Five weeks old but wearing 6 month old clothes!

We've been living with Ramon for five weeks now and it definitely feels like he's been here a lot longer. Time doesn't flow the same way anymore :).

I haven't posted in a while so I'll try to provide highlights of Ramon's first five weeks with us. Then maybe I can post more often from here on out :).

Doctor visits have been largely positive experiences. All the Westcare Pediatricians are very nice. They all gush over how cute Ramon is and assure us that not all babies are cute but Ramon definitely is :). Ramon continues to be off the charts on all measurements. Here's how he measured at his doctor appointments so far:
1 week appt: Height 22 inches, weight 8 lbs 7 oz, head circumference 39 cm
2 week appt: Height 23.5 inches, weight 10 lbs 15 oz, head circumference 41 cm
percentile for 2 week: height 105%, weight 96%, head circumference 100+%
4 week appt: Height 24 inches, weight 13 lbs 3 oz, head circumference 43 cm
all percentiles are 100+% now :)

We gave all our newborn, 0-3 and most 3 month clothes to the little duckling (Shaun and Matt's baby in the oven). I checked the sizing charts for Gerber and Carter since those were our most popular brands of sleepers and Ramon is now in the 6 month sizing section at 5 weeks! Both of them say any baby longer than 24 inches and weighing more than 12.5 lbs is in the 6 month range. At Baby Gap Ramon is in the 3-6 month range.

Ramon is pretty well traveled so far. He has been to our Warren, Vermont house and got to walk around all bundled up outside in the sun. He has been to Richmond, Virginia to go to the shower for his cousin to be.

We have also been renovating our apartment. The wall between 1C and 1D is down and the guys are working on the electricity today. Tomorrow they plan to sand and polyurethane the parquet wood floors. We decided to match the floors from the rest of the apartment even in the new kitchen. I think it will be beautiful. We ordered the cabinets yesterday. We are going with shaker style light wood finish and a bright orange quartzite counter top. We still plan to buy a new, larger stove and microwave combination and a new sink. Ramon finds the noise to be helpful in falling asleep. Ruta finds the noise to be very upsetting and he barks at some of the workers because they won't pet him. Other workers are very fun to play with. The guys that came to combine and move the intercom units for both apartments were very fun. They played keep away with Ruta's nylabone and even threw it for him to fetch :).

And last week Johanna, Caleb, Leo and Lucy visited us. Their visit was an adventure for us. We got to go to a playground near Riverside park, the Natural History Museum, the Intrepid Museum and Inwood Hill Park. Ramon slept through every one of the adventures but cried sometimes on the drives. He hates traffic as much as his daddy does and is much more vocal about it :). He prefers to be moving all the time. Sometimes he fusses in the evening if he has been static too long. Then we have to put him in one of his carriers and go outside for a walk or walk around the apartment. When we stop, he cries :).

Ramon's daddy has been reading Dr. Harvey Karp. He talks a lot about the 5 S's: swaddling, side/ stomach lying, swinging, shushing and sucking. So we have been swaddling at night for sleeping and Ramon sleeps much longer and deeper....at least when he keeps the swaddle on. Most of the time he escapes so we have been looking for better swaddle blankets to keep his very active arms captive at night. If they are free they have a tendency to hit poor Ramon in the face....stupid arms. Hopefully he will develop arm control sooner rather than later so that his arms can stop attacking him in the night. It must be very frustrating for him...I know it is very frustrating for his parents :).

