Weight gain!

Declan has been having weekly weight checks with his pediatrician because he lost so much weight after he was born.

The last  three visits he has gained a measly 2 oz or less per week. We were feeling very discouraged and had been doing lots of supplementation in the SNS and bottle as well as counting all wet and poopy diapers.

Today when we went in for our weekly check we had a huge surprise! Declan gained 8 oz in the last week! His doctor was so excited and dropped a few colorful words when expressing her joy. She told me she just prayed on the way to work that he would finally put on some weight.

I hope it's not a fluke. His doctor doesn't think it is so she doesn't want us to come back until the 21st of next month. She did his one month check so we didn't have to come back next week. I hope in three weeks he has put on 1-2 pounds. We are going to continue to supplement about 2.5 ounces at each feed and wake him up to eat so that he goes no more than 4 hours between eating.

It makes me so happy that he has finally put on some weight. He is less than an ounce from his birth weight. He doesn't seem much bigger to me though.

In other news... I got a sneak peek at the newborn photos that our friend Suzanne took. It's only one, but I'm so excited because the others I'm sure will look as amazing as this...

We are having pictures taken tomorrow as well. They are family photos with my entire family, including my three nephews. We are having them done at a studio vs an independent photographer so we'll have the pictures back the day of so I'll post them in the next day or two. 

We are having them done tomorrow because my sister, brother in law, and my nephews are moving back to California this coming weekend. I'm so bummed. I've gotten so use to them being here and seeing them so regularly. We probably won't seem them again until November and that is only if they are able to make it to Declan's baptism and then again in December for a doctor's appointment. We already know they won't be in town for Christmas because John is the new guy. We are planning on doing our Christmas in January when the boys come back for surgery. 

Stay tuned for the cuteness that will ensue (and say a thought or a prayer that Silas will be cooperative when it comes to pictures with all four babies!)

Newborn high

We are three weeks into our baby moon and I'm intoxicated by the newborn high.

The sleepless nights and the poopy diapers aren't much fun, but there are so many amazing things that make being tired and covered in poo tolerable.

The newborn smell. I can't get enough of that sweet delicious scent. I have no idea how to describe it but it's probably the best smell in the world. I could spend hours with my nose pressed against the top of his head inhaling his sweetness.

Baby noises. I love the coos, sighs, and even the cries. His tiny voice brings a smile to my face and I find his random sounds adorable. I find myself just staring at him and smiling at his gurgles and squeaks.

Soft skin and hair. My favorite thing to do is to lay on the couch with Declan laying against my chest. I spend the entire nap time stroking his delicate arms, hands, legs and feet. I run my fingers through his fine baby hair and wonder if it will stay or if it will fall out. I softly rub my fingers against his chubby little cheeks and watch as nestles in against me closer.

It's all so wonderful even during the unpleasant parts. I'm sure this is why you forget the laboring processes and want to do it all over again... not saying that I'm ready to talk about that though!

two weeks - BFAR

Declan is two weeks old!

We had a follow up appointment on Monday to check his weight. He has gained two ounces since our last appointment, which sounds great, but is not exactly the gain we were hoping for.

Ideally babies should gain four to eight ounces a week. Declan's two ounces does not meet expectations at this point. It's a step in the right direction, but  it means we have to really work at the new plan to help him gain more. This plan includes using more supplementation in the SNS while he is on the breast and pumping a minimum of ten minutes after each feed. Our pediatrician/IBCLC wants me to make sure I get enough sleep, eat well, stay hydrated, and makes sure I don't burn myself out, which is a delicate balance.

I know a few people wonder why I don't just forgo breastfeeding and switch to the bottle. Or just forget breast milk and switch to formula. I know for many people it seems like an easier choice. I have never been one to take the easy road, especially when it's something I feel passionate about. Will it be easy? No. Will it be worth it? In my eyes, yes.

I am a BFAR woman. I'm breast feeding after a reduction. I had a breast reduction in December of 2002. I was 19. At the time I was told it was either a breast reduction or back surgery, and at 19 that was an easy choice. It would still be an easy choice at 30. I knew going into the surgery that breast feeding may or may not be possible and if it were possible I could struggle with it.

When Silas was born I struggled with it. I had difficulty producing milk and worked with an IBCLC who was also a pediatrician. She gave me so much hope. We worked on a plan to give Silas what I could by pumping and supplementing with formula. I pumped for three months and kept Silas to the breast as long as I could, but our breast feeding relationship struggled. I didn't take it well, especially have all of my other complications from his cesarean section.

