The Starnes' Saga

Back to the blogging world with the story of our son's birth and subsequent events for your enjoyment and our posterity...

Dec 23rd: 37 week visit to the OB for a check-up and biophysical profile (ultrasound to check health indicators of the baby). My blood pressure continued to be in the intermediate range and my cervix was still closed. Isaiah was doing well according to the ultrasound, and his estimated weight was 8lb (88th percentile!!). The ultrasound tech noted how chubby his cheeks were. We had postponed deciding on whether to travel for Christmas until this visit, and after discussing this with my OB, we decided it should be fine for us to travel to Middle TN to visit family over the next few days. My OB (Dr. Peeler) said something to the effect of, "this baby isn't going to just drop out." He continued to express concern that my pelvis may be too narrow for a vaginal delivery, but he also reinforced that it's a very difficult thing to predict and he could be wrong.

Dec 24th: We packed up and headed out of Memphis around lunchtime. We had just packed our hospital bags two nights before, and we decided we should put them in the car with the rest of our luggage 'just in case'. We also decided to go ahead and install the carseat so Frankie could get used to sharing the back seat on trips. We made it to Waverly around 3pm and settled in for celebrating Christmas with my family that evening. After dinner and opening gifts, we settled down for bed around 10:45. Lying in bed semi-conscious, I felt a strange popping sensation around 11pm. I almost brushed it off and gave in to sleep, but the thought occurred to me that this could be IT. I stood up to test my theory that my water had broken, which was quickly confirmed. Between feelings of shock, hilarity, and panic, I quickly woke Chris up. Neither of us were in the frame of mind to make decisions, so I called down the steps for my Mom and told her what had happened. She brought us back to reality and suggested we call my OB for advice. Sitting in the floor of my childhood bedroom shaking from the shock of it all (and leaking all the while), I called the answering service for my OB and then awaited the return call. The OB on call (Dr. Long) suggested we head back to Memphis (two and a half hour drive) since I wasn't yet having contractions and shouldn't have a problem making it in time.

(Christmas Eve with the family before we knew what our true Christmas gift would be.)

Thirty minutes later, we were in the car driving to the hospital in Memphis and praying we wouldn't have any problems along the way. Chris put on the emergency flashers and drove faster than he ever has before. My sister and brother-in-law weren't far behind with Frankie and their two dogs in tow. Mom stayed behind to pack up for the week since she was going to stay with us after the birth, and after calling my Dad in Murfreesboro, he quickly got on the road to Memphis as well.

Shortly after we got in the car, I started having regular contractions. This really made me anxious because my OB's advice had been based on me having ruptured membranes without contractions. I kept worrying about Isaiah thinking about all of the fluid draining from around him, and I had to remind myself that it would be doing that regardless of whether I was in the car of at the hospital. For the first hour of the drive, my contractions came every 2-3 minutes. We seriously debated whether we should change plans and go to the hospital in Jackson, TN. For the second half of the trip they were a little more irregular, ranging from every 2-6 minutes.

Dec 25th: We arrived at Methodist Germantown Hospital around 1:45am Christmas morning. The labor and delivery department was thankfully very slow, and we were promptly put in L&D room 1. I felt much calmer once I was hooked up to the monitors and could see that Isaiah was doing well. At that point, my cervix was dilated to 1-2 cm and my contractions were still ranging from 2-6 minutes. Unfortunately, my blood pressure was really elevated (~ 180/110), and it quickly became evident that I was now pre-eclamptic. The decision to start magnesium was held until lab work could be done.

They allowed me to go ahead and get an epidural a couple hours after admission despite the fact I wasn't very dilated because it appeared I was in for a long labor. While the Stadol had helped some with the pain and made me very drowsy, the epidural made a big difference and I was able to relax more. At 5am, Pitocin was started at the slowest rate with the plan to titrate up. I saw Dr. Long for the first time around 5:30, and I was dilated to 3-4 cm at that point. My contractions became very regular and strong (though I could barely feel them) and it was decided that the Pitocin wasn't necessary. At around 7:30, Dr. Crenshaw (having just come on call) checked my cervix again and I was dilated to 7cm. With such a significant change in 2 hours, everyone felt delivery was imminent and I couldn't have been happier.

