Colette Vivienne

It's finally June. May was a very long month and though not what I would've planned, turned out to be the month baby number 3 would make her appearance. Colette Vivienne McDowell arrived at 10:44am on Tuesday, May 17 weighing 7lbs 10oz and measuring 18 inches long. It was the most terrifying day of my life.

So where to begin? I guess at the very beginning. I was shocked when I found out I was pregnant back in October, so much so that it took me 4 days past my missed period to take a pregnancy test. Dave and I very much wanted another baby but weren't 'trying' that month so when I had some spotting around the time of my period, I wasn't really disappointed. Even after the positive pregnancy test, I don't think I told Dave for another week. I went into the doctor to get my hcg levels checked the day after I found out, and then again the following Monday. Things were going up as normal... Again I had my doubts so my doctor humored me and allowed me to come in for several early ultrasounds. Each week... 5 weeks, 6 weeks, 8 weeks, 9 weeks... all seemed to be progressing despite the continued spotting (which finally stopped around 9 weeks). Despite my constant worrying, there was something in the back of my head telling me that if this unlikely month was the one that we got pregnant, it just had to be meant to be. We were relieved when they confirmed it was only one baby. It was definitely a conversation we had when we discussed going for a third, that it could very likely be a third and a fourth. We also expected another boy and were totally fine with that.

We had the non-invasive testing during the first trimester, and again, all was coming up fine. I finally sighed a huge breath of relief as I entered the second trimester just as the new year began. I did feel slightly different during the first trimester this time versus last time. Around 7 weeks for a few weeks I felt a bit 'off'. Hard to describe as I wasn't nauseous but there were times that I just had to have food immediately. In general nothing sounded or tasted good yet I could still eat everything. Just as Dave got the sparkling water dispenser installed, I had an aversion to sparkling water, though that lasted only a month.

I knew I'd likely need a cerclage again with this pregnancy and Dr. Katz confirmed that my body carrying twins at 20 weeks (when I required a cerclage last time) would be like my body carrying a singleton at 24 or 25 weeks... so too late to get a cerclage if I ended up needing one. So I got a precautionary cerclage placed at 15 weeks in mid-January. It was a fairly quick recovery and I had no complaints. We then had our big ultrasound just before 20 weeks and were again relieved that the baby continued to be developing on track. I was adamant about not finding out the sex and though not thrilled, Dave agreed. We finally started sharing the news of the pregnancy once we were through all of these hurdles.

The weeks slowly progressed but then again starting at week 22, spotting began again. I had an ultrasound and visit with Dr. Katz and they confirmed all looked fine and it was likely just from the cerclage stitch. Though each ultrasound (which I was having every 2 weeks anyway) was reassuring, it still made me nervous when the spotting didn't let up. I stopped exercising at that point (I had been doing yoga and pilates classes, and swimming, but nothing intense by any means), not ordered by the doctor, but it just made me feel more comfortable. He was right, not exercising didn't make it go away. It lasted through week 27 when we went to Hawaii. I'm so grateful we were able to go on our trip and get through the trip without any complications. It was a last minute decision that perhaps a few sessions of acupuncture assisted in having the spotting stop for one single day when they could perform the ffn test to confirm that I would not go into labor in the following two weeks. The spotting finally let up in Hawaii (maybe relaxation was key??) and for 3 blissful weeks I felt great about the pregnancy. I was in the third trimester, my ultrasound at 29 weeks showed the baby was already in the 81st percentile for weight at over 4lbs. I wondered how big a baby I'd have if it was already this big, and was grateful for my scheduled c-section on June 30, just a few days before my July 3 due date. At this point it was just passing time and growing this baby. I was already taking it easy, not lifting the boys, driving instead of walking, resting as much as possible. But really, I felt like we were in the home stretch. And then I started having contractions more frequently. I had been having them for several weeks already throughout the day, but never more than 5 or 6 in an hour like they tell you to look out for. But then I felt like it was getting to the point where maybe I did need to keep track of them more closely, specifically around 8 or 9pm at night. This is when everything became a bit of a whirlwind.