A successful birth story

Any birth story that ends in a healthy, happy baby and mom is a successful birth story even if the story doesn't progress as it was imagined. The last update on the birth was all day contractions on Monday, February 16th and then nothing on Tuesday. The contractions were sporadic on Wednesday. Our midwife, Tamara, checked dilation...nothing but I was 90% effaced. Thursday we had to go back for another non-stress test and ultrasound to check amniotic fluid. Contractions were again sporadic and mild. The grand momster had already arrived from Virginia and we were all eagerly awaiting an escalation. The non-stress test was early this time and the baby was asleep....the technician used a vibration tool to "buzz" the baby awake. This really got him going so then we had to hang out for longer to get the heart rate back to a more relaxed baseline. Babies do not like being "buzzed" in utero...he did not want to go back to resting and instead kicked and elbowed me like crazy. The ultrasound showed our amniotic fluid was normal. I reluctantly scheduled another non-stress test and ultrasound for Monday, February 23rd and hoped with all my might that I wouldn't make it to the appointment because we would already be birthed.

Thursday night contractions woke me up at first every 15-20 minutes. They were getting stronger and closer. I had to listen to my hypbirthing CDs to get through them in a relaxed state and get any rest at all. I tried eating occasionally on Friday and couldn't keep anything down. I puked 3 times before I decided to avoid food. I drank smart water, gatorade and water. All day Friday the contractions were closer and stronger. For hours they were 5 minutes apart. It hurt to sit through them. The only thing that felt better was if Ray or Momster put a hand on my lower back...for some reason that reminded those muscles to relax. Occasionally I would go lie down for a nap and listen to the hypbirthing CDs again. This helped and I think I really should have had the CDs on repeat throughout the whole day Friday...as the contractions got more intense and I got more tired I got a little more tense. My legs started shaking through contractions and sometimes in between around 7 or 8pm. We called Tamara around 3pm to let her know we were 3 minutes apart for an hour. She said call again in 2 hours. We did and then we called again in another 2 hours and then another...you're getting the picture. Around 9pm we switched to a call every hour. Then at 11 we promised to call in a half hour. At 11:30 I thought we should go in because I had monstrous poop cramps. I was able to go to the bathroom and alleviate them a little so then I thought we should wait. I was getting delirious with pain and exhaustion at this point so when I looked in the mirror I thought I saw a hand coming out and then had my mom look and it was not a hand but a previously unknown body part of my own :). At midnight I decided that if we were not ready to have the baby very soon I would be signing myself up for some massive pain killers. We called Tamara and told her we were on our way to the hospital. The drive was painful during contractions but fine when not contracting. We arrived at labor and delivery triage at around 12:20...exactly one week and 20 minutes past my due date and 20 minutes too late for the birthing center. I had to change into a hospital gown...very hard to do at this point...in the bathroom. Then I wanted to stay there to poo because it felt like I still had massive poop cramps. I had been pushing through contractions for about 45 minutes because I couldn't help myself at this point. The nurse wouldn't let me stay in the bathroom :). I had to lay down with a monitoring belt around my belly. This was highly uncomfortable but it didn't occur to me at this point not to lie on my back. When Tamara got there she had me switch to my side...much better and I should have been able to figure that one out on my own :). She checked my dilation...9 centimeters! If she had said 2-3 I think I would have demanded pain killers....9 centimeters I could handle. I was so happy that I waited to arrive...I didn't want to be in a hospital any longer than I had to be. Tamara was great at counseling us to remain home and more comfortable.

