Update la starea de pretravaliu

Toma are bronsita si RSV (nu stiu cum sa-l traduc pe virusul respirator cu pricina), bunicul are probleme cu o raceala suspecta si cu inima si nu are nitroglicerina iar Stefan a anticipat toate astea prin zbateri de ochi premonitorii, despre care eu in continuare cred ca sunt coincidente fatidice. Si mai e stresat de perspective incerte si de ezitarile mele. Daca as avea raspunsul corect...

In aceste conditii contractiile mele par desigur derizorii si neadecvate si chiar nadajduiesc sa fie Braxton Hicks. Maine implinim termenul de 40 de saptamani, e foarte frig si dupa ninsoarea de ieri strada arata ca un croissant pudrat. Si eu n-am timp sa nasc. Vreau soare si primavara si sa ma sustrag dizarmoniilor din jur.

Ultimele retusuri la tabloul 3+1

Am reusit sa ne edificam care e data limita pana la care mai locuim in simbioza: daca nu doreste sa ne intalnim pana joi, atunci ii facem cadou 3 Martie drept zi de nastere. Ieri, la ecograf, toate erau bune, apa in acvariu destula, 154 batai/minut si pace multa in imparatia materna.

Doctorul care ar putea potential sa ma asiste la inductie pare foarte prietenos, naturalist si firesc. Pana acum e cel care mi-a dat cele mai multe explicatii despre ce se intampla cu mine si puiul din dotare, si primul care a citit planul de nastere fara surprindere sau indignare. A estimat ca bebe are in jur de 7.5 - 8 pounds (3.4 - 3.6 kg) si ca nu voi avea nevoie de pitocina. Dilatatia e tot la 4-5 cm, colul 80% sters si statia -1. Foarte favorabil unei nasteri usoare, dar nu intotdeauna exista o corelatie clara intre parametrii tehnici si realitatile din teren :)

Tot in tainele mamiceniei se inscrie si raceala lui Toma care a reusit sa ma epuizeze fizic si psihic intr-atat incat ma intreb daca sunt in stare sa ma conduc singura azi de la servici acasa. Partea buna e ca e vineri si ca ar trebui sa ii treaca si sa doarma mai bine si el, pisoiul moshmolit de tuse si nesomn.

Baietelul din burtica

Poate ca e venirea primaverii sau iminenta nasterii si pendularea hormonala aferenta sau apropierea mutarii la munte, sau toate la un loc, dar zilele-astea ma simt fericita, implinita, privilegiata si increzatoare in tot ce va fi sa vina.

Abia astept sa il intalnesc pe baietelul din burtica, sa ii spun povesti despre dragoste si dor, despre paduri si ape, despre nori si alte forme efemere. Sa il tin in brate si sa il legan catre somn, sa ii numar in sarutari degetele de la picioare, gropitele de la maini si alte cute numai pentru nou nascuti inventate. Nu stiu cand vrea sa ne-ntalnim, dar eu sunt pregatita sa iubesc si mai mult.

Cei sapte ani de-a casa(toria)

Azi se rotunjesc sapte ani de cand visez cu ochii deschisi, sapte ani de cand am zis "da, vreau sa rad si sa plang cu tine, vreau sa vin dupa tine in lume si vreau sa ma tii in gand sau in brate in toate noptile"... Pare insa ca am trait infinit mai mult, intre continente si avioane, scoli si vacante, case provizorii si semi-permanente, si mai ales in zambetul mic cu gropite de mine si tine amestecat.

Te iubesc mai mult de cat la inceput pentru ca in fiecare zi te-am descoperit cate putin. Iubesc rabdarea, blandetea si tenacitatea cu care crezi in noi. Iubesc sa ne facem planuri in fiecare zi, sa le modelam si sa le punem in contextul lumii absurde in care ne-am cunoscut. Iubesc sa te vad jucandu-te cu Toma, citindu-i si invatandu-l de-ale pisoilor. Nu mi-as fi putut dori nimic mai mult si iti multumesc ca ai avut rabdare pana m-ai gasit.

Intalnirea mea cu Toma - III

Prima sarcina a fost extrem de usoara si energizanta. In multe randuri, am simtit ca pot sa forez muntii, daca nu sa ii mut. Am aflat ca vom avea un copil exact acum trei ani, si pe parcursul celor noua luni, m-am simtit fenomenal: fara greturi, pofte, istericale (desi am batut putin din picior sa ne luam casa, ca deh, ne trebuia cuib) sau alte neplaceri. Am facut yoga/pilates pana pe la sapte luni, dupa care am redus activitatile fizice la varuit, asamblat mobila si shopping.

