I had a lot of anxiety leading up to Jaden's birth, not just about how how the delivery would go, but about how things would go after the delivery. Much of it was logistical. We didn't know up until the day of whether or not Jason and I would have a room following the delivery.
In typical delivery situations, the baby rooms with the mother. In typical delivery situations, the mother is the one delivering the baby. So, since our situation was anything but typical, we weren't sure what that meant for Jason and I. We were hopeful that the PBO we had in place would help.
At around 20 weeks gestation,with the help of our attorney Jason and I petitioned the court for a PBO or a Pre-Birth Order. A PBO is a court order signed by a judge establishing parentage of an expected child when the woman giving birth to the child is not genetically related to the child. The law assumes that a woman who gives birth to a child is the genetic mother of the child; if she is married her husband is presumed to be the father of the child. Invariably, the presumption about the husband being the father of the child has in some cases been wrong (when there's another baby daddy), but until recently, it was never wrong about the mother. Enter modern science. With the advent of surrogacy, some states (including Georgia) began the practice of utilizing Pre-Birth Orders to address this issue. The fee for obtaining a PBO in Atlanta varies anywhere from $2600 to $5000. While the surrogate can waive her right to an attorney for the contract phase of surrogacy, it is mandatory that she has an attorney for the PBO in order to ensure that she is not being coerced into signing the petition. The Intended Parents are responsible for the surros attorney's fees as well, usually amounting to around $750. What happens if you don't live in a surro-friendly state that grants PBO's? You obtain a post-birth order, or in some cases, adopt your baby. This makes the hospital situation trickier. If the PBO is granted (thankfully it typically is), the hospital is ordered to put the names of the genetic parents (Jason and I) on the birth certificate. Additionally, the court order states that Jason and I are to make all medical decisions for the child once he is born.
In theory, having a PBO in hand should have made the hospital situation pretty seemless. With Jason and I being recognized as biological parents, we would both be given hospital security bands which allows us all access to our baby. We also hoped that we would be given a hospital room following his delivery. When Ellen was around 30 weeks pregnant, I called the hospital to see if this was possible. I was initially told it would depend on the hospital census, but later told that we wouldn't be able to get a room regardless of the census since hospital rooms are only given to patients. We asked if we could stay in Ellen's room with her, since she is technically the patient. They told us only one person was permitted to stay the night in Ellen's room. The Charge Nurse that headed up the Mother and Baby floor did say that there is a special "Family Room" that she has designated for families of patients who need to stay the night and told us we were welcome to stay there. She said it isn't technically a hospital room but should be sufficient. We were still hopeful the PBO would help get us a room, but grateful that there was at least a back up option in place.
The three of us decided it would probably be best to go to the hospital to introduce ourselves and speak to the powers-that-be (in this case, we started with the charge nurses). We also wanted to check out the "Family Room" in case we did end up having to stay there. Unfortunately, the "Family Room" was less than ideal. The room was quite small and just had a chair and a bench in it. No bed. No bathroom. Not even really room for a bed. After seeing the room and my clear disappointment, Ellen told us not to worry- we could just bunk up with her if we couldn't get our own hospital room. We asked the Charge Nurse about this and were once again told only one person was permitted to stay the night in Ellen's room. Hospital policy. We were also informed that once the baby is born he is given four security bands. Two of the bands would go on each of the baby's ankles, one would go to Ellen, and the final one would go to whichever one of us Ellen chose. We explained that Jason and I both should be given bands but they insisted since Ellen is giving birth to the baby, the baby goes with her. No way around it. Hospital policy. Okay, we said. Well then can we get additional bands so that Jason and I can both have a band? No dice. They only come in sets of four. The nurses we spoke to were quite nice, but it was clear that they were not familiar with surrogacy and weren't sure how to bend hospital policy to accommodate our situation.
With PBO in hand, we eventually asked to speak to the Director of Nursing. We explained that we know our situation is unique but surely there must be a way around hospital policy. She assured us that she is familiar with surrogacy but still insisted that Ellen gets the security band because she is the "birth mother". Birth mother? Um....this is not an adoption. The Director must have seen the look of discontent on my face in reaction to her choice of words so she corrected herself. "She's not the birth mother. She's the....vessel...giving birth". Vessel?? She told us that we need not worry though, because even if Jason didn't have an arm band, it would be communicated to the staff that he was the biological father and would be given all access to the baby. The hospital isn't that big, she told us. It would be fine.
This didn't sit well with us so when I got home I immediately contacted our attorney. We have an incredible relationship with our surrogate but there are some surrogacy journeys that don't go as well as ours. In fact, I have heard of cases where there is such a breakdown in the relationship that the surrogate and Intended Parents don't speak at all and only receive updates about the pregnancy from their attorney. If our situation was like that, we certainly wouldn't feel comfortable with our surrogate having armband access to our baby while one of us was denied this access. After several emails, phone calls and weeks of waiting, our attorney spoke with hospital counsel and got the security band situation straightened out. Jason and I would both be given armbands. Ellen would not receive a band.