Things moved very quickly then. I was moved to a delivery room and a really great nurse joined us. So did a not so great pediatrician....she hovered in the corner waiting for us to deliver a baby that she could attend to. She was very antsy and asked a couple of times if things were happening or if she should go away and come back. The nurse gave me an IV of fluid to avoid dehydration.It turned out that my water had broken on the drive in...my clothing was super wet and I hadn't noticed. Tamara and Kira (the nurse) had me push lying on my back holding my legs behind the thighs...this is not a natural feeling...trying to poop lying on your back. I asked a couple of times if I could squat and they told me they didn't have time to set up the bed that way. I think I could have pushed much better and faster if we had taken the time to squat...even if they just held me up. I had lots of help. Ray and my mom were holding my back up and coaching me to breathe and try to relax and push :). I was making good progress but the fetal heart rate was depressed during contraction...not surprising since I was lying on my back and we already knew the baby didn't like that. So Tamara put her hands up there and tickled the baby's head to get his heart rate back up. This along with the pushing stressed the poor kid out so much that it scared the poo out of him. So now we had to go faster so they could suction his lungs out because the fluid still left in there was poo and he was still drinking it into his lungs. This kind of poo is called meconium and is sterile while in the womb but can develop bacteria quickly when exposed outside the womb. It has to be sucked out of a baby's lungs very quickly after birth to avoid the risk of a lung infection. So the team was getting nervous watching the heart rate and then seeing the baby poo. They decided to call in an obstetrician on call and assist delivery with a vacuum. Okay, so pushing without any interference actually felt good...like I was accomplishing something. Pushing with Tamara's hand tickling the baby did not feel that great but was still doable. Pushing with a metal ring of a vacuum tube stuck in me felt horrible. I felt like I was pushing against an immovable wall or something. Apparently I was still pushing well enough to move the baby's head close enough to the vacuum to get a good seal a couple times. Thankfully, it did not take too long once the vacuum came out to get Ramon out. His head came out turned slightly upwards...nearly sunny side up which explained the pressure on my tailbone that felt like poo cramps :). His arm shot out afterward like Super Man flying :). It was 2:11am on Saturday, February 21st less than 2 hours after we arrived at the hospital.

I was shaky and tired but felt fine otherwise afterward. They moved Ramon over to a table in the corner to suck the meconium out of his lungs and gave him extra oxygen. My mom went over and massaged him and held his oxygen tube. He kicked all the stuff on the table to the bottom and tried to grab the oxygen tube. He was talkative and active. Now that the excitement was over, it became clear that the obstetrician on duty thought I had been under the influence of pain killers so had not been terribly gentle with the vacuum. She did give me some lidocaine before asking Tamara if she wanted to stitch me up. Tamara said sure and spent the next 15-20 minutes stitching. The vacuum was not gentle with my soft parts. Ah well. My mom massaged Ramon and Ray held my hand and teared up a bit with awe at seeing his son born and in empathy with my stitching pain (which burned just a little). Once I was stitched up the awesome nurse, Kira, brought Ramon over and helped me latch him on to nurse. He nursed a solid 15 minutes. She also foot printed and measured him. His feet barely fit on the hospital commemorative certificate. He was 8 pounds 15 ounces (on the smaller side of the predicted 9 pounds 7 ounces) and 21.5 inches long.

In the meantime, the annoying pediatrician was discussing cord blood gas levels with the nurse. The nurse appeared to be educating her on how to read the results and what the normal numbers were. She argued that Ramon's cord blood gas levels were borderline but acceptable. The pediatrician was more risk averse. She decided that Ramon despite getting an 8/9 APGAR score would be admitted to the Neonatal Intensive Care Unit (NICU) for 24 hours of observation just in case. So Dr. Atakent (the risk averse pediatrician) asked Ray to take Ramon away and put him back on the table. Then the nurse came back and handed him back to me while we waited for the doctor to get ready to wheel him away. I was heart broken to see him go. Kira promised we could go to the NICU to see him on the way to recovery.

It never occurred to me in the preparation for birthing to ask questions about the pediatrician coverage during birth. If I had asked I would have found out that Roosevelt does not have a pediatrics practice. They only have a neonatal unit so they tend to be risk averse and overly interventionist. Another woman from my birthing class had a similar experience with them. She called them the baby snatchers. They tend to confine a lot of babies to the NICU. On the flip side, they have a very low infant mortality rate.

