Birth Story

It is April17th and it is a pretty typical day except it is my middle sister’s birthday. As I did every Tuesday and Friday for the last four months of this pregnancy, I am getting an ultrasound of my baby. This one marks ultrasound #63 and 64. I have spent more time in doctor’s office waiting rooms and being poked, prodded, and examined than I ever anticipated during this “high risk pregnancy” due to Intrauterine Growth Restriction. As it turns out, this day is different. The doctor says that baby has not grown enough since the last ultrasound; it is time to deliver the baby. I am in shock; feeling like a second place winner since I wanted to make it all the way to 40 weeks but instead, I am one week shy at 39 weeks.  My head is swimming with thoughts of what this induction would be like or would I have another cesarean section. I met my husband  at Women & Infants Triage at 3 p.m. We sat there waiting to meet with the doctor or midwife on call but after being there for over an hour, we were told that no one was available  to discuss my options. Instead, we got a phone call saying that I should go home to get my things and come back to the hospital later in the evening. This was my chance to buy time. I wanted to savor my last hours with my daughter who was up until that point, an only child. We ate dinner, goofed around in the front yard, and told her stories about princesses before bed. It was now 9 p.m. and Women & Infants called to see when I will be arriving to the hospital. I left my house at 9:30 p.m. knowing this would be last time I would close the door of house as a mother of one.

            At 11:00 p.m., one of the midwives came into my hospital room to explain the induction since we decided that I should attempt a VBAC. My birth experience with my first daughter was traumatic and the thought of a traditional cesarean section terrified me.  The midwife was aware of my desire to have a natural non-medicated birth so she opted for a more holistic approach to the induction. And she said she wouldn’t be able to any drugs to start the induction any way due to my prior cesarean, so instead she was going to manually dilate my cervix using a catheter. I slept through the night with the catheter hoping that it would work. It did! The next morning, April 18^th, I woke up to be pleasantly surprised that I was 3 cm dilated. The nurses brought me down to the Labor & Delivery floor at 6 a.m. to start a Pitocin IV. It was around 7:30 a.m. when my husband arrived at the hospital after taking our daughter to daycare. It wasn’t much longer when the contractions started. As the morning wore on, they became more and more intense. The midwife checked my progress at 10:00 a.m. to find that I was 4 cm dilated. It was not much longer when I thought my body was going to explode. I did not anticipate that type of uncontrollable, unrelenting pain. My mantra “I am in pain but I am not hurt.” was no longer working. As much as I did not want an epidural, it was my saving grace. The epidural put my mind at ease and allowed my body to do what it is supposed to do. It was a short time later when my water broke and the midwife announced that I was 10 cm dilated.  She told me to rest for a little bit and then I would start pushing. This was a thrilling moment to know that my “baby dream” might actually come to true--that I may be able to deliver my baby and get her place directly into my arms. The whole time, I had a picture from National Geographic in my mind. It is a woman in a tub of water holding her baby for the first time. The expression on the woman’s was pure joy and relief. I wanted to have that feeling that was lost due to groggy drugs during my prior c-section. My husband called this picture my “Rocky photo”.  One of the greatest compliments that my husband has ever given me was when he told me that I had that same expression on my face when I touched our baby girl for the first time. The pride that I feel for having a VBAC after all of the struggles, fears and disappointments of a high risk pregnancy is unexplainable. My original doctor told me once that “happiness is healing”. Those words will forever ring in my head because for all of hurt and trauma that came my first born’s delivery and the frustrations and disappointments of this high risk pregnancy-- all of the negative feelings have melted away in the first touch of my second born. Rebecca Hope Rocchio was born at 4 pounds, 4 ounces on April 18^th at 1:47 p.m. She truly is my second first born.

Monday, April 2nd
I went to the PDC today.... only 6 more appointments remaining there! (And 4 more doctor appointments left!). Everything was swell today. The baby gained 400 grams making the baby weight almost 5 lbs! I am thrilled. Everything else was fine including amniotic fluid level, heart rate, etc. Rob and I went to Memorial Hospital's fundraiser on Friday. So, I think that planted a seed in Rob's head that maybe we can go to Memorial Hospital to have this baby. We'll see....

Wednesday, March 28th

I am swimming in a sea of spreadsheets getting ready for my annual review but I'll take a few minutes to share my fall out with our minister.