As for the room? We were told that we still wouldn't be given a room but, if there was a room available, we would be given the opportunity to purchase a room for $450. This wasn't exorbitant, but was no steal either. We figured we would just make a game-day decision and see how we felt, and packed an airbed and a sleeping bag just in case.
Stay tuned for the next blog post to see what we ended up deciding...
Sunday, December 21, 2014
Monday, December 15, 2014
Saturday, December 6, 2014
#Jadenwatch2014 or Our Surrogacy Birth Story
Little man has been here just over 72 hours (well now more like 120 hours- its hard to get things done with a newborn!) so I wanted to get down his birth story while its still fresh in my mind.
#Jadenwatch2014 (hashtag complements of my friend Mary) started about two weeks ago when Ellen was already dilated to 3cm at 37 weeks 4 days. The OB scheduled the induction initially for Black Friday but then switched it to the Monday after Thanksgiving since staffing would be better following the holiday. Two different OB's told us they doubted we would make it to the induction so we had our hospital bags packed and were on high alert all week. My parents came in town Thanksgiving day and joined us on #Jadenwatch2014. We all thought it would be pretty fitting if he came during the Florida/Florida State game but Jaden had other plans and decided to stay put until the induction.
We arrived at the hospital Monday at 8am. Since Ellen was positive for Group B Strep she needed to get IV antibiotics in order to prevent passing anything to the baby. We were hoping she would have time to get two doses in, as at our last OB appointment on Wednesday the doctor told us the baby would have to stay in the hospital 48 hours if she didn't get both doses. Given that this was Ellen's fifth pregnancy, the doctor doubted she would have time for both and predicted the baby would be here by noon. Thankfully, that didn't turn out to be the case.
My parents and Jason's mother set up camp in the waiting room while Ellen, Chris, Jason and I headed to the Labor and Delivery Room. Ellen's mother joined the other parents soon after. Our nurse Meg was really amazing. She had donated her eggs twice before so was very familiar with the process of IVF as well as the struggles so many go through to create a family. She asked me for my birth plan so she could understand my desires and assured me that she would help make sure my wishes were respected. She even read the instruction manual for my skin-to-skin shirt and told me she would help me get him situated in it. It felt really nice to have her support, especially since I felt slightly crazy wearing that shirt.
Ellen got hooked up to the monitors and the nurse explained that the top lines measured the baby's heartbeat and the bottom measured contractions. Contractions were minimal when we arrived. They had to special order Ellen's antibiotics so they didn't start her first dose until around 10:30 AM. Ellen was hoping the doctor would break her water and allow her to walk the halls in lieu of starting the pitocin (aka "the devil" in Ellen's eyes) but the doctor opted to just start her on a tiny dose of pitocin along with the antibiotics. After about an hour there was very little movement, so Meg said she was going to ask Dr. Ramani to break her water. We had to wait a while since the doctor was in a C-section (Chris almost took matters into his own hands when he found the "poker") so it was about 12:30 when her water was finally broken. We all gave a sigh of relief when we saw the water was clear (which meant no meconium) . Meg bumped up the pitocin shortly after in the hopes that this would speed thing up. She told us she had a woman next door who was also dilated the same amount. This was good motivation for Ellen, who is as competitive as Jason and I. "Oh, we are so going to be first, Ellen said. About an hour later, she bumped up the pitocin again and around 2:00 the strong contractions started kicking in. The nurse checked Ellen and she was dilated to about a seven.
I probably should mention that Ellen opted not to get an epidural. She has never had one- apparently for Ellen, the idea of not being able to feel below her legs is worse than the excruciating pain that comes with labor. By this time, the charge nurse Kenna had joined us since Meg was next door tending to the other delivery (she was still behind us, and she was already on her second epidural) I asked Kenna how many women don't get epidurals and she replied "On purpose? Maybe five percent". I was pretty surprised by that number and Ellen was too- she didn't realize she was in such a minority. I'm not sure how Ellen feels about it, but in retrospect, I think that her decision not to get an epidural actually enhanced the birth experience for me. It was undoubtedly difficult to watch someone I love and care about be in so much pain, but it really made me appreciate her even more (as if that was even possible). And the fact that she was going through this pain for me, for us, for our baby...