Thu, April 28: I counted 6 or 7 contractions in an hour around 8pm and shortly later noticed some bleeding. I called my ob's after hours line and they sent me into triage to get checked. Thankfully a couple doses of nifedipine slowed everything down, the doctor confirmed that my cervix was still long and closed and the little bleeding had already stopped. Everything seemed fine with the baby, though she ordered an ultrasound the next day to check everything further. An ultrasound one week prior on Thu, April 21 was totally normal.

Fri, April 29: I had to head to a different campus since they couldn't get me a last minute appointment at the hospital I usually go to. I didn't expect anything to be wrong since despite all my worries throughout the pregnancy, everything always seemed to be fine. It's normal for the ultrasound tech not to say much, but this time she said she was going to get the doctor on the phone to speak to me as unfortunately she wasn't in the office but had viewed the results of the ultrasound. Again, I wasn't concerned, until I was on the phone with her and she said there was fluid in the baby's lungs. My heart dropped and I tried to ask some questions but overall she didn't seem overly concerned and made it sound like it was something we would watch and that no, it wasn't necessary to deliver now. I got her phone number and requested a full report to take back to Dave. I briefly shared the news with him before heading back to CPMC for a stress-test they booked for me to check the baby. Everything appeared to be fine. I made it through the weekend just fine, sort of pushing the worry out of my head. I didn't read anything about 'pleural effusions' and was really taking the approach of 'wait and see'. Dave on the other hand read everything and was really stressed out, though he hid it from me well.

Mon, May 2: Dave had canceled his NYC work trip so he could come to the appointments with me. We had an ultrasound that revealed that the fluid had increased, not significantly, but it had gone up in the past few days. They sent me downstairs for an EKG of the baby's heart, which thankfully, showed everything was normal. It was left with a 'wait-and-see' approach yet again, with another ultrasound scheduled for the following Monday. This was definitely the day when my worries skyrocketed.

Thu, May 5: I was just scheduled for another non-stress test, when I got a call from the doctor that they wanted me to come upstairs for an ultrasound when I was done. Apparently the doctor from Friday was briefing the doctor who would be reading my ultrasound Monday and she wanted to see me immediately. I called Dave and he came straight from work. The ultrasound showed that yet again the fluid had increased, and now there was also fluid in the skin and abdominal category, which means the pleural effusions had evolved into hydrops... definitely not what we wanted to see. The perinatologist told Dave and I to go get lunch and then come back to be admitted to the hospital to get steroid shots for the baby's lungs, just in case. I was terrified. I was admitted about 2pm and the plan was for me to be discharged at 6am. All the doctors has pulled together and we'd decided we'd go over to UCSF for a day of ultrasounds, EKG, and meetings with different doctors to decide the next steps, including the possibility of getting a shunt placed, which they only perform at UCSF and not CPMC. I was nervous for that big day as I wasn't sold on getting the shunt and didn't want to make that decision.

Fri, May 6: I didn't have to make that decision as I woke up at 5am to frequent contractions and bleeding. I was immediately put on magnesium for 30 hours (I tolerated it pretty well but the worst part is you can have very limited liquids while you're on it so I'd have to savor a 5oz cup of ice over 8 hours, ugh!). There was no leaving CPMC at this point. The good news is the magnesium worked and my contractions calmed down and the bleeding stopped. Still, it appeared I would be on hospital bed rest until delivery, which I likely would've been even without this complication. At this point I was a few days away from 32 weeks. We talked to the neonatalogist about what to expect at the time of delivery. Every doctor I talked to reiterated the goal of making it to 34 weeks when the baby's lungs would be a bit more developed and overall he/she would be stronger and bigger.

I remained on bedrest for another week and a half. I continued to have ultrasounds every few days and though things got worse, they didn't change significantly. In fact, the last ultrasound I had on Monday, May 16, appeared that the fluid may even have decreased just slightly. I was very uncomfortable, especially those last few days. I was sleeping in 5-minute blocks. Literally waking up hoping it had been hours when it hadn't even been 10 minutes. The L&D nurses were amazing. They were getting me different mattresses, etc., but now I realize it was just my body telling me it was almost done. The baby's hydrops were causing excess amniotic fluid, and though I was told it wasn't really a concern, my belly was starting to measure much bigger. I couldn't get comfortable in any position.