So the baby snatchers put Ramon on an IV of antibiotics just in case there was still meconium in his lungs and then an IV of dextrose to keep him hydrated. When we went by to see him on my way to recovery they wouldn't let us in because they were trying to put the IV drip on him. They continued to monitor his blood gas levels as the pH had been on the slightly acidic side...a condition called acidosis with no real known cause. The pH was normal during the entire monitoring period. As was every other indicator. I was allowed to visit whenever I wanted except at 7am or 7pm for their staff meetings and during pediatric rounds. I was allowed to feed him every 3 hours. So I was exhausted and waddling because my tailbone and nether regions were sore...so were my abs and legs from pushing. But I walked to the NICU every 2 hours to sit for at least an hour breast feeding and hanging out with Ramon. He was the model healthy newborn and didn't even fit in the NICU box very well at 8 pounds 15 ounces and 21.5 inches long. The nurses were annoyed when he fussed for food because he wasn't on a 3 hour feeding schedule and I wasn't there to read his cues. They started calling me for feedings and I started begging them to let him room in with me so that I could read his cues and they and the truly needy newborns wouldn't be bothered by his fussing. We were told the pediatrician on duty would speak with us after his rounds at 10am on Saturday. He never came to find us and we didn't see him during any of the many visits we made to the NICU. So we never got to find out why Ramon was still being held captive. The nurses couldn't really tell us much.

There was a really nice lactation consultant who had very laid back and relaxing breast feeding advice. The other nurses all wanted to give advice too. So every time I breast fed I had at least 2 different nurses come check on me and give conflicting advice. Many of them wanted to know if my milk had come in or if I was pumping. It was less than 24 hours after delivery and I had read enough to know that my milk definitely had NOT come in and wouldn't for another 24-48 hours but they acted like it was a problem that it had not. I was told by one nurse that pumping colostrum was a waste of time if Ramon was sucking well because there isn't very much of it and we would have to syringe it out of the bags and then feed it to Ramon by syringe. If he was sucking well then that was a much better way of getting to colostrum. He was definitely sucking well so I thought we were fine. There were alarmist nurses who did not. After one interaction in the middle of Saturday night/ Sunday early morning I ended up sobbing. The nurse was not tactful or helpful and acted like they would hold Ramon hostage until I could prove my milk had come in. This was not why they were observing him so I felt they were adding criteria the longer he stayed. I resolved to find the pediatrician in charge and beg him to let Ramon go since he was clearly healthy...all the data supported that conclusion. We found Dr. Paley the next morning. He was clearly overworked but made time for us. He was nice and knew exactly which baby we meant when we mentioned our name and knew why he was being monitored. I had just seen a nurse who told me they had just removed the IV because it was leaking. Dr. Paley said all the numbers looked fine except the head circumference. He said Ramon had a circumference in the 98th percentile so he wanted a sonogram to make sure there was no fluid in the brain cavity. Now, Ramon had been vacuumed out so he had a hematoma on the back of his head and his skull had been misshapen by the vacuum...making it larger than it should have been. Dr. Paley either did not know this or thought it was too risky not to check. I was near tears when I said we would really like him to be in our room as soon as possible. He stopped and looked hard at me and then said, once he is off the IV and we check his blood gas levels one more time you should be able to do that. I told him the IV just came off and he was surprised but happy. He said we should be able to take him back to our room in a couple hours. Yay! So we left happy.

A couple hours later we returned. Ramon had been moved across the hall and the nurse in charge of his previous room very condescendingly pointed me in that direction. I explained the Dr. Paley said we could take him back to our room now and she said, "Oh really, he said that?" like I was lying. She disavowed any responsibility and said I had to talk to the nurse in charge of his care. I went to see him and found a really nice and competent nurse who went out of her way to help me nurse him. He was fussing from all the movement and she calmed him in a very authoritative manner. Ray and I were very impressed but have been unable to repeat her feat. Ramon seemed to be surprised into silence by her demand :). I explained that Dr. Paley had said we could move him to our room and instead of acting like we were lying she went and confirmed and immediately started the paper work to get him released. Less than an hour later we were moving him to our floor. Whew!