When I fell pregnant with Declan I contacted Dr. Jones right away. We switched over to her care as our pediatrician after Silas was a month old so it was easy to see her at one of his appointments. We made a plan for Declan right away. I would see her as soon as I could after he was born, I would take a medication to help build my supply, and I would gain access to a pump.

I was prepared for Declan to lose weight. I knew that I would need to supplement and we started as soon as we returned home. My wonderful sister has been able to supply us with breast milk and because it's of newborn content and I know the source I felt very comfortable using her milk. Thanks to the supplement he gained weight, but not quite enough. At our first pediatrician appointment we learned that Declan had a lip and tongue tie making it difficult for him to eat on the breast and on the bottle.

Our first action was to get the tongue tie corrected, and that has helped his latch. Unfortunately he had caused a lot of nipple trauma so latching him is still painful. We are waiting for the lip tie to be corrected and hopefully that will keep him from ripping my nipples up. Our pediatrician/IBCLC wants me to use a shield to allow my nipples to heal. There are concerns about babies becoming addicted to the shield, but our intention is to wean him from it once the healing process is completed. The next steps included feeding every three hours and supplementing using a bottle.

Of course Declan didn't gain as much weight as we had wanted, so we came up with a new plan which we will reevaluate at next week's weight check. My nipples are not yet healed so I'll continue to use the shield, but instead of supplementing with the bottle I will try to supplement using the SNS. Dr. Jones was able to explain how to use it with the shield at the same time. When I don't use the SNS I will use a bottle that Declan will tolerate, which at this time is the Dr. Brown bottle (so far it's the one that he spits up with the least). I will keep him at the breast for 20 minutes at each breast and then pump for 10 minutes after to stimulate production.

It sounds like a lot, but it's worth it to me. It's worth it to keep at it so I can build a supply that will sustain him, or at least a supply that with supplementation will continue to satisfy him. I feel empowered to know I can feed my child with my body, even if I need a little extra help. I'm grateful for the women who have offered their breast milk. I'm grateful for the support from my amazing husband. I'm grateful to the people who support me in breast feeding even though it's something I struggle with.

I know there will always be people who don't get it, but this is something important to me. I have no idea how long I'll be able to do it, but right now my goal is three months. To make it where I did with Silas. Once I get there I will  make another goal. I don't know what that goal will look like since I will be back at work, but we'll cross that bridge when we get to it.

Hospital Photos

The hospital has a company that takes pictures of newborns. I wish this company was at the hospital Silas was born at because they took the customary single photo and that was that. Good Sam's company did a whole mini session. We were really impressed with the photos. We had a number printed out for family, but here are the shots that they took...

I wish Silas was there to have his pictures taken too, but a wonderful friend and fellow MOMs Club member came to the house this morning to do newborn photos.

 She got lots of pictures of Silas cuddling his little brother. It was quite the event. Declan peed on both Josh and me. To top it off I also was pooped on, not once, but twice. 

It was an interesting morning, but I can't wait to see the results. Suzanne was so meticulous, tender, and loving while photographing the boys. When I have the photos I will post those as well! 

1 week

Our little Declan is one week old today!

It was a little bit of a roller coaster ride with the birth, but we were discharged from the hospital on Saturday. There was some concern because he has lost over 10% of his birth weight and he seemed to be struggling with breathing when he became upset, so they gave us orders to see the pediatrician on Monday.

My family came to the hospital to see us off, just like they did when Silas came home. Our first night was spent just with Josh, Declan and myself. Silas stayed over at his Bubby and Huny's house to give us a chance to settle in. We came home to a cleaned house and a little camp area already set up thanks to Josh's mom. We are super lucky to have such wonderful family members.

Getting around after a cesarean is no easy feat. I've been sleeping on the couch because climbing up the stairs is really difficult. I make a trip up once a day to shower and change into clean clothes. Josh has been wonderful in terms of helping me and taking care of Silas' major needs. Silas has also been very awesome at helping around the house and really taking on the role of awesome big brother.

At our appointment on Monday we learned that Declan has a lip and tongue tie, which is making breastfeeding (and bottle feeding) difficult and contributing to his weight loss. We've been supplementing with breast milk thanks to my sister and good friend Liz, but it's not been enough. Apparently poor Declan hasn't been able to extend his tongue far enough to pull milk out of the nipple (breast or bottle) and his lip tie is making his latching abilities less than stellar. My poor nipples have so much trauma from it that it made sense to look into the ties.