The doctors were also incredible. I had a team of perinatologists and my awesome ob all reaching out to their connections at hospitals around the country to talk through different scenarios. At one point there was discussion of me going to LA to have a shunt placed by a doctor there (that was quickly ruled out). On Friday, May 13, I talked with a doctor at UC Davis about placing the shunt. He was heading out of town for a medical conference but the loose plan was for me to be transported by ambulance in the middle of the night on Tuesday, May 17, so that he could meet with me Wednesday and do the shunt procedure that afternoon if we all decided it was the best plan. Again, I was nervous about making that decision -- there was not a clear consensus about what to do since hydrops is pretty rare and it often develops earlier in pregnancy, when an aggressive treatment is necessary to be able to get the baby further along in pregnancy. Anyway, there were a lot of moving pieces during that almost 2-week hospital bed rest, even though much of the time was rather relaxed and was just a waiting game. I laid in bed most of the day with monitors on my belly. I continued to have contractions so I got the anti-contraction medicine every 4 hours. I tried just about everything on the food menu, and it actually wasn't that bad. I watched a lot of shows and read a couple of books. Because I was sleeping so poorly, I would drift off for catnaps throughout the day. It's so funny, it you had told me I'd have 2 weeks of completely free time, I could've listed off 10 things I would've done that have been sitting on my to-do list. Unfortunately I didn't do any of them. I just didn't have the energy or the motivation. Overall, my spirits were okay. I had plenty of visitors, a room full of flowers and was grateful for each day we made it further into the pregnancy. The doctors continued to look for a cause by running various tests but nothing came back out of the norm.

Dave was the one who had to deal with everything at home. He basically took 2 weeks off of work and got everything squared away with a lot of family help. My brother coordinated a meal calendar. Of course all of this was in the midst of still looking for a new nanny. Oh, and then George got hand, foot, mouth. So the boys couldn't come visit for a full week. As we had no idea how long I'd be on bed rest, and were of course hoping it would be a while for the baby's sake, Dave really had to scramble to get a long term plan in place since he had to get back to work at some point. As fate would have it, Jessica was looking to find a new family as her new job wasn't working out. Dave decided to hire her back full-time.

It seemed like everything was coming together. After fairly good news on the May 16 ultrasound, I think we decided that we'd hold off on going to UC Davis and instead have a follow-up ultrasound on Wednesday, and then decide how to proceed. By this point, I was even more uncomfortable, especially at night.

During the night on Monday night, while not sleeping of course, it was around 3am when I felt a pain on either side of my belly. Sort of like a cramp, nothing super painful, but it felt different than anything so far, so I alerted the nurse. She thought it was just round ligament pain and my belly stretching with all the extra fluid. I was having frequent contractions that they were keeping a close eye on and I think I also got an extra dose of nifedipine. I got up to go to the bathroom around 5am and the pains had stopped, but the contractions were still regular. I was becoming more and more uncomfortable. The nurse noticed a deceleration of the baby's heartrate at some point, probably around 5:30am. The continued to monitor but within the hour, I started bleeding. They called the doctor in and he checked me and saw that I was slightly dilated , 80% effaced and thought my water was leaking. He called in my team of doctors since I had so many people working on my care and he knew he needed them to make a final decision. My ob stopped by and the call was made to start magnesium again to try to stop the contractions. They would give me an hour and then make a decision. My perinatalogist came in and checked me again and basically said the cerclage was holding everything together and that we'd definitely deliver. That was at 9:55am.

There was a flurry of people in and out of my room. NICU nurses, nurses for me, getting my IV in, the anesthesiologist, all my doctors. Before I knew it, I was being wheeled to the OR. I've never been so terrified. I knew it was too early for the baby to come, but beyond that, was the unknown. Yes, we had been prepped for what would happen with the baby once delivered, but who knows what would actually happen based on how she was doing. I couldn't believe that moment was here whether we were ready or not. I remember the room being filled with so many people, probably 15-20, more than were there for the boys' birth which was so odd. I was glad my ob had come back over for the surgery and my favorite L&D nurse happened to be with me that morning. Ironically, she is due just a couple of days after me in July. Thankfully, after the epidural had kicked in, I was much more relaxed. It was a surreal experience as you're just waiting for the baby to be out, but even when she was out, we didn't hear a cry or anything. It was actually rather calm (though I'm not sure if Dave would agree). Colette was born at 10:44am. Throughout the pregnancy I always thought was an incredible moment that would be, when they pulled the baby out and announced, 'it's a X!' All along you tell people that you don't care if it's a boy or a girl, as long as it's healthy. And this is the prime example of that. The baby was out several minutes before someone (not Dave or I) asked, 'is it a boy or a girl?' That was the furthest thing on our minds. I was holding my breath waiting to hear how she was doing. Dave took a photo and brought it over to me. He thought she looked better than expected as she was pink and not as swollen as he thought she'd be. I was relieved. And I felt a million times better just having a c-section than I had for the past few days. My body had definitely been telling me that it was time.

