3.5

I have been pregnant and/or nursing continuously without a day off for good behavior since October 2008.

I couldn't love my children more and can't believe that I was fortunate enough to be in this predicament after so many losses.

I am so fucking tired.

Sweet Spot

I almost have a four month old baby.  How could that be?  I swear I just delivered.  Like.  Just last week or something.  I think four months is kind of the sweet spot of infancy for me.  Breastfeeding is easy at this age ...not overwhelmingly time consuming and full of smiles ....haven't yet hit the distraction stage.  There's no stranger anxiety and yet, still a very strong preference for mama.  I love it. 

Unfortunately, I think that baby A2 senses how much I love it as well and is both regressing in a very stereotypical manner and acting out with anger.  I've been trying to spend extra time with him one one one, kissing, cuddling, reading, indulging in the regression.  Scheduling play dates and "big boy" time to remind him that it's fun to be 2 and that there's lots of things that he can do that the baby can't.I'm not making much progress.  If anything, he's getting worse.  I'm sort of ready to poke out my eyeballs if you want to know the truth.

Today, I took him with me for a quickie grocery shopping trip.  He can be such a sweetheart at this age, "I love shopping with you, mama."  "I love helping you make vegetables, mama."  As we were checking out, a woman in line behind us started to engage him in conversation while I unloaded the cart.  They talked about cars and trucks and little brothers.  I was fascinated by the conversation my son was having with a complete stranger, and by the stranger herself.   She wasn't in the least bit condescending or fake.  She honestly seemed interested in what he was saying.  As I was paying, A2 said, "Well, thanks for talking to me.  Have a good day!" and she said, "You too!!" and smiled warmly at him.  As I started to push the cart away, he said, "Oh, mama.  She was a GREAT talker."  It was sort of like watching him fall in love for the first time.

But it also got me thinking.  For all of the time that I'm investing trying to make him feel special and loved - a complete stranger captured his heart by actually being interested in the things that interest him.  I'm not so good at that.  I've never been a good "player".  I sit on the floor and play trains and cars and whatever ... but I feel like I come off as being condescending.  I feel like he knows that I'm faking it.  I remember my mom sitting in the sand box with me for hours and hours a day, totally engaged in what I was doing.  I have a really hard time setting aside work and chores and things that interest me to really be present with him.  With any of my children, actually.  As sweet as a spot having a four month old is?  I frequently find myself checking my phone ..or facebook ...or reading a couple of pages in a book while he nurses.  I picked the golden child up from a week long trip where she was in Florida, and found myself having to force my mind back into the conversation to hear about the trip because I was thinking about the bills I have to pay, how little sleep I've gotten, etc., etc., how to carve out some time from Monk to make sure he feels loved with all of these children around.  How horrible is that?? I haven't seen her in a week and I can't pay enough attention to stay engaged in an hour and half long car ride.  I need ritalin.  Or something.

So ... I need to change some things.  How do you do it?  How do you keep yourself in the moment??

Three

When I had the golden child, it was just her and I.  Our relationship is still very much her and I against the world.  We're super close as a mother and daughter, and I'm still blessed enough that she considers me her friend at 16.  I couldn't imagine where another child would fit in when I had A2.  How could I possibly love someone as much as I loved her?  And then I had him ...and found that although the love was different, it was equally as overwhelming and fierce.  The children themselves were polar opposites ...she was overwhelmingly shy and dependent ...he is outgoing and fiercely independent.  I had always imagined that they would be very similar - I was raising them both, right?  And yet ...they were born with these personalities. 

During this last pregnancy, I always imagined that this baby would fit somewhere in the middle of them.  And maybe he will.  Right now, he looks so much like his older brother did at the same age that I sometimes find myself thinking of him as his older brother.  And yet, already, his personality is so different from either of them.  He's so easily soothed - he literally needs to just hear my voice to stop crying ..so blindly trusting that I'll be able to fix what ails him.  He laughs and giggles easily ...and still has a lot of the seriousness that I remember from the golden child's infancy. 

This afternoon, Monk took two pictures of the baby ...

The seriousness of his sister:

The silliness of his brother:

And yet ..somehow ...both of them are all him.

Who knew you could possibly love three this much.

Broken.

