(this is a repost of an email we sent out:)
At 9:45pm on Thursday October 11th, 2012, Nettie Maude Parker Thomas entered the world, a beautiful 8 lb 2.6 oz baby girl with a full head of black hair. Her parents couldn't be more smitten. Probably because she's such a perfect baby, the gods made sure her family would have some sort of struggle. Nettie will have to have heart surgery this Tuesday (tentatively). The chaplain described it as needing her plumbing fixed; I less elegantly described it as having her heart pants on backwards. Fortunately we recently moved to the Boston area, and are literally at the best hospital in the world for her particular surgery; so even though it is complicated and scary, she's in the best hands, and chances are she'll lead a healthy normal life, with many visits to the cardiologist. Below is a (not so) quick account of Nettie Maude's incredible entrance into this world.
When Julie and I found out she was pregnant, we signed up at a birthing center with a midwife and enrolled in Bradley Method natural childbirth classes. Julie really wanted a drug and intervention free birth, with my full support. During a first trimester exam in the spring we were "red flagged" that something might be awry. By the end of April the doctors in DC had figured out there was something wrong with the baby's heart. We switched first to a midwife in a hospital, then to a high-risk OB, with everyone agreeing that a vaginal birth was best for the baby, as she was completely fine in utero. By then I had accepted the doctoral program at MIT, Julie's job transfer was looking promising, and the cardiac doctors in DC were already in comunication with the doctors in Boston. The diagnosis changed throughout the pregnancy, which is common, but lead to too many hours reading online and freaking out about conditions that our little one didn't have. Dealing with all this during the pregnancy perhaps replaced some of the bliss with a good amount of stress, but Julie and I are so glad we were prepared for where we are now, which would have been so much harder had we not been processing for the past 6 months. We still had all the joys of feeling her kick and seeing her chubby cheeks and head of hair in ultra-sounds. Well, maybe Julie didn't really enjoy being kicked in ribs everyday for a few months, but you know what I'm saying.
The doctors in Boston have been amazing, and our OB decided to let Julie go to 40 weeks before inducing, instead of the standard 39 for cardio babies, in the hopes that Julie could go into labor spontaneously. It is also common for cardio babies to be premature, which makes the surgery more difficult. The proof is in the pudding that our chubby little 8 pounder is as fit for the surgery as anyone could have hoped. Another aspect of the heart condition is that Nettie could have been born "blue", and then would immediately have to be whisked away after birth. If we got lucky and she was born "pink", Julie would be able to hold her for just a minute or so, before she was taken to intensive care. Julie really wanted to hold her for a second if possible, and the doctors seemed open to try that. On top of that, the hospital has a volunteer doula program, and a special sub group called "Heart to Heart" (http://www.birthinggently.
40 weeks arrived without any natural labor, so at our exam last Tuesday the 9th, our doctor scheduled an induction for Wednesday. At that exam, though, Julie was dilated to 1 cm and about 30% effaced (apologies to the non-breeders for the labor lingo; a baby needs 10 cm to fit through), which was promising. After spending about 8 hours at the hospital on Tues, we arrived 6am on Wednesday for the induction. Around 8:30am, they gave Julie cytotec, a cervical ripener, which can take hours or even days to start working. We went for a walk to the museum, which was too expensive to enter, and I fought a terrible cold, stupidly taking too much medicine on an empty stomach, which combined with nerves, made it so I couldn't keep any food down until the next day; hell of a birth partner I was turning out to be.
At 12:30pm Julie got re-examined and had dilated to 2 cm and 50% effacement. The doc thought it was time to move from triage to the labor room and start the low-level pitocin, a synthetic version of the hormone released by the body to start contractions. Our first nurse, Diane, was super great and supportive of our birth plan for no pain meds, but did say most inductions usually end with an epidural just because they take so so long. By late afternoon Julie's contractions were steady, she was handling them, but I was seeming sicker, so we called the doula in. Julie and I were both scared the doctors would kick me out of the room for fear of getting the baby sick. Justine showed up around 7pm, and my constant sneezing was starting to subside. Having the doula there allowed me to get a power nap, pull myself together, and be the birth-partner I needed to be.
