Saturday, June 28, 2008

First Days at Home

Ruthann was born on Grandpa Jim's birthday, so we all got birthday ice cream cake. Yum-ola!

Ruthann and Noni

Everyone loves Thomas

Ruthann and Grandma

A moment of bliss. Thomas asleep in his crib and Ruthann asleep in the bouncer.

Monday, June 23, 2008

A Birth Day Story

When my OB said, "You know, once your water breaks, you're going to have this baby in an hour," I started thinking about how long it takes from the time you arrive at a hospital till you are actually seen by someone. We decided to schedule a time to break my water at the hospital. My doctor gave me two choices, Friday or Monday. Since Monday was the day that Great-Grandpa had put a $500 incentive plan on, I said Monday.

The Before Picture

Monday, June 16th, at 7:30 in the morning, my entourage showed up at the hospital. Mom and I went to admitting, while Curtis drove Thomas to the sitter's. He was back in plenty of time, since it took an hour and a half (9 am) for the hospital to get things organized and start the I.V. with the Pitocin (to start contractions). Those contractions were SO easy that even though they were 5 minutes apart, I would not have realized that they were the sign to head to the hospital. At 9:30, my doctor came in and broke my water. Now the contractions were definitely painful and it was only about 15 minutes before I was in enough pain that I would not have been able to walk or really do much of anything. If not for the induction, I would have had this baby on the bathroom floor.

Pretty soon, I'm in transition, which means SERIOUS pain. The nurse asks me if I want something for the pain. "YES!!" I gasp, but she just leaves the room. Confused, when she returns, I try to remind her of her offer. "At this point, anything we gave you would slow the baby's heart rate too much." Incredulously and in MAJOR pain, I gasp/shout, "Then WHY did you offer?!"

Another nurse decides that the baby's heart rate is dropping too low, so I get to lay on my side and get oxygen. This is good as my hands and feet had been tingling and going numb. I keep asking (begging) the nurses to let me push (since I remember with Thomas that all the transition pain goes away once you start pushing). They haven't checked me in a while, but couldn't believe I could possibly be at 10 cm yet (HA!) and besides, I should wait for my doctor. I try not to push, but it just hurt too much not to. My secret pushing was revealed when my doctor arrived, helped me roll to my back to check the progress and found that the baby's head was already there. I didn't have to even push for her to be delivered. It was 11:02 am, two hours after they started the I.V. and only an hour and a half since my water broke. (I think it could have been even faster if only they had just let me push.)

Getting Examined After Delivery

She came out screaming (which is good), but with the cord wrapped around her (not a problem, since the doctor just clamped and cut it right then). She was cleaned up, but was very white. They were worried that she might be anemic or something, so took her to the NICU to be examined. She pinked up after about 10 minutes, but they kept her for a "four-hour observation." Eventually, she was cleared by a doctor and allowed to go to the regular nursery. They had to do yet another examination and paperwork, while I was making phone calls trying to track down what had happened to my baby, who I had not seen since she was born over 5 hours earlier. At last she was brought to my room, just in time for two cars of visitors to arrive. Car 1 brought Thomas back to us and the second car had Ruthann's godmother and her sister. We all had a good time for an hour or so before visiting hours ended at 8 pm. (Well, all except Thomas who got scared by my reaction when he yanked on my I.V. and then was bored and tired.) As my visitors left, Ruthann was taken back to the nursery to get checked out by her pediatrician. This is getting long, so what happened the rest of the night will be taken up in the next post.

In My Room, At Last

Ruthann's First Visitors

So, between 7 pm and 8 pm on her birth day, Ruthann and I had lots of visitors. Everyone enjoyed passing her and Thomas around. Ruthann just mostly wanted to sleep. Hey! I look surprisingly decent for having given birth eight hours ago.

Mama enjoys visitors in her super-flattering hospital gown

Big brother Thomas wants up on the bed to trample Mama's poor tummy and yank on her I.V.

Ruthann gets some adoration from her godmother

Curtis smirks that he has the dominant genes, since yet another child looks pretty much just like him.

A Baby Post with Heart

The Mystery
As our visitors were leaving, Ruthann's pediatrician arrived and took her to the nursery for (yet another) examination. After a while, I started trying to track down my baby (again!). After all, I had seen her for a grand total of an hour. The pediatrician came in to tell me that while she was examining Ruthann, she heard a heart murmur and then the baby turned blue. The blue spell lasted less than a minute. (Apparently, because it was so unexpected, it totally freaked out the nurses and they had her on oxygen in a flash. I kept overhearing them talking about it at their desk for the rest of the shift.) Ruthann had been taken back to the NICU to have a full workup (chest x-ray, EKG, etc) done by the neonatologist. The pediatrician started telling me about the different possibilities which ranged all the way from "which she'll outgrow in time" to "requires transfer downtown for immediate heart surgery."  After the neonatologist finished the tests on Ruthann, he sent all her test results to a pediatric cardiologist (to his home even) for evaluation.  The cardiologist came in in the morning to see me with the diagnosis. 

The Bottom Line
Ruthann has a heart condition called Tetralogy of Fallot. It fell in the middle of the possibilities raised by the pediatrician. There are no day-to-day symptoms or problems, but it requires open-heart surgery to repair.  This surgery would happen sometime between four and eight months of age.  If left untreated, Ruthann's blood oxygen levels would gradually decrease and by the time she was seven to ten years old, she'd be one sick little kid.  Nowadays, they can operate on even very small children, so they no longer have to wait until the children start to have problems to operate.

The repair surgery is now common and there are three hospitals in L.A. that are quite skilled at it. She is not on any medicines, oxygen, or active monitoring and she will grow at the same rate as any other baby. All she has is an extra set of appointments with a cardiologist who will check her blood oxygen levels every couple of weeks.  

The doctors wanted to keep her under observation for a few additional days to rule out anything else like infection.  We finally got to take her home from the NICU Friday afternoon.  (I had been discharged Wednesday afternoon.)

Two Days Old Being Observed in the NICU

Overall, if the cardiologist hadn't told me about her condition, I never would have guessed it from looking at her. She is pink and pretty, feeds well (better than Thomas at this age), and sleeps well for a newborn. It's kind of strange to say that a heart condition is no big deal, but this one really isn't. We don't have to treat her any differently from any other newborn baby and her condition will be repaired before she (or Thomas) ever has any memory of it.

The Technical Stuff
Tetralogy of Fallot has four components (pictures below).  The most serious is called pulmonary stenosis (A), which means the valve going from the right ventricle to the lungs does not completely open.  There may also be some muscle below the valve that also partially blocks it.  This reduces the amount of blood going to the lungs, which causes her blood oxygen levels to decline as she gets larger.  If the blood cannot flow to the lungs because of the stenosis, it passes through a Ventricular-Septal Defect (B) (a hole between the ventricles) and mixes with blood that is already oxygenated.  The third component is an Overriding Aorta (C).  The artery that carries oxygenated blood to the body is shifted over to service both ventricles.  

The final component is a secondary feature.  Because of the Ventricular-Septal Defect, both ventricles feel the same pressure (which is more than the right ventricle would usually feel).  This causes the right ventricle to build up additional muscle.  This is called Ventricular Hypertrophy (D).  There is also a small hole between the atria (E). The surgery will patch both holes and repair (not replace) the pulmonary valve to restore normal blood flow. We'll learn more about the surgery as it gets closer.

Wikipedia also has a pretty good article.

Normal heart with oxygenated blood in red and old blood in blue

Heart with Tetralogy of Fallot (letters refer to components above)