Around 2:30, I could tell by Ellen's face and lack of ability to talk that she was in immense pain so asked if the nurse would check her dilation again. The nurse said they don't like to check too often as this can promote bacteria but felt like Ellen would know when it was time. Really?!? You don't want to try something a little more scientific than a feeling? The nurse was about to leave the room when Ellen said "If I'm still a seven, I'm gonna need that epidural". Thankfully the nurse checked again because the next thing you know, she asked Chris to hold one of her legs and had me hold the other. Jason initially stood by Chris near Ellen's head and then kind of floated between Chris and I, still remaining by her head. Ellen was clearly in a lot of pain and I heard the nurse say, "This is the part where most patients give up and feel like they can't do it but you are really close. I know that you can do it". Really close? My heart was beating a mile a minute. I mouthed to Jason "Where's the doctor?"
No sooner did I say that then the doctor arrived and instructed Ellen to lift her legs higher and begin pushing. Still holding her leg, I was standing on my tippy-toes trying to brace myself against the weight of her push. I told someone I was on my tippy-toes and they brought me a stool, which was a relief. I remember thinking I didn't have the strength to keep holding her leg and it would have been terribly embarrassing if I gave up before Ellen did. Ellen pushed just three times and during the last push, at 3:17 PM, we were instructed to go watch our son being born. Jason was always a bit reluctant about doing that- I think most men are uncomfortable about that with their own wives, never mind someone else wife. All that discomfort went out the window when, mid-push, Ellen looked at Jason and said "Get down there!".
I cannot adequately describe what that felt like. It was truly surreal. When I first saw the crowning I was in shock. His head was itty-bitty- like a kewpie doll- and I was like- oh my god, he really is a tiny baby! As more of his head came out I saw that it wasn't quite as small as I initially thought. He was small, but he was amazing. Dr. Ramani pulled him out and placed him on Ellen's stomach and you know what? I didn't even care. I think it was probably just habit for the doctor to lay the baby on the woman and when he realized what he did, he looked back at me like "Oh crap- I wasn't supposed to do that, was I?" I just said "It's okay, it's okay" with tears streaming down my face, then went to Ellen and said "He deserves to go on you first because of all that". He was just on her for a few seconds- they clamped the cord, Jason cut it, and then the NICU team whisked him away.
They began examining him while Jason and I looked on. He was crying, which is a good sign, but I guess his breathing was a bit coarse. They said this was because he came so quick and didn't have time for his lungs to get cleared in the birth canal. They spent several minutes, which felt like hours, attempting to clear his passageways by sticking a tube up his nose and down his throat and using the bulb in his mouth and nose. They were all business and it was pretty scary. I finally asked if he was okay and if he failed his APGAR, and they assured me that he got a 9 and an 8 and was just fine.
Finally, they let us have him and the nurse helped me into my Nuroo shirt. As soon as he was all nestled up inside of the shirt, skin-to-skin, I no longer felt crazy for wearing it. I just felt like mom. At last.
EDITOR'S NOTE: If you are reading this on your phone, you may want to go to a computer when you can and watch these videos. After we were home about four days Jason said "Oh yeah, I forgot about these". Apparently he snuck a few videos during and just after the birth. They are so amazing. It was really interesting to watch it back. There have been a few times in my life when I have just wailed- when I could hear this sound coming from me and wasn't sure where it was coming from. Up to this point, those times were following a miscarriage. It was surreal to hear that same sound coming from tears of joy. And my exclamations, "Oh my G-d, Oh my G-d, Oh my G-d"! That was fitting too. Our son's name is Jaden Court. We knew early on that if we had a girl, his middle name would be Ellen. Since it was a boy, we chose Ellen's maiden name, Court, to honor her and so that he would always know his birth story. His first name is Hebrew for "G-d has heard". Indeed he has.
#Jadenwatch2014 (hashtag complements of my friend Mary) started about two weeks ago when Ellen was already dilated to 3cm at 37 weeks 4 days. The OB scheduled the induction initially for Black Friday but then switched it to the Monday after Thanksgiving since staffing would be better following the holiday. Two different OB's told us they doubted we would make it to the induction so we had our hospital bags packed and were on high alert all week. My parents came in town Thanksgiving day and joined us on #Jadenwatch2014. We all thought it would be pretty fitting if he came during the Florida/Florida State game but Jaden had other plans and decided to stay put until the induction.
We arrived at the hospital Monday at 8am. Since Ellen was positive for Group B Strep she needed to get IV antibiotics in order to prevent passing anything to the baby. We were hoping she would have time to get two doses in, as at our last OB appointment on Wednesday the doctor told us the baby would have to stay in the hospital 48 hours if she didn't get both doses. Given that this was Ellen's fifth pregnancy, the doctor doubted she would have time for both and predicted the baby would be here by noon. Thankfully, that didn't turn out to be the case.