By the end of the night, despite consistent contractions, Julie wasn't making much noticeable progress, and some doctors (mainly the residents, not the head, actually) started strongly recommending that they break Julie's water to try and jump start the labor (basically induction is trying to trick the body into thinking it is ready for something sooner than it really is). Julie, in consultation with me, the doula, and our wonderful night nurse Stephanie, went back and forth on this. On the one hand, breaking the water will cause the baby's head to press on the cervix, which naturally releases hormones that start labor, so it's sort of more natural than upping the pitocin. On the other hand, more interventions tend to lead to further and more severe interventions, so that was a palpable fear. Julie decided to have her water broken around midnight, and the doctors kept her on the pitocin at less then a third of the maximum. In Julie's water, the doctors noticed "light" meconium, or baby poop, meaning Nettie had done some business and possibly swallowed a little, which is very common, but can add further risk.
Pretty quickly the labor became incredibly hard, and with the pitocin, her contractions were non-stop, with barely 30 secs in-between, no real time to recoup. Julie powered on like that for hours, with Justine coaching and me assisting her breathe through all of it, letting out deep guttural raw animal noises, trying tons of different positions to get into her natural birthing rhythm. She went to this zone that I had never seen in anyone before, it was the strongest I'd ever seen a person be, I fell even deeper in love with her. Around 3am, she made a half-joke that she should have scheduled an c-section, and then soon started asking for an epidural. Justine and I suggested she have an exam and see what progress she had made before she made that decision. We both thought she'd be at least to 4 or 5 cm, which would have been real progress. Despite all her hard work (Justine later said it was longer hard labor that she had for her first child) Julie was only at 3 cm at 4am. Very smartly, Julie opted for an epidural, 22 hours after arriving at the hospital. When they stopped the pitocin to get ready for the epidural, her contractions completely stopped, which meant the drugs hadn't tricked her body into laboring naturally, but rather were forcing it.
With the epidural, we were all able to get a few hours of much needed sleep and wait. An epidural makes contraction painless but also numbs the legs so Julie was now bound to the bed. Julie slept on and off for most of the day. Our primary doula, Justine, went home for a few hours to rest, and our back-up doula Yael showed up around noon and ended up staying through till the end, even after Justine got back. While Justine was away and I was out getting coffee, a doctor from the NICU (natal intensive care unit) came by and told Julie her report cited "heavy" meconium, which meant that Julie may not get to hold Nettie when she comes out. Julie told her that the doctors who broke the water described the meconium as "light" and super thursday Day Nurse Kate confirmed that from her reports. When I ran into the NICU doctor in the hall as she was on her way out of our room she told me the same "heavy" story, but the coffee was in my hand, not in my system, and I was too out of it to tell her I remembered "light". So after that, we all were mentally preparing for little Nettie Maude to be whisked right away.
By 3:30pm Julie had progressed to 8 cm! We were all so excited. Our nurse Kate took amazing care of Julie. The doctors (it's a teaching hospital so tons of rotating doctors) said she should progress 1 cm per hour now. At 5:30pm, she was only 9.5 cm, with an "lip" or bump-out on her cervix. The doctors said they would give her one more hour, after that they would have to perform a c-section. At 6:45pm on Thursday, over 36 hours after we arrived at the hospital, Julie was at 10 cm and the baby's head was past Julie's pelvis ("over +1" for the breeders); it was push time!