On a funny sidenote, my Mom had delayed getting on the road until she could get a few hours of sleep as she didn't feel she was safe to drive when we left. Her labor with each of us had been very slow, and she assumed mine would be the same. When Chris called her at 7:30 to let her know I was dilated to 7cm, she was shocked and dismayed that she wasn't at the hospital yet. In her rush to get to the hospital, she got pulled over for speeding across the road from the hospital. Thankfully, the policeman was gracious and didn't give her a ticket once she explained the situation.

At 9:30, my cervix had changed very little (7-8cm), and at 11:30 I was 9cm but asymmetric--one side of my cervix was swollen and still covering Isaiah's head. They had me lay on my right side in an awkward position for the next two hours in an effort to decrease the swelling and get me fully dilated. Dr. Crenshaw told me at 12:30 that if I wasn't fully dilated in an hour we'd need to do a c-section. The last hour was pretty difficult--despite the epidural, my contractions had become quite painful. Part of me hoped I would dilate the remaining centimeter and have a vaginal delivery, and part of me just wanted a cesarean to have it over with already. When Dr. Crenshaw re-checked me around 1:30 and nothing had changed, I said something to the effect of, "just take me back!" So, preparations were made for a c-section and we rolled back to the OR shortly thereafter.

Once in the OR, I remember being so exhausted I could barely keep my eyes open. I so wanted to give in to sleep, but I knew I'd never forgive myself if I missed my baby's birth. Having assisted with c-sections on my OB rotation made me more nervous at this point because I knew what was going to happen to my body on the other side of that blue drape. I was glad at least to have Chris (white as a ghost by this point) by my side. The surgery itself went quickly--I remember feeling a tremendous pressure on my abdomen as they pulled Isaiah from his cozy womb and then hearing his precious first cry as he emerged into the world at 1:55pm. Tears of joy came then and I couldn't believe I had a baby boy. Chris left my side to take pictures of Isaiah's first moments, and I impatiently awaited seeing my son for the first time. What a precious site! I was so relieved to have him there whole and healthy, and I couldn't wait to hold him. By the molding of Isaiah's head, it was felt that the reason behind my failure to progress to complete dilatation was cephalopelvic disproportion (his head was too big or my pelvis too small or some combination of the two).

I don't remember a whole lot from the rest of that day. Despite my blood pressure remaining elevated (though not as severely as initially), they decided against starting me on magnesium. I went back to L&D room 1 with Isaiah to recover for ~ 1 hour, and then they rolled me up to a postpartum room (324 East) while he went to the nursery for routine measures. My family was only allowed to visit me by 2's--they didn't want me overwhelmed by visitors and my blood pressure elevated further. Unfortunately, they all had to see Isaiah for the first time through the glass of the nursery window. By that point, Mom, Dad, Marie, Lindsay, Chase, Jordan, Meagan, and Austin were all present.

Dec 26: My family came to visit that morning and each got to hold Isaiah for the first time. It was quickly agreed that he has Chris' nose and resembles him most closely overall. My Dad did point out that he has the crooked Littrell fingers--what a wonderful trait to pass on :) The rest of the hospital stay was fairly uneventful--learning how to breastfeed and catching up on sleep consumed most of my time. Mom stayed with me in the hospital the second night so Chris could go home and attend to things and get more rest. The rest of my family had to return to Middle Tennessee.

Dec 27: We were discharged home with many precautions of taking it easy, no heavy lifting, checking my blood pressure occasionally, etc. My dear college friends, Laura and Paige, arrived at the hospital just as we were being discharged and then accompanied us home for a nice visit.