My parents and Jason's mother set up camp in the waiting room while Ellen, Chris, Jason and I headed to the Labor and Delivery Room. Ellen's mother joined the other parents soon after. Our nurse Meg was really amazing. She had donated her eggs twice before so was very familiar with the process of IVF as well as the struggles so many go through to create a family. She asked me for my birth plan so she could understand my desires and assured me that she would help make sure my wishes were respected. She even read the instruction manual for my skin-to-skin shirt and told me she would help me get him situated in it. It felt really nice to have her support, especially since I felt slightly crazy wearing that shirt.
Ellen got hooked up to the monitors and the nurse explained that the top lines measured the baby's heartbeat and the bottom measured contractions. Contractions were minimal when we arrived. They had to special order Ellen's antibiotics so they didn't start her first dose until around 10:30 AM. Ellen was hoping the doctor would break her water and allow her to walk the halls in lieu of starting the pitocin (aka "the devil" in Ellen's eyes) but the doctor opted to just start her on a tiny dose of pitocin along with the antibiotics. After about an hour there was very little movement, so Meg said she was going to ask Dr. Ramani to break her water. We had to wait a while since the doctor was in a C-section (Chris almost took matters into his own hands when he found the "poker") so it was about 12:30 when her water was finally broken. We all gave a sigh of relief when we saw the water was clear (which meant no meconium) . Meg bumped up the pitocin shortly after in the hopes that this would speed thing up. She told us she had a woman next door who was also dilated the same amount. This was good motivation for Ellen, who is as competitive as Jason and I. "Oh, we are so going to be first, Ellen said. About an hour later, she bumped up the pitocin again and around 2:00 the strong contractions started kicking in. The nurse checked Ellen and she was dilated to about a seven.
I probably should mention that Ellen opted not to get an epidural. She has never had one- apparently for Ellen, the idea of not being able to feel below her legs is worse than the excruciating pain that comes with labor. By this time, the charge nurse Kenna had joined us since Meg was next door tending to the other delivery (she was still behind us, and she was already on her second epidural) I asked Kenna how many women don't get epidurals and she replied "On purpose? Maybe five percent". I was pretty surprised by that number and Ellen was too- she didn't realize she was in such a minority. I'm not sure how Ellen feels about it, but in retrospect, I think that her decision not to get an epidural actually enhanced the birth experience for me. It was undoubtedly difficult to watch someone I love and care about be in so much pain, but it really made me appreciate her even more (as if that was even possible). And the fact that she was going through this pain for me, for us, for our baby...
Around 2:30, I could tell by Ellen's face and lack of ability to talk that she was in immense pain so asked if the nurse would check her dilation again. The nurse said they don't like to check too often as this can promote bacteria but felt like Ellen would know when it was time. Really?!? You don't want to try something a little more scientific than a feeling? The nurse was about to leave the room when Ellen said "If I'm still a seven, I'm gonna need that epidural". Thankfully the nurse checked again because the next thing you know, she asked Chris to hold one of her legs and had me hold the other. Jason initially stood by Chris near Ellen's head and then kind of floated between Chris and I, still remaining by her head. Ellen was clearly in a lot of pain and I heard the nurse say, "This is the part where most patients give up and feel like they can't do it but you are really close. I know that you can do it". Really close? My heart was beating a mile a minute. I mouthed to Jason "Where's the doctor?"
No sooner did I say that then the doctor arrived and instructed Ellen to lift her legs higher and begin pushing. Still holding her leg, I was standing on my tippy-toes trying to brace myself against the weight of her push. I told someone I was on my tippy-toes and they brought me a stool, which was a relief. I remember thinking I didn't have the strength to keep holding her leg and it would have been terribly embarrassing if I gave up before Ellen did. Ellen pushed just three times and during the last push, at 3:17 PM, we were instructed to go watch our son being born. Jason was always a bit reluctant about doing that- I think most men are uncomfortable about that with their own wives, never mind someone else wife. All that discomfort went out the window when, mid-push, Ellen looked at Jason and said "Get down there!".
I cannot adequately describe what that felt like. It was truly surreal. When I first saw the crowning I was in shock. His head was itty-bitty- like a kewpie doll- and I was like- oh my god, he really is a tiny baby! As more of his head came out I saw that it wasn't quite as small as I initially thought. He was small, but he was amazing. Dr. Ramani pulled him out and placed him on Ellen's stomach and you know what? I didn't even care. I think it was probably just habit for the doctor to lay the baby on the woman and when he realized what he did, he looked back at me like "Oh crap- I wasn't supposed to do that, was I?" I just said "It's okay, it's okay" with tears streaming down my face, then went to Ellen and said "He deserves to go on you first because of all that". He was just on her for a few seconds- they clamped the cord, Jason cut it, and then the NICU team whisked him away.