So ...the good news is that I've managed to stay off the Zoloft and still feel like a normal person.  So I suppose I owe an apology to my physicians and healthcare in general.  It appears they were right ... I really did need to wait out the hormones.

I went back to work this week.  It honestly broke my heart.  As hard as it was to leave A2 ...leaving two babies was at least twice as bad.   The first day I had gut rot ...the baby wouldn't take a bottle despite the $300 in various nipples and bottles that I purchased.  We diligently attempted every day from the time he was 2 weeks old.  There would be rare occasions when he would manage an ounce or two, but for the most part was unable to latch on.  It got to the point that his jaw would start trembling  and he would start crying when he saw the bottle. Leaving babies is bad.  Leaving a baby and knowing that he's going to be starving, dehydrated, screaming and miserable was worse.  We made arrangements for Monk to stay home so that he could drive the baby to me if needed.  Monk called me a 9 ....to tell me that the baby drank 7 ounces of breastmilk from a bottle like it was no big deal and something he did everyday.  Thank the lord for small wonders ...and stubborn babies.

My heart feels broken tonight.  In my practice, there are 4 new babies ages 5 months and younger.  A virtual baby boom.    One of my partners is 42 and infertile.  I think she has resigned herself to living child free.  I can't imagine how painful this little baby boom is for her.

One of my partners, someone who is relatively new to the practice in the last year but with whom I've become close to because of our shared pregnancy and other similarities, is currently 34 weeks pregnant.  She fell in the parking lot last week.  They admitted her to L&D for observation and did an ultrasound.  The ultrasound revealed the baby was way too small for gestational age and was missing a corpus callosum in her brain.  To make a long story short, she had an amnio which was normal - and began to feel some hope.  She had a fetal MRI at UofM yesterday.  They called her at work today to let her know very, very bad news about the baby.  She left work feeling extremely distressed.

I can't even begin to imagine.  Can.  Not. Imagine.

It's truly beyond a miracle that any of our babies make it out "normal" and "healthy".  One little misalignment of a part of a gene.  Just one. 

I came home to squeeze my three extra tight.  Extra, extra tight.

All Roads Lead To Agoraphobia

The state of mental health care in this country is truly appalling.  It embarrasses me to admit that I'm a healthcare provider.  Honestly.  


I've had really wacky hormones throughout this entire pregnancy.  I felt like I was headed towards severe post partum depression stuff.  I discussed it with both my OB and my primary care provider prior to delivery.  At that time, they both offered options, but recommended riding things out because I've never had any problems with PPD in the past.   Pretty quickly after delivery, things went awry.  Anxiety that I could normally recognize for itself was unmanageable.  I cried at the drop of a hat.  I didn't truly feel depressed .... but I was angry and pissed off and anxious.  Ohmygod anxious.  I loved the baby.  I loved my family.  But I would have thoughts of leaving.  Like.   Abandoning this family I worked so hard for.  The intellectual side of me recognized what was going on.  I went in and talked to my OB about it when Baby K was 3 weeks old.  I told her that I was struggling making even small decisions - like what we would have for dinner - because I was terrified that somehow whatever decision I made would end in misfortune for someone that I loved.  If we needed bread and I asked Monk to go buy it - he would surely die in a car accident on the way there.   If we were driving to a doctor's appointment and I chose to take both kids instead of one - we'd get into an accident and the unnecessary child would be hurt because I made the call to bring them.  It didn't end really.  It was a horrible version of magical thinking that kept spinning out of control.  Even hearing all of that ?  The OB told me that she would write whatever prescription I wanted, or that she would be comfortable with me waiting to ride out the hormones a bit longer if I wanted to.  Umm.  I think I just told you that I was incapable of making decisions, right?  So ....anyway.  I ended up waiting another five weeks before I virtually demanded medicine.   And things got ugly during that five weeks. 