About 3 years ago, our beloved minster Bob Brooks retired. He is a great guy. We went on a mission trip to New Orleans with him, he married us and he blessed Rachel in the NICU. He has a special place in our hearts. His replacement came from France; The Episcopal Cathedral of America in Paris. He is in his early 40's with a son who is the same age as Rachel and his wife is expecting a baby in April. Our children are practically the same ages.

I sought spiritual counsel from Jonathan Hyuck, our new minister starting in January when things looked grim for this baby. We had some good conversations but he did not seem to remember one conversation from the last. It was always as if, he had never talked to me before. I did not think too much about it at the time. Then in early March when we realized that everything is going to be fine, I contacted Jonathan (we don't typically use Father/Pastor in front of the minster's first name unless they prefer it) regarding this baby's baptism. I told him that we wanted the baby to be baptized in the summer. He explained that is not the "policy of the church" and it must happen either on Memorial Day weekend or in November. I can not see how either is feasible. The baby will only be 4 weeks old at the end of May--- way too young. And November seems to be a lifetime away. I would not be able to live with myself knowing that my baby was not baptized and we are going about our lives. I wouldn't be able to live with myself if in that time period something happened and the baby did not receive her First Sacrament. So, I told Jonathan that Rachel was baptized in August and he still would not make an exception. From what I understand, the Episcopal Church wants to baptize on Feast Days which happen 4 times a year--- Easter, Pentecost, All Saints Day and Epiphany. Baptize is a celebration of inclusion, in other words, these feasts days has more people in the pews than other Sundays. But there is nothing in the Episcopal Church that says you can't do it other days, just the Feast Days are preferred. Bob Brooks thought it was too long between May and November so he picked a Minor Feast Day called the Feast of Transfiguration in early August. Jonathan would  not budge plus he inferred that we were looking for a "drive thru" church for our sacraments like marriage and baptism. He did not recognize that we have been members of this church for 10 years and before Rachel, did our share of volunteer work with the church.

We basically felt like we are being pushed out of our church. I have never heard this happening to an Episcopalian like you would hear from a Catholic because of the more firm rules in the Catholic church. See, one of the reasons why I love the Episcopal Church is the liberties each rector and each church are given. There is a set of rules but there is flexibility in those rules and as times change, we change to better suit the needs to our people i.e Everyone is welcome, gay or straight; Women are minsters; etc.

So, we are now trying to find a new church. It is so hard to leave Grace Church. I love it there. I love the people there. We will have to wait until the leadership changes when a time comes when people are more important than the rules it serves. So sad!

Monday, March 26th

Wow, it's less than a month from my due date. Hope is eternal! I remember the day when Rob was violently banging his fist against the steering wheel yelling that this baby will not make it to full term, that I was going to have a c-section and this baby was going to be in the NICU. Well, this baby will be considered full term in two weeks (37 weeks); I am having a boatload of "practice" contractions and there are no indications that this baby will be in the NICU. Back in January, I held my ground firmly believing that everything was going to be okay. I wasn't in denial nor was I not listening to the counsel of my doctors. I simply had faith that everything was going to okay. This caused a lot of strife in my marriage; to the point that we did not know how we were going to stay together. In the end, Rob is getting what he wants... to have this baby at Women & Infants. I am going to pick my battles and let him "win".  I rather be happy than right. (Now if only Women & Infants would allow Pediatric ENT privileges to see newborns, then I would be fully comfortable, but that isn't going to happen.)