They began examining him while Jason and I looked on. He was crying, which is a good sign, but I guess his breathing was a bit coarse. They said this was because he came so quick and didn't have time for his lungs to get cleared in the birth canal. They spent several minutes, which felt like hours, attempting to clear his passageways by sticking a tube up his nose and down his throat and using the bulb in his mouth and nose. They were all business and it was pretty scary. I finally asked if he was okay and if he failed his APGAR, and they assured me that he got a 9 and an 8 and was just fine.
Finally, they let us have him and the nurse helped me into my Nuroo shirt. As soon as he was all nestled up inside of the shirt, skin-to-skin, I no longer felt crazy for wearing it. I just felt like mom. At last.
EDITOR'S NOTE: If you are reading this on your phone, you may want to go to a computer when you can and watch these videos. After we were home about four days Jason said "Oh yeah, I forgot about these". Apparently he snuck a few videos during and just after the birth. They are so amazing. It was really interesting to watch it back. There have been a few times in my life when I have just wailed- when I could hear this sound coming from me and wasn't sure where it was coming from. Up to this point, those times were following a miscarriage. It was surreal to hear that same sound coming from tears of joy. And my exclamations, "Oh my G-d, Oh my G-d, Oh my G-d"! That was fitting too. Our son's name is Jaden Court. We knew early on that if we had a girl, his middle name would be Ellen. Since it was a boy, we chose Ellen's maiden name, Court, to honor her and so that he would always know his birth story. His first name is Hebrew for "G-d has heard". Indeed he has.
Tuesday, December 2, 2014
Introducing Jaden Court
Little man arrived yesterday at 3:13 PM. 5lbs15.4oz and 19 inches of perfection. We couldn't be happier.
This is what five years of waiting to be parents looks like...
We are eternally grateful to these two who helped us become a family...and who are now part of our family too!
I will update about the birth story later...
Tuesday, November 25, 2014
All We Need Now is the Baby!
We've been waiting a long time for this baby, which also means we've had a long time to think about the nursery decor. We knew we wanted to
do something music-themed and I spent a lot of time on Pinterest and Project Nursery trying to find something I liked. While those gave me some good ideas, I didn't quite see what I wanted. Fortunately, I have an in-house graphic artist so decided we would be doing a lot of the design ourselves. By we, I really
mean Jason, though I am the art director in the family. I found this
cute guitar-playing chick on Pinterest and asked Jason if he could come
up with something similar for the nursery.
For the final touch, we painted some IKEA spice racks and used them for book shelves (thanks pinterest!)
I was thinking maybe different animals playing instruments but Jason came up with an even better idea.
He went on to represent some of our favorite artists. How great are these?
We also framed lyrics from some of our favorite songs that deliver a message for Baby O. These include "I got you. I got everything" (Jack Johnson) "Decide what to be and go be it"(The Avett Brothers) "See the path cut by the moon for you to walk on" (Pearl Jam) and "Don't worry about a thing" (Bob Marley). We arranged the framed artists and lyrics over the dresser.
We put "Here Comes the Sun" (The Beatles) over the crib. I had originally planned to hang the Dave Matthews lyrics "Wake up sleepy head, I think the sun's a little brighter today" on the other wall, but Jason randomly found a lighthouse print while at the thrift shop looking for frames for the artwork. He knew it belonged on the wall instead. Once again, we could feel the presence of Jason's father.
And thanks to Ellen for gifting us so many amazing books. We can't wait to read them to Baby O- especially the ones with the sweet inscriptions!
Here's a panoramic-ish shot of the room. In the corner we hung the first guitar Jason ever owned, a gift from his father when he was twenty years old. Jason was so excited about finally owning a guitar that he would just stare at it from across the room. Now Baby O can do the same!
Jason and I also created a "Songs from the Nursery" playlist and gave each of our amazing baby shower hostesses a CD. The playlist is filled with some of our favorite artists that are represented in the nursery as well as songs that really resonated for us along this journey. One in particular, the Bob Marley song "Coming In From the Cold" with the lyric "When one door is closed, don't you know, many more is open" really hits home. Another really meaningful song is "Father, Son". Jason discovered this song about a year after his father passed away when he decided to make a tribute video for him. Click here to see that incredible video (but be sure to grab your kleenex). It's really special that the song will take on new meaning with the birth of Baby O. Here's our "Born to Rock" playlist. If you have Spotify, you can listen now. Enjoy!
