might want to consider getting it before they broke my water.
We started Pitocin and my contractions ramped up significantly to the point where I just wanted relief and all my tactics of meditation, breathing, and essential oils just weren’t cutting it. I was also feeling generally terrible being on the magnesium. Kevin continued to help me through the contractions and eventually my foley bulb was easily removed.
At this point it was evening and I was on my second nursing shift. My blood pressure was still very high, so a second medication was added. A different doctor from my practice arrived and checked my cervix. At this point I was at 6cm dilated and they mentioned wanting to break my water to speed up labor (particularly because my blood pressure was dangerously high). After talking with Kevin, I decided to get an epidural then have them break my water.
The epidural insertion was honestly a breeze, which surprised me a lot as it had been something I’d feared/dreaded. The pain was immediately lessened and I retained control of my legs. While epidurals can cause your blood pressure to drop, we had a lot of “wiggle room” with mine because it was still trending so high, so we all hoped it wouldn’t be an issue. Still, despite my high pressure readings, my blood pressure bottomed out and I felt like I was going to pass out. Then I vomited, a lot.
Hilariously (to me, anyway) I'd been watching the Holiday Baking Championship on Food Network to take my mind off of my contractions and mid-vomit the winner (who was NOT the person I wanted to win) was announced. I took the time to mutter, "Of course it's f*cking Adam" before continuing to vomit. Whoops, sorry care providers!
Once my blood pressure stabilized again, I felt really good. I still had control of my legs, despite a general numbness. At this point the doctor came in and broke my water, to hopefully speed up the process. A few times the contractions started to get very painful again and I was rotated side to side, which helped.
Unfortunately, breaking my water did not seem to speed things up. In fact, the baby didn't do very well with my water being broken so at one point they actually had to return some water into my uterus. I continued laboring through the night and the next morning until the next nurse on duty helped me with the peanut ball to continue to dilate my cervix. I needed a re-up on the epidural, but my cervix was finally dilating. After a few more checks, I was fully dilated and effaced by around 3pm on the 21st.
My doctor, who had been in clinic all day, was able to get to the hospital and began coaching me through my contractions and pushing, along with a resident, the nurse, and Kevin. I was still able to feel the pressure of my contractions so pushing felt intuitive, which I appreciated. I had requested a mirror for delivery, and that helped a lot, too. It really kept me motivated once my doctor pointed out my baby’s head peeking out from behind my pubic bone.
My labor playlist (yes, that's a thing I prepared ahead of time, much to the delight of my doctor) was super helpful in getting me through this period of laboring, as was Kevin, who held one of my legs while the nurse held the other as I pushed.
Once the baby’s head made it past my pubic bone and was clearly visible, the doctor had me stop pushing while they called in more providers (because of my preeclampsia diagnosis) and prepped for the delivery itself. Holding off from pushing at that point was really difficult, but once I was allowed to push again it took just two pushes for the baby to be delivered. Kevin was able to catch him and put him on my chest at 5:47pm.
Then, the scariest moment of my life occurred. My baby wasn’t crying. He was looking up at me, sort of dazed. Knowing it was a bad sign, I pleaded with him to cry. I knew it was serious when those additional providers in the room took him back from me after what seemed like just a few seconds (my hospital has a policy of an hour of skin to skin, unless there’s an emergency).
Kevin looked on as they worked him over and took his APGAR score (not great at first, but better on a repeat). They even asked him if he wanted to take some photos of our sweet little guy, which he happily did.
They thought it was my magnesium infusion making DJ lethargic, but they wanted to take him to the NICU because he was having trouble breathing well on his own. Kevin went up with him while I continued to be monitored before I could go to the Mother/Baby Unit. Kevin was sent back down to my room shortly afterward because he wasn't allowed in the NICU during shift change, but was able to go back up an hour later. It was yet another hour before I was able to go see them.
When I got to the NICU, I could tell right away from Kevin's face that something was up. Unfortunately, it turned out not to be the magnesium making the baby lethargic. He’d passed meconium during labor and inhaled it; he was suffering from meconium aspiration syndrome. That first visit in the NICU was incredibly difficult. He was hooked up to all sorts of machines and was receiving oxygen. I was only allowed to stay for a few minutes because I was still being monitored due the magnesium infusion (which I had to stay on for 24 hours after delivery), so I was taken to Mother/Baby and Kevin stayed with DJ for a while longer.
After my next blood pressure check, I was allowed to go back up to the NICU as long as the nurse went with me and I stayed in my wheelchair. By this point DJ was off of oxygen, but was hooked to a CPAP machine to help him breathe. It was still hard to see him that way, but was definitely an improvement. Though it wasn't how we'd imagined it, we got our first family photo.
The next day I was finally able to go see DJ again and hold him for the first time since he'd been put on my chest after delivery. He was being tube fed and was still on the CPAP, but he was doing better overall.
It was so difficult to leave him in the NICU and return to our room on the Mother/Baby Unit, but luckily once I hit 24 hours post-delivery, I was taken off the magnesium and (after a short wait) was able to go to the NICU without the nurse, which meant I could go virtually whenever I wanted as long as I was back for blood pressure checks at appointed times. We continued to visit DJ as often as we could, doing skin to skin and attending rounds with the doctors to get updates about how he was doing.
On Thursday, the 23rd, he came off antibiotics because his lab work hadn't shown any infection and he was able to come off the CPAP.
Though he still had his feeding tube in, we were able to start feeding him some of the breastmilk I'd expressed along with donor breastmilk, when needed. Eventually I was able to start breastfeeding him as well. He was continuing to improve by leaps and bounds, which was incredibly reassuring.
On Saturday, Christmas morning, DJ's feeding tube was removed and we were moved to the transition unit where we were responsible for all of his care and feedings, but where there was still a dedicated nurse to come check his vitals and if we needed help. As long as he did well in transition, we would be going home soon. The same day, I was discharged as a patient as my blood pressure was being well controlled with medication so I stayed in the transition unit with DJ and Kevin.
Finally, on Sunday, December 26th, DJ was discharged. The doctors all said he had a remarkable recovery and needed less time in the NICU than they would have assumed based on his initial presentation.
Despite the long, hard labor and DJ's traumatic birth and first few days, I’m so grateful to all the providers who helped us bring him into this world and then make sure he could come home a healthy baby. We’re over the moon in love with him and are so grateful things turned out okay in the end. He's absolutely thriving and I'll be sharing periodic updates about him and what I learn about parenting as a first-time mom. Spoiler: it's the most difficult and most rewarding job I've ever had.