I should be working on my annual performance review right now but I am going to take a moment to write about the Vietnam Vet doc (perhaps tomorrow, I will write about the church situation). Since I am now going to a large OB/GYN practice again (there is about 8 docs), I decided to find out what makes each doctor tick. I think I will do this for the rest of my life when dealing with the game changers/decision makers in my life (i.e. doctors, real estate agents, lawyers...people who can really effect your quality of life or change your life). I ask them... Why did you become a OB/GYN? Dr. David Beitle (sp?) who is widely liked and respected gave this answer: I love surgery but found it to be boring. There is no thrill taking out tumors but surgically delivering babies is a lot of fun. (It makes senses that his c-section rate is 60%). Dr. Colleen Cavanaugh gave the answer: I wanted to be an OB/GYN because it encompasses much of the life cycle of women from puberty to childbearing to older women who have incontinence or reproductive cancers. Plus dealing with women has a strong psychological component to it. I like dealing with the whole woman (In my book, good answer!). At the same practice as Dr. Cavanaugh, Dr. John Bert told me an interesting story why he became an OG/GYN. He recalled his time in Vietnam being a combat surgeon. He loved the excitement of putting people back together. Once he came back to the United States, he found surgery to be less than exciting due to practical nature of taking out gall bladders and tumors, etc. He decided that surgically delivering babies was closer to his experience in Vietnam. (Yikes! I hope he doesn't have a flash back when I am on the table). Next week, I am going to meet the doctor who is scheduled to deliver this baby via Gentle C-section; pray tell she has a good reason on why went into this line of work.

Friday, March 23rd
It has been too long since I have written anything here. I have so much to say and not enough time to say it. I still need to write about my doctor experience with the Vietnam Vet and need to write about my fall out with our minister. That has weighted heavy on my mind and heart; and needs resolution since we feel like we are being pushed out of our church & now need to find a new church to baptize this baby.

So, I will quickly give a quick run down on the baby's progress....
As of last Friday, the baby is weighing about 4 lbs. The doctors want the baby to gain 225 grams every two weeks until the due date.  That will mean if the baby is brought to full term (April 25th is the due date) then the baby will weigh 5 1/2 pounds (just a few ounces shy of Rachel who was 5 lbs 10 oz at 2 weeks overdue). We will be thrilled at having a 5 1/2 pound baby. Everything else has been fine such as amniotic fluid levels, heart rate, etc. The non-stress stress tests are showing that I am having some "practice" contractions. I am so happy about that! Since I did not have any Braxton Hicks contractions with Rachel. We have scheduled a gentle c-section for April 25th but I am keeping my fingers and toes crossed for a VBAC. If it doesn't happen, I am okay with it but it would be great to bring this baby into the world in a non-surgical way.

A lot of my thinking, reasoning and some would say obsession about pregnancy, childbearing and birth stems from my experience having Rachel. I finally found an article that adequately expresses my feelings. If you have a moment, please read it: http://midwifethinking.com/2011/05/13/guest-post-when-birth-is-trauma/

Friday, March 9th
Today was a little bit of nerve racking day. Every time, I have this one tech-- Lisa perform the ultrasound, it comes back off kilter. The s/d ratios were much higher in the 5-6 range. I was very nervous as I sat waiting for the doctor to review the ultrasound that he/she would say, this is the day that you are going to have the baby. Fortunately, that did not happen! The doctor said the s/d ratios were high but the most accurate one was 2.9, so I was in the clear. Sigh of relief.

Then, I went to get my second ultrasound of the day and non-stress test. Baby had a heart deceleration (which is what Rachel had during my labor with her). I was scared that I was, again, going to get bad news. The nurses and doctor who reviewed the non-stress strip said it was most likely from the baby holding onto the umbilical cord and nothing to be worried about.

As for Tuesday's appointments, I don't really remember... but when I have a chance I need to write about my doctor's appointment on Wednesday (he was a Vietnam Vet who turned his combat surgery career into becoming OB-GYN) and I have to write about my falling out with our minister. So sad about that one...

My last thought for the entry is... I had my 3rd glucose test and I do not have gestational diabetes! Thank heavens!

My hero, my favorite doctor....Dr. Susanna Magee featured in this NBC 10 Heath Watch piece
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March 2, 2012
Good stuff all around! I went to the PDC today and got some good news. The baby gained nearly a whole pound over the last two weeks measuring now at 3 lbs, 9 oz; 6% percentile. Everything else was fine, too. So thrilled with the weight gain! I think it is because I actually got to rest while in Oklahoma City.

After the PDC, I went to the OB/GYN's office and met one of the midwives. She said she attended two "gentle c-sections" at Women & Infants last week. THRILLING NEWS to hear Women & Infants is actually doing them. It takes less of the debate out of my head regarding Women & Infants vs Memorial Hospital. Now if only Women & Infants would perform frenotomy (cutting the tongue tie) then I would have no debate at all knowing that I have a good chance of breastfeeding since Rachel could not latch on due to her tongue tie that ultimately resulted in her going to the NICU.