We went to a consultation on Tuesday with a pediatric office that specializes in ties. Not only did our own pediatrician recommend them, but a number of my mom friends have taken their kiddos in to see Dr. Agarwal and those who have needed the ties remedied have had lots of success afterwards. They agreed that his tongue and lip needed to cauterized and we were able to get an appointment this morning. They did the tongue tie first and the lip tie will be taken care of in a few weeks once the tongue has time to heal.

Declan was a trouper and Silas was very patient while waiting for the procedure to happen. When it was finished I fed Declan and could feel a difference in his latch right away. We have some oral exercises to work with him on and hopefully this will make his weight gain happen more steadily. In addition to the procedure this morning we also have a weight check with our regular pediatrician.

We had some down time before the second appointment so we took Silas to the Play Factory to reward his excellent behavior. Even the doctor commented on how well behaved he was even though we had waited over an hour and a half. Silas had a blast and Declan slept right through it all.

At the weight check we found out that Declan gained a little weight, but not exactly the amount we were hoping for. The boys' doctor is an IBCLC and she took a look at his latch and was very impressed with the difference from two days prior. We go back on Monday for another weight check and will probably make a few weekly appointments as we get a strong relationship established.

Declan has been super sleepy from the day's events and we are hoping that he won't be up all night long. Thankfully we'll have a few days at home with no appointments to rest. They've taken a lot out of me as well!

Silas loves being a big brother. He enjoys holding his brother and gives him kisses whenever he can. He gets so concerned when he cries and never wants us to put him down. It's really super sweet how much he enjoys his brother already. 

Lots of Declan! He is so alert most of the time, but when he is sleepy is so super sweet! 

Declan's birth story; My TOLAC experience

TOLAC: Trial of Labor after a Cesarean

Monday September 2nd I had a fourth NST/AFI scheduled. I asked that my doula, Kimberly, be present with me because I wasn't quite sure what would happen and I was fairly anxious. I had spent the morning with Silas and Josh at the children's museum and we drove separately so I could head to the NST while they played at the museum. I got to the hospital a little after 11 and Kimberly met me a little bit after that. When I was on the monitor it was picking up frequent and strong contractions. My OB, Dr. Thompson happened to be on call and came in to check me and discuss what she thought we should do. I was not dilated, but 90% effaced and she felt that at that point we should induce based off of the NST and also because I was 41 weeks and 6 days along. Technically I wasn't over due yet, at least not until 42 weeks, but I was also a VBAC hopeful and most providers get a little antsy when a client goes that far past their EDD.

I wasn't anticipating staying at the hospital at all. I thought I would have to come back three days later for another NST and be done. When my OB went ahead and admitted me I called Josh, who wasn't anticipating it either. The plan was to insert a Foley catheter, which has a special balloon that is filled with saline to help stretch open the cervix. The labor room I was assigned had a large laboring tub and my doctor suggested I try taking a bath to calm my nerves and get settled, which was helpful. I had no idea I staying, so I didn't have anything with me. I made a list of the things I needed and my doula said she would drive my car home and help Josh. While they were gone my OB came by to check on me. She said that she could wait to insert the Foley bulb until Josh and Kimberly returned, but I decided to just have her do it.

The Foley was painful, but Dr. Thompson got it inserted and it was weighted with a bag of saline which we referred to as "my pal sal". Josh and Kimberly arrived shortly after the Foley was inserted. Josh brought dinner and I labored in and out of the tub, on the birthing ball and in and out of bed after I ate. Around 3 am "my pal sal" fell to the floor and the Foley came out with bloody show. We assumed I was at least 3 cm dilated, but I unfortunately was not. I was only 1.5 cm, which is unusual, however that type of catheter can often squeak by is what my nurse told me. My nurse contacted my OB and she suggested we start a low dose of pitocin. My doula agreed at this point it might be helpful, so they got me started on it. The pitocin wasn't too bad and I tired to sleep as much as I could while on it.

When I woke up on Tuesday morning (officially 42 weeks pregnant) the contractions were still strong, constant and a little more intense. My OB came by around 9 am before going into the office. She checked me and I was about 2 cm dilated so she suggested a second catheter called a Hook, which is similar to the Foley, but has two balloons that are filled with saline on either side of the cervix. She told me that the pitocin in conjunction with the Hook would give me more of a chance to labor and get Declan into position. I spent the day laboring in and out of the water. My day time nurse even brought in essential oils to help relieve some of the pain and discomfort, which helped for a little while. Kimberly was able to help apply more oil through out the day. By 5 pm I was so tired and in so much discomfort that I discussed IV pain medication with both my doula and my nurse. We agreed it would be a good idea since I had been on the pitocin for so long. I agreed to dilaudid because I had a bad experience with stadol with my last labor. The dilaudid helped to take the edge off. I spent most of the evening back in the tub, which was one of the few places that helped with the pain from the contractions.