Tuesday, November 18, 2014
Birth Plan Schmurf Plan
On Friday we went to the OB/GYN for the beta Strep B test and a cervical check as Ellen was 36w2d. Since ours is a unique birthing situation, I decided to come up with a birth preference plan in order to minimize confusion. Ellen has never used a birth plan with any of her prior pregnancies knowing that plans don't really mean anything when it comes to actual delivery. Still, she agreed that it would make sense to have something in writing so that the hospital was aware that Jason and I are to make all medical decisions following his birth. I scoured the internet trying to find birth plans for surrogates and intended parents and really only found this. My sister-in-law gave us a copy of her birth preference (she took the word plan out of the name but I think we all know it was still a plan) and I used both of those sources as a guideline to for ours. Both plans included a lot more information about labor preferences but since Ellen wasn't concerned about that, I omitted that part. The main things I was concerned about was having delayed cord clamping and doing immediate skin-to-skin contact with the baby.
I had my birth preference plan in hand when the doctor walked in. He glanced at it and said in a somewhat snarky manner, "Oh no, she's got it written down". I told him that I'm really not Type-A but wanted to have things in writing since this is such a unique situation. He then said, "Well you might as well tell me what's in it because I'm going to have to read it anyway". I told him about my two main preferences and to my dismay, he told me it wasn't possible. "We can do delayed clamping- no problem. But you can't do immediate skin-to-skin. The baby will need to go on her belly (gesturing toward Ellen) because the cord will still be attached". He went on to say that the NICU team will then need to assess him since he will likely be under 5lbs as he is IUGR. NICU?!? IUGR?!? These are terms I hadn't yet heard associated with my baby. I knew he was measuring small, but I thought he was just SGA. I told the doctor that and he said "They're the same thing".
So what are all these acronyms anyway? IUGR stands for Inter-uterine Growth Restriction (though I've also seen it referred to as Growth Retardation) and refers to a baby that is not growing at the normal rate in the womb. Specifically, it means the baby is below the 10th percentile. Our baby has been measuring small since we first went to the specialist at 22 weeks. This is why we have the weekly appointments with the specialist where they measure his growth every other week and do biophysical profiles on alternate weeks. His biophysical profiles have always been perfect and the specialist has never given us any reason to believe that the baby would need the NICU. I was quite alarmed to hear otherwise from the OB. The specialist has always maintained that thought he is behind, he is likely just a small baby. I'm just five feet and Ellen has never carried a baby over 6lbs 8oz, so its likely that the fact that Ellen grows smaller babies and the fact that his mom is small plays a role in his size. I was under the impression that IUGR meant there is a problematic reason that the baby is measuring small (problem with blood flow from the cord, problems with the placenta, etc) but SGA (Small for Gestational Age) meant just that- the baby is small for his gestational age but there is no known cause. This doctor was suggesting otherwise and it was certainly concerning.
Also concerning was the fact that I was told I could not do immediate skin-to-skin contact. Skin-to-skin contact (also known as kangaroo care) entails placing the newborn naked baby on the mother's chest immediately following birth. Research has shown this helps regulate the baby's body temperature, respiration and glucose stability in addition to enhancing bonding and helping to promote lactation in nursing mothers. Now, I obviously won't be nursing which is why skin-to-skin felt extra important for me. I really want to have that time to be finally be mom to this baby. I even registered for a special shirt that I plan to wear during delivery so I can do kangaroo care. It never occurred to me that I would be unable to do so right away. The doctor told me that I would get the baby once the cord was cut, though suggested that if he was under five pounds the NICU team would get him first. Upon hearing that, I took the birth preference plan and threw it into the trash. What was the point of having a preference plan when my preferences weren't going to be realized? I know that the birth process is not typically what we imagine, but now all I could see was the baby being put on Ellen's stomach and not mine, and this image hurt.
After the appointment I talked to some well-intentioned family and friends, who assured me that I would have plenty of time to do skin-to-skin, that not doing it immediately wouldn't really make a difference, that I have his whole life to bond with him, etc etc. And while all this is true, it didn't really help in the moment. In the end, what it comes down to is if I was the one delivering my baby none of this would be an issue. It would be my belly he would be placed upon. I, once again, had to grieve the fact that I wouldn't get to deliver my baby. Just when I thought I was done crying about this....
I shed my tears. More than once. Then I pulled myself together and met Jason and some friends for a quick bite before we saw Interstellar. The next morning, Jason and I headed for a baby prep-filled day- a Baby Essentials Class from 9-12 followed immediately by Infant CPR from 12-2. I was a bit nervous about how I would feel being the only woman in the class who wasn't visibly pregnant, but soon realized we were all just clueless first-time parents learning to swaddle. After the class we went over to our good friends home to pick up car seats and tons of baby toys that they so graciously passed along to us, dropped off an extra car seat at Jason's mom's house, and went to Buy Buy Baby to get some last minute essentials. It was an educational, exciting, exhausting day but it helped me shift gears a bit beyond the delivery room and into baby's room.