Tuesday, Feb. 28th
I got back last night from Oklahoma City. It was a great four day trip to refocus and reset my mind. I really enjoyed seeing all of my co-workers and it did a world of good to be solely an employee for a few days...not a mother, not a wife, not a patient. I did nothing other than sit in meeting, rest and sleep. Every time I called Rob, he was in a great mood-- just loving every minute with Rachel. He did not lash out at me once, much different than my trip to Florida last year. I could breathe and not worry for the first time in a long time. Rob has been absolutely wonderful; he came home early from work on Thursday last week so I could get done some packing and last minute things. He has been helpful and supportive. I feel like I have a partner and an ally. I am thinking that the reduced anxiety level can only help this baby. I went to the PDC today and had good results... 3.3 s/d ratio (normal), 138 heart beat, 12 cm amniotic fluid. Everything was great. Dr. Carr suggested that I use some guided imagery or meditation to help the baby grown. I am enough of a tree hugger to believe in that... so that is exactly what I am going to do!

Thursday, Feb. 23rd

This is definitely one of those weeks when I do not feel ahead of the game. Too much to do and too little time to do it. Not to mention, these doctor's appointments add to the existing stress of being a working mother and wife. I went to my first diagnostic appointment at Ob-Gyn Associates on Tuesday. I had a 9 am appointment but was not seen until 11 am.... sitting in the waiting with my anxieties brewing. The tech who performed the non-stress test fumbled around and could not pick up the baby's heart beat easily, so that was frustrating. Then, I had the Doppler ultrasound where the tech found the s/d ratios to be high and the amniotic fluid to be low. Afterwards, I saw my doctor who realized she forgot to do the biophysical profile. At this point, I was visibly upset. The doctor suggested that I continue to be seen at the PDC because this set up at Ob-Gyn Associates was not working for me. I agreed! I finally got out of there at 11:45 am. Half  my day was gone.

Today, I went back to PDC for my appointment at 8:15 and got out of there just a little after 9:00 am. Much better!!! Everything was pretty much fine. Amniotic fluid was up to 9 1/2 cm (7 cm on Tuesday), baby's heartbeat was 145,  baby has a full bladder which is a good indication that it is being nourished, the s/d ratios was okay. They did it 6 times--- 5 were normal and one was elevated, but nothing to be concerned about. Whew!

Friday, Feb. 17, 2012

Quick post while I am running out the door...
I had a early morning appointment at PDC today before taking a trip to PA.
Everything was GREAT! The baby is 2 lbs, 11 oz. at 3% percentile. The baby was supposed to gain 200 grams over the last 2 weeks, instead there was a 300 gram gain. Thrilled. (Granted, I wish the baby was above the 10% percentile then I could stop with all these tests!!!) The Doppler was normal, 3.4 s/d ratio, in fact very normal. Everything else was a-okay including amniotic fluid, heartbeat, etc. The doctor today was the head of the program and again, I expressed my concerns about "too much testing" for a constitutionally small baby. She said that I have to stick to the program and wait it out:(

Feb. 14, 2012--- Valentine's Day
What a great day! I had my Doppler ultrasound this morning and it was very good, probably one of the best. The s/d ratio was 3.3 (anything above 4.19 is too high). I met with Dr. Carr afterwards. He is my favorite doctor because he seems realistic-optimistic. He explains the tests thoroughly and talks to you as if you are an intelligent human being with feelings! (Imagine that!) He told me that baby's bladder is full which is a good indication that the baby is healthy. If the baby is being compromised, then the resources go to the heart and brain and other bodily functions lower than the heart are suppressed. The full bladder shows the lower part of the body is working and the top half is being nourished. Additionally, the amniotic fluid was nearly 12 cm, that is very good. The heartbeat was 140, healthy & strong.

Afterwards, I went to OB-GYN Associates to meet with my doctor and meet with one of the midwives. I believe my doctor is a nervous nellie after talking with her on the phone on Monday. She was nervous about the high s/d ratios on Friday and wanted to intervene i.e. bed rest, hospitalization or deliver the baby. On the other hand, when I met with the midwife it felt like I was finally speaking to someone who speaks my language. She is going to talk about gentle c-section at the Doctor's Round table Meeting on Wednesday. I am praying they will get on board! Hope is eternal.