Despite the medical interventions, Julie still had to push like the dickens, like a bazillion dickens, to pass baby Nettie through her hoo-haa. They say a first time mother will have to push for 1 to 3 hours, and Julie pushed for all three. Our beloved Nurse Kate handed off the reigns to Nurse Jen reluctantly due to a carpool at 7:30pm. Nurse Jen turned out to be the pushing coach of the year, quietly whispering to Julie when to push and when to rest, even when the young resident doctors were over-eagerly telling Julie to push. It was one of the most diplomatic and effective actions I've ever witnessed. Around 9pm a young doctor came by, who was a little excitable for my tastes, and gave Julie a stern talking to about how they may need to use a vacuum to get the baby out. I was a little pissed off at the guy, but man did that motivate Julie to push! That was exactly what Julie needed to muster the inner strength to get the baby out.
At 9:45pm, almost 40hrs after we checked in, Nettie Maude came out, she cried(!, a great sign for a cardio-baby!) and the doctors put the naked baby right on Julie's belly while I cut her cord (even while a "head-honcho" doctor who had been in the back checking his cell the whole time was yelling "get that baby off of her"). They cleaned up little Nettie, she had a great apgar score (good signs and "pink"), they swaddled her up and then let Julie hold her for a few minutes. Baby Nettie tried and almost found mommy's nipple, but then it was time for her to go intensive care and prepare to transfer to the children's hospital.
Our primary doula stayed with Julie while Yael, the back up doula, came with me as we followed Nettie first to the NICU at the labor hospital, where they put IVs in both her hands and did a bunch of other tests. After 30 mins we followed her as she was transferred via an enclosed pedestrian bridge to the Children's Hospital next door, where the night team of cardiologist were waiting. We stayed there and got a mini debriefing while the doctors prepared to do the tests that would determine exactly what heart conditions our little one had. Nettie's room has a little bed surrounded by a virtual wall of machines, like a Cronenberg version of Dr. Frankenstien's lab. But fortunately I had seen it in a tour a few weeks before, so I wasn't shocked or freaked out.
Sleep.
Friday around 9am or so I pushed Julie in a wheel chair over to the Children's Hospital. The doctors had taken all their tests and told us the final diagnosis:
Nettie Maude has a VSD, TGA, and a coarctation.
VSD = Ventrical Septal Defect, i.e. a hole in her heart. This one is a pretty easy fix, and the hole actually helps with the next problem before surgery
TGA = Transposition of the Great Arteries - this means the out-flow & and in-flow veins to her heart are switched (i.e. my bad "pants on backwards" analogy). This is the tricky operation, but again, we're at the best hospital in the world.
The coarctation means there's a speed bump in one of the arteries leaving the heart. It's not that tricky of an operation, but tricky in that the surgeons need to do all the three operations at once.
They've only been doing these surgeries for 35 years or so, but there are some older TGA kids in med school and on athletic scholarships, so she's got a really great chance at a normal life (with lots of doctor visits).
So right now she is stabilized with some medicines, and tentatively set for surgery on Tuesday. Between now and then Julie and I can take turns holding her, though she has to stay hooked up to two IVs and many monitors. The doctors think we should hold her as much as possible till surgery, and we concur. After surgery we won't be able to hold her for a while. She could be in the hospital for up to a month depending. Then finally, once she's healed enough, we can take her home.
Witnessing Julie's inner strength during labor, the unbelievable support from our doulas and the hospital staff, and the great doctors and nurses at the children's hospital have all made this the greatest thing that I've ever experienced. And I haven't even begun to talk about what a miracle Nettie Maude is, the feeling of love that comes over me while holding her, watching Julie hold her, and just thinking about her. Right now as I type this Julie is singing to her, and I can't help but tear up.
I know this email is too long, but since this really has been the best of times and the worst of times for our family, we really wanted to share with all of you, our extended family, what's going on. To the people whom we've already shared knowledge of Nettie's heart condition, your support has been invaluable. To everyone, we ask you to hold little Nettie Maude in your thoughts and prayers as she struggles through this tough time, and we can't wait for all of you to meet her once we make it to sunnier days.
With Love,
-Lou & Julie & Nettie
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