Around 11 pm Tuesday night I had such a long on going contraction that I never thought it was going to end. My doula applied counter pressure and tried to get me to relax. The resident on call came in to remove the Hook catheter, but couldn't until the contraction passed. They were right on top of each other at that point. When it had finally passed the Hook was removed, but I was only 3 cm dilated. The resident called my OB and decided to turn the pitocin off, let me rest and turn it back on after an hour. The rest was helpful and going from 24 units of pitocin to 0 was enough to let me sleep.

I was up by 4 am on Wednesday with regular contractions again. When the resident on call checked me I was still only 3 cm dilated. Her suggestion was to rupture my membranes and see if the fluid was restricting Declan's ability to descend on the cervix. My doula agreed, but reminded me once my membranes were ruptures I wouldn't be able to labor in the water anymore, so I put off the rupture. I tried laboring in the water again and was in so much pain I asked for more IV medication. They couldn't give me anymore dilaudid, but offered a half dose of the stadol. I went ahead and accepted the stadol dose. Josh assured me that whatever happened after I took the stadol he loved me and wouldn't be leaving me. He said this because when I had stadol during Silas' labor I hallucinated that he was leaving me. It was frightening and I didn't want to repeat that again.

The half dose didn't do much so it was only about a hour later that I agreed to the rupture. The pain was intense and I really wanted things to progress, so at about 5:30 the resident ruptured my membranes. There was light meconium present in the fluid, but both the resident, my nurse, and my doula assured me that it wasn't uncommon for 42 weeks. It would mean that a NICU team would be present during the birth so they could do an assessment and determine if he had aspirated any into his lungs. There was a lot of fluid and the pain was really intense about two hours later.  There was no cushion of the bag of waters for Declan's head. Although I was really afraid of an epidural and the events that followed after when I had Silas, everyone thought it would be a good idea. At that point I had been in labor for over 40 hours, with pitocin and only minimal IV drugs.

The anesthesiologist came in and it was a completely different experience from the last one. The epidural went in easily and was pretty painless. I felt some tingling in my right leg, but beside that things were okay. My OB came in to visit me around 8 am and she said she was glad I agreed to the epidural and that she would have encouraged me to have one at that point. She did a cervical check and said I was 5 cm dilated and baby was a -1 station. She mentioned that something felt a little funny during the check. She mentioned that she thought baby was brow presenting. She manipulated the baby and more fluid was released. She wanted me to labor on and she would come back and see me later on in the day.

I couldn't labor in the water anymore, but the epidural helped with the intense pain I was having. We continued to use the pitocin and I tried to rest between contractions the best I could. My doula, Kimberly had been with me for almost 48 straight hours and she needed to attend rounds at the practice she works with. I felt comfortable with her leaving since I had the epidural and she promised she was just a phone call away. A different resident came in and checked me around noon, he mentioned he felt a fore bag of water, which he ruptured. I was still 5 cm, but Declan was at a zero station. Josh and I rested off and on for a few hours and then my friend Liz came by for a while so Josh could grab a shower and pick up some clean clothes from home. It was nice to have someone with me even if I was resting most of the time.

At three my nurse checked me at my request. I was feeling a lot of pressure in my bottom. When she checked me she also told me she felt something that could have been a hand. She phoned my OB and
told her. My OB said she would be there after four and Liz had called Kimberly for me and my doula said she would be there by four as well. My nurse suggest laying the bed all the way back and upside down to encourage Declan to re position or at least let gravity pull him back down. I spent nearly half an hour inverted to encourage movement.

Kimberly came in first and I caught her up with the days events including the possible brow or hand presentation. Kimberly, Josh and I discussed how Josh and I would feel if a repeat c-section was brought up. I surprisingly was not upset by the idea. What else could I do or could I have done to further prevent a repeat cesarean? Aside from trying to manually manipulate Declan, I couldn't really think of anything. I was 42 weeks and a day, I used a two types of Foley catheters with pit without any medication pain relief for nearly 40 hours, my waters were ruptured on my own time line and I asked for the epidural after two and a half days of laboring without one.

The plan was if Dr. Thompson could manipulate him, then we would do that and if not then we would be okay with the cesarean. Josh was so supportive of everything and was such a present partner during the entire labor. He hardly left my side and gave me a hand to squeeze or a shoulder to cry on and just reminded me over and over again how strong I was and what an amazing opportunity I gave Declan to grow and choose his own delivery, which in the end he did.