We got him to our floor and a nurse there immediately took him to check him into the local nursery....arrrgh...more baby snatching. She did bring him back less than 15 minutes later to our relief. Finally we could begin bonding and adjusting to his cues for hunger and comforting...it was about 36 hours after Ramon's birth but it felt like a week.

They say the birthing process is the time in our lives when the most stress hormones we will ever produce are released. Inhumane medical practices and nurses with robotic and rule based bedside manners must increase this stress. I appreciate that Ramon's body and lungs were well cared for but I think we should be doing more. We should be caring for his emotions and spirit and the emotions and spirit of the mom too. There must be a way to do both safely.

In the middle of the day on Saturday we requested a private room. We moved by the end of the day. That made a huge difference for Ray's comfort and for our visitors. The original room had two uncomfortable chairs. Ray napped in one of them for a while. In the new room he had his own bed and we had several comfortable chairs and a couch! In order to get this kind of humane treatment we had to pay an additional $750 a night. This included some pretty good food from their gourmet kitchen and lots of water and juice and other beverages.

We were all going to be released on Monday after Ramon's head scan. Tamara came to see us several times during our stay to make sure we were okay. She said that if we had not had to get Ramon out so quickly I would definitely have been able to birth him with no troubles...I was built to deliver much larger babies and would have a much easier time for future children she was sure. Our pediatrician came by and clearly thought that the Roosevelt staff had been overly conservative in their approach to Ramon. She was very nice and grounded and helpful. She said Ramon looked very healthy and we could leave and come visit the office in 3 days for our newborn checkup. She and the nurse were concerned that Ramon hadn't had a confirmed pee in 12 hours so he might be dehydrated. She said if he hadn't peed by 2pm we should consider giving him formula in addition to my breast milk. She said that 70% of mothers supplement breast milk with formula so I shouldn't feel alone in deciding to supplement if it came to that.

We napped and ate and relaxed and kept bugging the nurses about when our sonogram appointment for Ramon would be. They finally came to take him and Ray was allowed to go too. Everything was normal. Then we waited around until around 2pm so we could change Ramon and check to see if we had a ticket out of the hospital...they said he had to pee before he could leave. When we changed him we found a huge tarry poo and a PEE...yay!! We could leave! My mom was so excited she ran to tell the nurses station and we all started to prepare ourselves to leave. The nurse was bemused that we were already preparing. Apparently discharge takes a while so we had time to relax.

Somewhere in here a medical biller appeared and asked about insurance and explained that mine would be primary and Ray's would be secondary as it was customary for the mother's insurance to cover the baby automatically for 30 days. She also explained that we might want to drop by admissions to straighten out our medical records as someone in the NICU had put some procedures for Ramon against a mother with a last name of Paschke instead of against our name and that things might be hopelessly confused at this point. What?!?! Suddenly the wrist bands that baby and mom and dad all wear seemed a much needed safety precaution and not an over-reaction at all. At this point we were overwhelmed by our hospital stay and did not have any desire to go talk to admissions about confused medical records. I hope things work out on the billing end...we haven't seen a bill yet...I imagine they are saving them up for us and will send us lots of paper soon. I also haven't seen a birth certificate yet though we applied for one and I have ordered a copy from the city health department. The Department of Education started bugging me for an official birth certificate before Ramon was even born....they were very threatening in their request...there was no "congratulations on your new addition"...just, "you better send us a birth certificate or we won't approve your childcare leave."

So, the nurse weighed Ramon again (8 pounds 3 ounces now) and asked us to sign a whole bunch of papers saying we promised to go to the doctors for Ramon and for me. We signed that we knew all about Shaken Babies and that you're not supposed to shake babies because their brains could get hurt.

We did some more fun stuff like dressed Ramon up in his coming home outfit. We rode home in the car and Ramon fell asleep in his car seat. And then we were finally home!!!

Whew....we sure needed a rest at home after all the craziness at the hospital.