Friday, Feb. 10th
Just came back from the PDC.... a little upset that the doppler ultrasound showed the s/d ratio as high.
It was 4.3; it should have been 4.1... so it is too terribly bad. Everything else was fine including the biophysical profile, non-stress stress, etc.

I met my new doctor yesterday... she is no Dr. Magee. She was no aware of gentle c-sections which was very disheartening. I thought OB-GYN Associates was on board for gentle c-sections, so I am going to need to dig a little deeper on this one.

Tuesday, Feb 7, 2012
Last week, I said good bye to Dr. Susanna Magee who is Family Doctor with OB privileges that delivers at Memorial Hospital. It was extremely difficult to transfer my care out of her practice to a more "standard" ob/gyn. I have been feeling blue since then...knowing all of this is a reality. My baby dreams are not going to come true; instead I am on the path of a high risk pregnancy and all that "defensive" medicine can offer and the "midwifery model" cannot. It's a sad realization.

Today's appointment went well, nothing remarkable. The baby's heartbeat was 145 bpm; 3.13 was the s/d pressure, and everything looked fine.

I asked the doctor after my ultrasound if he could tell me how many babies who have similar diagnosis of IUGR end of the following categories

• Are delivered full term at 39-40 weeks
• Are delivered early at 36-37 weeks
• Are micro-preemies; under 3 lbs
• Fetal death occurs

He said that he rarely sees fetal death at the stage unless there is some other significant underlying issue; especially in the metropolitan area with a major medical center available. He told me not to worry about this baby being a micro-preemie since I am into my 3rd trimester. And then the conversation got interesting.. I asked him about the babies who are delivered between 36-40 weeks. He said most of them are "constitutionally" small.  That begged the question in my mind that I needed to ask "If that is the case then, where does legitimate medicine end and "defensive" medicine begin, if these babies are just small?" He said obsectrictics is very much defensive medicine especially high risk ob medicine because they cannot see the baby, the only can see the mother. That's why so much testing is used. I asked what the reasons why someone would deliver at 36 weeks and why 39 weeks instead of 40 weeks. He said 36 weeks delivery happens when there is low fluid, the umbilical cord pressure is unfavorable or there is a significant problem with growth. We talked about my "dreams" of VBAC and bring this baby to full term at 40 weeks. He said they may let me go beyond 39 weeks with additional monitoring. That was the answer that I wanted to hear... so I guess all is well that ends well.

(I will always wonder, "I know that Rachel loves me but how much more would she love me if she was born vaginally instead of a c-section?")

Came to the realization that this baby will have over 70 ultrasounds over the pregnancy.  I am feeling blue, frustrated and sad that I am a patient not a pregnant woman.

Jan. 31st and Feb 3rd
Tuesday's ultrasounds were non-eventful. The baby's heartbeat was 145 and the Doppler ultrasound was normal at 3.3 s/d.

Friday has been on my mind since it included a growth ultrasound. The growth ultrasound showed that baby is 2 lbs. 1 oz. (the baby should be 2 lbs, 8 oz.) and 1% on the growth curve. Certainly not the worst information but I had hoped it would be better. On a more positive note, the baby grew 2 cm which is what the doctors had hoped. The heartbeat was 144 and the Doppler ultrasound was 3.2 (the new threshold is 4.3 & below as normal). The doctor said I can remain pregnant as long as the Doppler ultrasounds are normal (in other words, becoming lower). After the ultrasounds, I went to say goodbye to Dr. Magee. It was my last appointment with her. I am so brokenhearted over it. I believe with every fiber of my being, she is singlehanding changing the face of maternal health care in Rhode Island. She is amazing. What other doctor would call you on New Year's Day just to see how you are doing? I have to the realitization that I cannot have this baby at Memorial and will have the baby at Women & Infants. When I was there in November visiting a friend who had a baby, I had a panic attack at Women & Infants. That place fills me with anxiety. I decided that I do not want the High Risk Docs as my OB; I need to be with a group that has a midwifery-model of care. There are not many good choices. The best that I have come up with Ob/Gyn Associates. As I left Dr. Magee's office, these words were running through my head... Why don't I deserve a better birth? I had hoped for better than what happened with Rachel and instead, I am in a worst situation. I need to re-frame the situation in my head--- preception is reality and I need to make the best of it.