Ultimately, I decided that I am going to print out a new copy of the birth preference plan. I think trashing it might have been a little rash. I do still think its important that the hospital is aware of our situation. I will likely make some changes on the new copy involving either asking for the skin-to-skin with the baby following the delayed cord clamping, or removing the delayed cord clamping request all together. At a physician friend's recommendation, I did some more research on delayed cord clamping and it seems while it is beneficial for premature babies, it is not necessarily beneficial and may even prove harmful (causing dangerously high volume of red blood cells or increased risk of jaundice). I intend to speak to the OB about this at our next meeting, and also want to express the reasons behind my desire for being the first to have skin-to-skin with the baby. I am hopeful that together we can come up with a solution that is best for the baby but is also sensitive to our situation.
Oh, and about that baby being IUGR and being under 5lbs at birth? We went to the specialist again on Monday. The doctor confirmed what I had thought all along- there is constitutional IUGR (meaning baby is just constitutionally small) and pathological IUGR (meaning something is wrong with the baby or the womb that is preventing proper growth). As suspected, he believes our baby is just constitutionally small. And Baby O had a growth spurt! He is 5lbs5oz and in the 7th percentile! NICU SCHMICKU!
Since I had a hard time finding a Gestational Surrogate/Intended Parent Birth Plan to use as a guideline, I'm including my original one here.
I had my birth preference plan in hand when the doctor walked in. He glanced at it and said in a somewhat snarky manner, "Oh no, she's got it written down". I told him that I'm really not Type-A but wanted to have things in writing since this is such a unique situation. He then said, "Well you might as well tell me what's in it because I'm going to have to read it anyway". I told him about my two main preferences and to my dismay, he told me it wasn't possible. "We can do delayed clamping- no problem. But you can't do immediate skin-to-skin. The baby will need to go on her belly (gesturing toward Ellen) because the cord will still be attached". He went on to say that the NICU team will then need to assess him since he will likely be under 5lbs as he is IUGR. NICU?!? IUGR?!? These are terms I hadn't yet heard associated with my baby. I knew he was measuring small, but I thought he was just SGA. I told the doctor that and he said "They're the same thing".
So what are all these acronyms anyway? IUGR stands for Inter-uterine Growth Restriction (though I've also seen it referred to as Growth Retardation) and refers to a baby that is not growing at the normal rate in the womb. Specifically, it means the baby is below the 10th percentile. Our baby has been measuring small since we first went to the specialist at 22 weeks. This is why we have the weekly appointments with the specialist where they measure his growth every other week and do biophysical profiles on alternate weeks. His biophysical profiles have always been perfect and the specialist has never given us any reason to believe that the baby would need the NICU. I was quite alarmed to hear otherwise from the OB. The specialist has always maintained that thought he is behind, he is likely just a small baby. I'm just five feet and Ellen has never carried a baby over 6lbs 8oz, so its likely that the fact that Ellen grows smaller babies and the fact that his mom is small plays a role in his size. I was under the impression that IUGR meant there is a problematic reason that the baby is measuring small (problem with blood flow from the cord, problems with the placenta, etc) but SGA (Small for Gestational Age) meant just that- the baby is small for his gestational age but there is no known cause. This doctor was suggesting otherwise and it was certainly concerning.
Also concerning was the fact that I was told I could not do immediate skin-to-skin contact. Skin-to-skin contact (also known as kangaroo care) entails placing the newborn naked baby on the mother's chest immediately following birth. Research has shown this helps regulate the baby's body temperature, respiration and glucose stability in addition to enhancing bonding and helping to promote lactation in nursing mothers. Now, I obviously won't be nursing which is why skin-to-skin felt extra important for me. I really want to have that time to be finally be mom to this baby. I even registered for a special shirt that I plan to wear during delivery so I can do kangaroo care. It never occurred to me that I would be unable to do so right away. The doctor told me that I would get the baby once the cord was cut, though suggested that if he was under five pounds the NICU team would get him first. Upon hearing that, I took the birth preference plan and threw it into the trash. What was the point of having a preference plan when my preferences weren't going to be realized? I know that the birth process is not typically what we imagine, but now all I could see was the baby being put on Ellen's stomach and not mine, and this image hurt.
After the appointment I talked to some well-intentioned family and friends, who assured me that I would have plenty of time to do skin-to-skin, that not doing it immediately wouldn't really make a difference, that I have his whole life to bond with him, etc etc. And while all this is true, it didn't really help in the moment. In the end, what it comes down to is if I was the one delivering my baby none of this would be an issue. It would be my belly he would be placed upon. I, once again, had to grieve the fact that I wouldn't get to deliver my baby. Just when I thought I was done crying about this....