It turned out that my placenta had started to abrupt, which can be caused by contractions or excess amniotic fluid, which is caused by the baby's hydrops. For some reason this provided me some comfort. I know many woman who have preterm labor feel like their body betrayed them. I don't feel this way. I feel like my body did the best it could in this situation, but it was time for the baby to come out. Do I wish I could've gone longer? Yes. Would I have endured all that pain and being uncomfortable for much longer to keep her in? Definitely. But I feel like it was out of my hands, in a good way. We didn't have to try to figure out what was the right decision regarding the shunt. That decision was made for us and I'm okay with that.

Dave went with the baby to NICU while I waited for my epidural to wear off. Eventually they wheeled my bed over and I got to meet her for the first time, reaching my hand into her isolette. I don't know if it was the meds or that I had been told she was doing well, but I was actually feeling great that afternoon. It was definitely a weird experience to be in the postpartum room by myself much of the time, while hearing babies cry throughout the day and night, but I was doing okay.

Colette had a rough time that first afternoon and apparently a respiratory therapist was literally pumping a breath for her for 2 hours straight. I had called over to get an update on her and didn't get a call back for hours as it was so intense. Day 2 had it's ups and downs too, but then she seemed to stabilize.

She's now 16 days old. But today was a very good day. 'Wean off respiratory assistance' has been on her Goals list for a while but I didn't know she was getting close to that. Today I arrived and they said, 'we're planning on taking the breathing tube out'. What?! Just like that? Even after 16 long days, I couldn't believe this huge milestone was here! I planned to finish this post with what I felt I've missed out on. Yes, I wish I had had a more 'normal' pregnancy. I'm jealous of women I see who are still pregnant. I should be counting down the final weeks until baby's healthy arrival. I'm envious of moms I see pushing or carrying their newborns as if it's no big deal. Colette is 16 days old today and I still haven't held her. I've never been a baby person, but was so looking forward to having 'just one' that I was hoping I'd get to enjoy these early days a bit more by focusing on just one baby, being able to breastfeed, etc. Instead, I'm pumping around the clock and had to buy a freezer for the garage to store all the breastmilk since she's taking less than an ounce every three hours, yet I'm producing 45oz each day. No, things aren't how I would've planned. I've had some really bad days where I can't get past the fact that this is our reality and it's going to be a very long road. But I've also had some good days, like today, where you get a surprise of real progress and you have hope that maybe things will be okay. I'm sure I will continue to have good days and bad ones, but I'm so grateful she's stable and trying to focus that she is heading in the right direction, even if progress sometimes appears negligible. She has some amazing nurses and doctors who are taking wonderful care of her and I know she's right where she needs to be.

I'm so grateful for the support we've received from friends and family. It's been a tough transition coming home, without a baby, when I was away from the boys for several weeks and everyone was in survival mode. It got to the point where I had so much help, I could really sit around and be sad all day if I wanted. I've spent the last week finding the right balance for me, which I've found has been getting back into the old routine as much as possible. I like to see Colette for several hours in the morning and at night, but have worked in plenty of time with the boys, running errands, making dinner here and there, and it's really made a difference in how I'm feeling overall. We're so lucky that the hospital is just a few blocks away... there are people in our NICU who live several hours away and I'm beyond grateful that I can be there within minutes whenever I want to be. I still can't believe we're in this situation, but am praying that people are right who say one day I'll look back on this and it will seem like a blink of the eye and it was over. For now, being patient is so tough and I can't picture what it will be like when it's over, but I'm sure they're right. We can't wait to welcome Colette home whenever she's ready!

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