Dr. Thompson came in and she checked me one more time. She said I was 6 cm, 90% effaced, and Declan was at a zero station. She said she couldn't be for sure what she was feeling. It seemed like it was a hand, but then she was certain she also felt his face, then confirmed that she felt his mouth. She attempted to manipulate him but he just wouldn't budge. Her recommendation was the cesarean but she knew how I felt about it and wanted to know my thoughts.

I told her about my view on things and she agreed. She didn't think there was anything else we could do or could have done for a different outcome and she was interested in seeing what position he really was in. We went over my requests for a natural cesarean experience and she said we could do it. Declan would have to be evaluated by the nicu team since my waters presented with meconium but once they cleared him we would have him on my chest. My nurse that day was ready to help enforce that as well. They were also prepared to give me my placenta and knew how important it was for me to have a say in what was going on around me.

Josh called our family to let them know what was going on and asked them not to come down until after I was in recovery so there would be no needless waiting. They prepped me and wheeled me back. Kimberly was not able to join us in the OR, but she would meet us back in recovery. She told me how strong I had been the entire process and how proud she was of me. I felt empowered over Declan's birthing journey and tried to focus on meeting my son.

I opted not to be sedated during the operation so I felt a lot more than I remember feeling when I has Silas. I listened carefully to my OB explain she was not using the same incision that was used for Silas and felt her pull Declan out after not only telling me he was face first in my birth canal, but had his hand on his cheek and his cord wrapped loosely around his body and neck. She said this in itself would have made it virtually impossible for Declan to be birthed vaginally and why he wasn't able to open my cervix more. I truly believe if he tried to birth vaginally it would have been a dangerous situation for both of us and his face/hand presentation were his own intervention to keep us healthy and strong.

Once he was out the nicu team evaluated him. His lungs were clear and clean and they brought him quickly to me. My nurse placed him on me and I was so shaky from the hormones that I didn't feel safe trying to hold him myself. I asked her to give Declan to Josh and he placed his cheek to my cheek and I felt his little hand reach out for me and touch my skin. I whispered my love affirmations to my son and husband and the team asked if they could take him to be measured. They did a quick weight and was told he was 8 pounds and 10 ounces, which was only 3 ounces larger than his big brother, who was only born 8 days passed his EDD, vs 15 days.

I joined in conversation with my nurse, my OB and her surgical team even through my chattering teeth. We talked about our favorite places to eat around the valley and before I knew it I was being rolled into recovery where my son was placed skin to skin on my chest before the breaks were even applied. I learned that my 8lbs 10oz baby was also 21.75 inches long (1.5 inches longer than his brother) and had a head circumference of 15 inches! I was surprised to see the amount of dark hair Declan had. It was much longer and darker than I thought it would be.

Kimberly was wonderful and stayed with us until our room was ready and helped me breastfeed Declan for the first time. He latched on easier than I thought he would and stayed close to my breast the entire time. Josh called our families and let them know the good news and made arrangements for them to come and visit us. Our postpartum room was ready to go around 7:30 and we were wheeled down with Declan on my chest as happy as could be. We were settled in by 8:15 and that is when Josh went down to meet our families.

We brought Silas in first to meet his little brother and I think he was at first confused by the fact that my big belly was not quite as big anymore. He was easily distracted by his little brother and asked to hold him right away. Josh let the rest of the family in and then they all took turns holding my newest little man.

It may not have been the VBAC birth plan I had envisioned, but it was the CBAC plan I had hoped for in the event that the VBAC wasn't a possibility. I couldn't ask for a more supportive provider, a more loving and encouraging doula, a man as devoted and amazing as my husband or a family as understanding as the one I have to carry me to 42 weeks and a day and respect and honor my wishes and requests for before, during, and after labor.

And now for what everyone is waiting for... pictures!

Laboring with Kimberly 

Preparing for surgery with Dr. Thompson

Reassurance from Kimberly

Focusing on Declan

The surgical team 

Working at getting Declan out

Unwinding the cord 

Our newest love has arrived! 

Seeing my second born for the first time

An unconventional family photo 

Our poor swollen boy... you can see where his hand was on his left cheek and where his face was pressing in the birth canal. 

Skin to skin in recovery

My doula and my nurse fawning over Declan

Mommy and daddy love their newest little guy

Thanking each other for the gift of life

Preparing to leave the recovery room

Brothers meeting for the first time!