We went to a mall when Baby K was just about 4 weeks old.  A2 was going insane with all the trapped in the house action and needed to get out.  He played in a play area.  About two days later, he came down with a wretched no good very bad virus which included 105 fevers, throwing up, diarrhea, and the worst bronchitis I've seen in a little one in quite some time.  It quickly spread to the rest of the family - including baby K - who ended up with RSV bronchiolitis, an ER visit, nebulizers, and projectile vomiting.  Both Monk and I got it a couple of days later and the Golden child fell victim several days after that.  It was awful.  And it happened in the middle of my anxiety - and after I made the decision to take a newborn to a mall.  Good God.   I distinctly remember telling Monk on several occasions - through racking sobs- that I was not okay and that I needed help.  He either didn't get it or didn't believe me.  But either way - my downward spiral continued for several weeks after that.  I had two follow up visits with doctors and told them about how I was struggling and never so much got even a recommendation for counseling - much less a prescription.  They kept doing whatever they could to talk me out of it.  I've never needed it before.  It would pass.   Let the hormones ride themselves out.  


I started on a low dose of zoloft - and literally within five days felt like myself again.  And almost immediately noticed a dramatic drop off in my milk supply.  I didn't see a lot about that in the literature but found some anecdotal reports on message boards from mom's wondering if there was a connection.  I reluctantly stopped the medicine to see if my supply would rebound.  It did.  I tried the medicine again - milk supply dropped off.  Went off again and it came back.   I've been off the zoloft now for several days, and while I'm not having issues with anxiety, I'm incredibly irritable.  Almost exclusively with Monk - the poor thing.  I really don't know what to do at this point.  Try Lexapro?  Try something else?  Give up on nursing and take the zoloft?  Hope that the anxiety is gone for good and I don't need it after a mere couple of weeks of inconsistent medication??  


What I want is for someone (my prescribing physician, ideally) to just tell me what to do.  I want someone to ignore that I write prescriptions and just write what they think I need. 


AARRRRGH.

Adjusting

Life around these parts has certainly changed.  In some ways, much more than I expected, and in others, the transition has been much easier than I expected.  Prior to K's birth, I was terrified about how A2 would handle the transition.  I couldn't imagine how I would take care of him in the same way that I was and also care for a newborn.  The two seemed to be mutually exclusive things that couldn't possibly exist together.  They were both full time plus occupations.  Shortly after we came home from the hospital I was left with the two of them without a chaperone for maybe 2 hours and I was terrified.  I was still incredibly sore, could barely move, and definitely couldn't lift A2.  Nap time came around and A2 requires someone to lay down with him to fall asleep.  I got us all upstairs and laid down with them just in time for K to wake up and need to nurse while A2 was overtired and desperate to cuddle.  Both of them screaming, one laying in the crook of each arm.  I started crying as well - sure that this reality was exactly what I was fearing and what our lives would be for the next couple of years.  In truth, the golden child came home very soon and helped.  And in the days since, A2 has made leaps and bounds in adjusting.  He loves his brother very much and is always ready to defer his needs to K so that K doesn't cry.  He might only be willing to defer for 5 minutes- but it's 5 minutes that make life doable.  I nurse with two boys on my lap, with A2 often "helping" K nurse.  We read bedtime stories together.  A2 helps give K baths.  When K cooed for the first time the other day I realized with horror that I had never cooed at him to encourage it.  And then I realized that  somehow he figured out anyway.  It certainly isn't the same one on one attention that the golden child and A2 got - but he's developing and growing nonetheless. 

We're surviving.  Some might even say thriving.

My health still sucks.  The severe headaches that I had for the last two weeks of pregnancy were apparently caused by a cracked and rotting molar that needed an emergency root canal.  I'm still sore. from the c-section.  Still having some weird nausea, swelling, and elevated blood pressure.  I'm having some bleeding issues that may honestly end up in a too soon after delivery hysterectomy.  But we're here.  And somehow, the picture above is mine.  My family. 

A family I could never have imagined being my reality in the days of loss.  Home is the place I now always long to be.

The Birth & Aftermath

After the amnio, we came home and I immediately started to contract again.  I spent the next 5 days contracting every 3-6 minutes.  I got nervous twice when they were 3 minutes apart and went to triage.  Still no cervical change so they sent me home - always with offers of more procardia.  Umm.  No thanks since I nearly died with the first dose.  I was flat out totally exhausted by the time it was scheduled c-section time.  I asked my sister to come up to help my mom and the golden child watch A2.  And truthfully, to help the stress level with the two of them.  The golden child had chewed the inside of her lip raw over the weekend worried about the impending birth and my mom was a nervous crying wreck.