Dec 29: I checked my blood pressure that morning and found it to be significantly elevated (~160/110), so I called my OB's office to let them know. They asked me to come on in to have it check in the office, where it initially was at a similar level and then came down (~140/90). Since it came down, Dr. Pickens was okay with letting me go home after drawing blood for labwork. I took a nap when I got home and woke up to the phone ringing--Dr. Pickens called saying my uric acid was further elevated from prior levels and that now one of my liver enzymes was also elevated. While the pre-eclampsia should have been improving after the delivery, my case was unexpectedly worsening, so he admitted me back to the hospital for administration of magnesium.
That was a pretty miserable night. Isaiah and Chris returned to the hospital with me, where I was restricted to the bed for the entire time and limited to a clear liquid diet (you can only eat chicken broth and JELLO so many times!!). I think I tolerated the magnesium better than many--the most noticeable side effect was that it made me feel like a radiator...I was burning up and froze Chris with needing the AC on. The most difficult part was not getting any sleep--between hourly nurse checks and feeling pretty crumby, I just couldn't fall asleep. On the positive side, I finally got rid of almost all of the water I had been retaining in the form of at least 6-7 liters of urine!!! The nurses were stunned by my output--I think I literally dropped ten or more pounds overnight. Isaiah had a pretty rough night also... he had some really long and difficult crying spells to the point that my nurse called one of the newborn nursery nurses to come help us. Needless to say, I was so glad to go home the next day!

Since coming home, I've made a somewhat slow but sure recovery. I was put on Labetalol to control my blood pressure with the plan to wean off of it once things improve. Initially I was really easily winded and fatigued, but that's been improving a lot the last day or two. I definitely experienced the "baby blues" for several days of Isaiah's first week of life, and I really had to fight trying to isolate myself from others. It was really difficult feeling so physically limited to care for my son and household, and the overwhelming responsibility of caring for this precious infant had me pretty scared. I know lack of sleep definitely didn't help my outlook either. Nevertheless, God is faithful and has carried me through this difficult experience as He has (and will) many others. Isaiah is still not sleeping great between feedings at night, but we're making some progress on that front. Overall, I have a great deal to be thankful for: a healthy and beautiful baby boy, a wonderfully supportive husband and family, and the promise of better health. God also taught me a lot about being a patient through this experience, and I know I'll have greater empathy as a physician as a result.

Thanks for your prayers and support! I'll post more pictures in the near future.

I never intended to let 3 weeks pass between posts, but it seems the last few weeks have just flown by and I lost track of time. I was 36 weeks along yesterday. Below is a 36 week belly shot:

Things have gotten a bit more difficult with the pregnancy in the last couple of weeks. Besides the typical discomforts and frequent bathroom trips, my blood pressure has been running a little high and my uric acid level (an indicator of pre-eclampsia) was elevated last week. As a result, my doctors have been watching me more closely. While I haven't yet met the criteria to diagnose pre-eclampsia, they're concerned that I may be heading that direction, so they put me on bedrest. Today I went back for a check-up, and they did a biophysical profile (BPP--an ultrasound looking for certain markers of health in the baby). Everything with Isaiah was fine, so it was really nice to have that reassurance. In fact, he's measuring at the 75% at around 7lb 2oz! I'm going back next Wednesday for my 37 week check and they're going to do another BPP. While the jury is still out on definitive plans for delivery route, induction, etc, my doctor has introduced the possibility of a primary c-section and it's very likely that they'll induce/do a c-section by 39 weeks if Isaiah hasn't come on his own already. I'm certainly fine with him coming sooner than later, though I wasn't bargaining for a recovery from a c-section. We know it's in God's hands, and we'd definitely appreciate your prayers in all of this.

Since I last posted, we've traveled to both Oklahoma City and Charleston for residency interviews. I liked both programs and the interviews went smoothly, but we're pretty worn out from the traveling. We shouldn't have to make any more big trips until a few weeks after Isaiah is born. We're not making final decisions about Christmas traveling until we see how things are going at my appointment next week (last minute decision), but the farthest we'll be traveling is Middle Tennessee.