This is my first entry into the blog format. It has become difficult to keep everyone up to speed on this baby's progress. Some want to know every detail, others want to the big picture. I figured this is the best way to keep everyone up to date.

THE BACK STORY...

Around Thanksgiving, I went for my 19 week ultrasound. This is a routine ultrasound that most women get to find out the gender of their baby. We went to New Beginnings Diagnostic Center here in Providence.  We learned the baby was measuring one (1) week small. There was no big concern due to human error or the baby's due date was correct. The physician who runs the diagnostic center is Dr. Marshall Carpenter, he was somewhat more concerned after hearing that Rachel was only 5 lbs. 11 oz. at birth. At his suggestion, we requested a pathology report of Rachel's placental and found out there was blood clots in it. (I was surprised to find this out since I never knew why I had an emergency c-section with Rachel; the blood clots make it very difficult for the baby to tolerate labor.) I was screened for a blood clotting disorder which would explain Rachel's placenta and the baby's small size. It came back negative.  We went back two weeks later to have another ultrasound to check on the baby's progress. This time, the baby was 2 1/2 weeks smaller than it should be. This raised some red flags. I was then sent to the Maternal-Fetal Medicine Department (High Risk Docs) at Women & Infants Hospital (where 10,000 babies are born each year here in Rhode Island). The doctors there said the common reasons for this problem is: the mother is doing something wrong like smoking or drinking; the baby has Down Syndrome; the baby has a viral infection; or there is a placenta problem. I went for additional testing and met with the genetic counselor. After much investigation, they decided it was a placental problem and gave the diagnosis of IUGR (Intrauterine Growth Restriction).

On January 6th, I went to Maternal-Fetal Medicine Department's Pre-natal Diagnostic Center (PDC) for a follow up ultrasound. This ultrasound made us feel like the heavens opened up and our prayers have been answered. The baby grew tremendous! The baby was at the 18% percentile and was only a few days behind its gestational age. I was taken off the high risk track and the doctors said the baby is "constitutionally" small. In other words, I am small person so I am going to have a small baby. I was told that I did not have to come back for one month. I believed that I should come back in two weeks just to make sure everything was okay and that's when things went haywire again.

On January 20th, I went back to the PDC for the two-week follow up ultrasound (about 26 weeks pregnant). I had a non-stress stress indicating the baby's heartbeat was perfectly normal at 145 beats per minute and then had a Doppler Ultrasound. I was told the Doppler Ultrasound was very important because it shows the flow or pressure of the umbilical cord. Obviously, it should be normal (the pressure should be less than 4.5). If the pressure is elevated (restricted) then they might give me steroids for 24 hours and deliver this 1 1/2 pound baby. If the flow is stopped or reverse, that is very serious and means the baby is in a fatal situation. I would be rushed to the operating room.  My test showed it was elevated at about 5.5-6.5. The high risk doctors advised me not to go to England on the following Wednesday and needed to put me back on the high risk track.

January 24th and January 27th: Now that I am on the high risk track, I have to go every Tuesday and Friday to the PDC. The Tuesday appointment showed that pressure was stablized and went down to 3.8 (normal) and then Friday's appointment showed the pressure was down to 3.3 (even more normal). Both times, the non-stress test was normal and the baby's heartbeat was 145. I was terribly sad and feel awful that I was not able to go to England. I feel guilty that my co-worker had to do my job for me.

This has been our roller coaster ride so far. We are praying for the best and preparing for the worst. It has taken an emotional toll on us. Rob and I are very divided on how we are thinking about this pregnancy. I am hopeful and he is full of fear. I wanted to stay with my super-awesome doctor, Susanna Magee and have this baby at Memorial Hospital...the only Mother-Friendly certified hospital (google it!) in the state. Rob wants to have this baby at Women & Infants because they have a NICU. We have divided viewpoints on birth and pregnancy. Rob believes it is my fault that the baby is not growing because I am not eating enough. To counteract that, I am trying my best to keep to the Brewer's Diet (google that!) and going to acupuncture. We are left with a lot of mixed emotions and resentment. We are both tired and frustrated but need to keep moving on... for the sake of this baby and our Rachel who we absolutely adore. We want her to be a big sister to a healthy baby. Now how can we get this baby here???...