We showed up on time and things got rolling.  As they were about to take me back, they had to take back an emergency c-section -  so I got bumped for about an hour.  Baby A2 came up with my mom and sister and wanted NOTHING to do with the whole process.  He saw me with an IV, my gown, and get up and immediately requested to go home.  Now.  Please.  Thank you.  Do you see the door over there?  Let's hit it.  So everyone went to lunch and I went to have a baby.

I had a sort of bad impending doom feeling as I walked into the OR and straddled the table to get the spinal.  I tried to chalk the feeling up to anxiety.  The CRNA student prepped my back and tried to put the spinal in and missed.  Unfortunately, at that exact moment, the anesthesiologist walked in to see how things were going.  I didn't recognize her and pretty quickly figured out that she was a locum tenens.  Bad news.  She then proceeded to attempt to get the spinal another six times.  Six.  As in - not enough fingers on one hand to count how many time she jammed a needle into my back.  There was talk of general anesthesia.  I was freaking out about getting an epidural abscess or hematoma or spinal cord injury from her nincompoopness when the OB/friend came in all scrubbed and ready.  I finally had enough and asked her to stop - and asked her to allow the CRNA to put the spinal in.  She got in on the first attempt - I was hugely relieved.  Relieved for about 30 seconds until my blood pressure and heart rate dropped down to nearly not measurable.

You guys.  Seriously.  I have never, ever felt that sick.  I was puking and freaking out, watching the monitor, listening to the anesthesiologist bark orders for drugs that I give patients during codes when the situation is nearly hopeless.  And then give more.  And more.  And more.  They gave me 6 liters of fluid in a matter of minutes.  I finally started to feel somewhat better - like I might possibly live through the experience and they let Monk in.  He took one look at me and freaked out.  I would have to imagine that I didn't look exactly excited and happy to be there. 

The nice part about them overdosing the spinal was that I didn't feel a cotton picking thing.  At all.  Nada.  They took the baby out and he immediately started screaming - a scream I was so glad that I was awake, alive, and able to hear.  He was perfect.  His lungs were obviously mature.  They collected cord blood (has anyone else done that?!?), tied my tubes,  and the closing took a long, long time.  I had a lot of muscle damage that she sewed up.  The OB/friend left to fly to a conference in Vegas and assured me that her partners would take care of me well in her absence. They moved us to recovery where I was finally able to hold my peanut.  After all my worries about a giant monster baby, he came out well over 7 pounds and 21 inches - but I swear he looks and feels like a 5 pound peanut.  He is still curled up soooo tight.  He looks just like his older brother did - but somehow tinier (actual weight difference was a mere 3 ounces), and much much darker in complexion.  His blood sugar was low - 35 - and they encouraged us to nurse.  He easily latched on and contentedly nursed for close to an hour.    I suddenly got another wave of nausea and started puking - and puking - and sweating.  It was so awful.  And just wouldn't stop.  They finally called anesthesia to give me something else.  I don't even remember what it was but it helped immensely.

Things with the baby went well after that - He was mildly jaundiced but passed all of his other screenings well.  He nursed, peed, and pooped like he was supposed to.  Things with me were incredibly uncomfortable.  I had close to no pain at all with Baby A2.  I realized that this was my 3rd section - but it honestly was nothing even close to the other two in terms of pain.  I could barely move - even with decent and frequent doses of pain medicine.  It hurt to lift and hold the baby- it hurt to walk, to turn.  My lower back was extremely achy - and bruised like you wouldn't believe from all of the spinal attempts.  They kept telling me that my incision was fine, that it was a different baby, different experience.  It didn't feel right.  I finally asked to go home because I felt like maybe I would be more comfortable here. 

I went to the OB to get my staples out on Tuesday to be told that I have a massive incisional hematoma - something that she felt I should have gone back to the OR for to have evacuated.  Apparently no one looked at me as close as I thought they did.  At this point, there are really no options but to let it resolve on it's own.  I'm just now - a week out - able to get in and out of bed without help.  My blood pressure is up and I still have massive swelling - so I'm getting a work up for post-partum ecclampsia.  Seriously.   

Baby A2 has done so much better than I thought he would.  He and I have both had melt downs at times - more on that later.  Someone in my house has hungry lips and is ready to nurse.  Had to get the details down before I forgot them.  And ohmygoodness the in-law drama. Seriously.  I might have to start a new blog just about in-law drama after this birth.