I shed my tears. More than once. Then I pulled myself together and met Jason and some friends for a quick bite before we saw Interstellar. The next morning, Jason and I headed for a baby prep-filled day- a Baby Essentials Class from 9-12 followed immediately by Infant CPR from 12-2. I was a bit nervous about how I would feel being the only woman in the class who wasn't visibly pregnant, but soon realized we were all just clueless first-time parents learning to swaddle. After the class we went over to our good friends home to pick up car seats and tons of baby toys that they so graciously passed along to us, dropped off an extra car seat at Jason's mom's house, and went to Buy Buy Baby to get some last minute essentials. It was an educational, exciting, exhausting day but it helped me shift gears a bit beyond the delivery room and into baby's room.
Ultimately, I decided that I am going to print out a new copy of the birth preference plan. I think trashing it might have been a little rash. I do still think its important that the hospital is aware of our situation. I will likely make some changes on the new copy involving either asking for the skin-to-skin with the baby following the delayed cord clamping, or removing the delayed cord clamping request all together. At a physician friend's recommendation, I did some more research on delayed cord clamping and it seems while it is beneficial for premature babies, it is not necessarily beneficial and may even prove harmful (causing dangerously high volume of red blood cells or increased risk of jaundice). I intend to speak to the OB about this at our next meeting, and also want to express the reasons behind my desire for being the first to have skin-to-skin with the baby. I am hopeful that together we can come up with a solution that is best for the baby but is also sensitive to our situation.
Oh, and about that baby being IUGR and being under 5lbs at birth? We went to the specialist again on Monday. The doctor confirmed what I had thought all along- there is constitutional IUGR (meaning baby is just constitutionally small) and pathological IUGR (meaning something is wrong with the baby or the womb that is preventing proper growth). As suspected, he believes our baby is just constitutionally small. And Baby O had a growth spurt! He is 5lbs5oz and in the 7th percentile! NICU SCHMICKU!
Since I had a hard time finding a Gestational Surrogate/Intended Parent Birth Plan to use as a guideline, I'm including my original one here.
ELLEN M (GESTATIONAL SURROGATE) AND JASON AND
KERRI ORANSKY (BIOLOGICAL/INTENDED PARENTS) BIRTH PREFERENCE
Attendants: Chris
M (Ellen’s husband) Jason and Kerri O (Intended Parents)
OB/GYN: Dr. Ramani,
Eagles Landing OBGYN
Pediatrician: Dr Deneta Sells,
Intown Pediatric and Adolescent Medicine
We
would like to thank the Piedmont Henry staff in advance for helping us achieve
our goal of natural childbirth via gestational carrier! Ellen M, the gestational surrogate, is carrying
a baby boy that was conceived via Kerri
O’s egg and Jason O’s sperm.
They are the biological parents of this baby and will be making all medical decisions for him upon birth. We know this is a unique delivery situation
and hope that with this plan we can minimize confusion and have a beautiful
birth experience for all involved. Ellen has had four previous natural
deliveries and would like to attempt a natural delivery for this baby as well. We
are aware that childbirth is unpredictable and are willing to be flexible
should Ellen or baby be in danger. The
below preferences have been discussed with Dr.Ramani. We are aware that many of our preferences
differ from the staff’s normal routine, so thank you for your support and
understanding!
.
Delivery Preferences:
- We ask your support in assisting us to find the most effective and comfortable position for pushing (gravity-positive), and would ask to avoid directed pushing – allowing Ellen to push when the urge is felt.
- Natural tearing is strongly preferred in lieu of an episiotomy. Please discuss with us if an
episiotomy is deemed medically necessary.
- Ellen would like to take the crowning stage slowly and requests warm compresses/perineal massage to help avoid any unnecessary tearing.
- We prefer the placenta be delivered naturally.
- To allow for bonding with the biological mother, we would like immediate skin-to-skin contact between Kerri and the baby. Please delay all tests for as long as possible.
- Delay cord clamping/cutting until pulsing has stopped, before it is cut by Jason.
Newborn Preferences:
- We do not want our baby to receive the HepB vaccine.
- We are planning an out-of-hospital circumcision procedure.
- If the baby needs to be taken to another area for testing, we request that a parent accompany him at all times.
Emergency Procedures:
- In the event of a C-section, we request that Kerri and Jason remain for the entirety of the surgery and for Kerri and Jason to stay with the baby until the family can be united. If an additional person is allowed, Ellen would like her husband Chris to be present. If only one person is allowed, Kerri will be the designated person.
- We would like immediate skin-to-skin contact between Kerri and baby as soon as possible following delivery.
- If the baby requires NICU care, we request the right to feed and care for him as much as possible, including the opportunity to provide Kangaroo Care.
Tuesday, November 11, 2014
It's Almost Time to Go and Meet Your Mom
The other day I came across this song on Twitter. Boy, did it get me. Grab your kleenex...
And then yesterday, our little man finally showed his face for Daddy on a 3-D ultrasound. Not just any face either- look what he did for us! We are both so excited to meet this guy!
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