Doctorii au estimat ca data nasterii va fi 14 octombrie, asa ca  am invitat ambele mame/soacre sa asiste si sa ajute la eveniment. Ne-am mutat in casa noua (veche, dar complet renovata in timp record) pe 4 septembrie si am terminat finisajele in ajunul venirii "ajutoarelor", adica prin 10 octombrie. Obositi dar extrem de multumiti de rezultatele muncii noastre ne-am asternut pe asteptat. Pe masura ce Toma se lasa asteptat, noua resedinta s-a transformat intr-o oala sub presiune cu soacrele tropaind pe hormonii mei si-asa jucausi, negasindu-si locul si rostul si mai ales neincapand una de cealalta desi casa e pe trei niveluri...

In fine, la controlul de la termen, in ciuda rezultatelor pozitive la toate testele si monitorizarile, am aflat ca daca nu se intampla nimic in urmatoarea saptamana, or sa imi provoace nasterea, pentru ca placenta risca sa devina ineficienta in procesarea si transmiterea oxigenului si nutrientilor. Deja tracasata de interactiunile cu cele doua doamne si obosita de mersul pinguinului, n-am rezistat propunerii. Drept pentru care, in dimineata cu pricina, dupa un telefon la spital menit sa ne asigure ca avem camera, am purces cu bagajul pregatit de-o vreme. Am sunat doula, cu care ne pregatisem in cele trei intalniri prealabile pentru varii scenarii, si a promis sa ajunga odata cu noi la spital.

Spitalul nou, cu dotari maiestre, intr-un decor relativ domestic. Asistenta ma intampina bucuroasa la 8 dimineata cu propunerea de Pitocin intravenos; eu intru in panica si zic pas, stai sa vina doula sa negociem. Ce doula? Care doula? Aia din planul de nastere. N-am stiut, si oricum asa e procedura. Nope, cheama doctoru' ca de nu eu plec acasa. Imi si imaginez scena cu gravida uriasa (o burta care imi tripla usor profilul - ca si cea de acum de altfel) raspicandu-se intr-o engleza medical aproximativa si cu accentul aferent :)

Apare doula si se face pace. Ora 9.  Nu primesc Pitocin decat daca nu progreseaza travaliul la o ora dupa ruperea artificiala a sacului amniotic. Asa ca am depus constiincioasa tot efortul de care m-am simtit in stare vreme de cateva ore bune, urcand si coborand sute de scari, si zabovind cate 15-20 minute pentru control si monitorizare. Gandindu-ma-n urma cred ca am fost extrem de norocoasa ca lucrurile au decurs asa si nu am intrat in spirala interventiilor medicale cauzate de lipsa progresului.

Cred ca in jur de ora 1 am intrat la dus si am primit un masaj buuun de la doula. Apoi am cerut prima doza de analgezic - dupa care m-am simtit ca dupa cateva pahare de vin, si a trebuit sa stau cuminte in pat sa nu ma accidentez. Efectul a durat cam o ora, si desi contiuam sa simt contractiile, devenisera suportabile.

Catre 2:30-3 am mai cerut un shot, dar efectul nu a mai fost la fel de puternic si pe la 4 si ceva deja ceream epidurala si as fi acceptat bucuroasa cateva cezariene. Din fericire, eram suficient de aproape de deznodamant, incat sa nu mi se mai poata administra nici un fel de medicament si sa-mi revina optimismul si energia pe ultima suta de metri. Partea cu push-push a fost destul de ireala, ca nu simteam ca imi vina sa imping desi asistentele (ca la final s-au inmultit) si doctorul faceau galerie intensa. In cele din urma, am cedat epiziotomiei si Toma s-a nascut cu un tipat sanatos, albastrui, ridat si fara dinti ca un strumf batran... L-am primit in brate asa ud si moshmolit si s-a linistit imediat la san - imi amintesc ca ne-am privit indelung in ochi si ne-am indragostit instantaneu. Stefan plangea de fericire (cred) si doula ne asigura pe toti ca am facut o treaba buna. Pe masura ce durerile s-au estompat, am intrat intr-o stare de beatitudine coplesitoare: m-am simtit intreaga, puternica si plina de magie!

Ce-am invatat data trecuta: sa eviti inflatia de estrogen (nu avem decat un bunic acum cu noi care sa se ocupe de Toma cat suntem la spital) si cine n-are doula sa-si faca rost. Au trecut doi ani si trei luni de atunci, si ma pregatesc sa nasc in orice zi acum. Imi doresc nespus un al doilea baietel la fel de sanatos si bun, indiferent de cum va fi nasterea, dar recunosc ca in secret sper sa fie o experienta la fel de buna.

Intalnirea doulei cu Toma - II

Mo had a healthy, enjoyable pregnancy with no complications. She started having non-stress tests around 38 weeks of pregnancy. I asked her if they had concerns about her and the baby since in my experience non-stress tests were not offered until 40-41 weeks and usually sooner if there were concerns or a multiple pregnancy. She said there were no concerns. It was routine for this doctor/group to do them. She made it to 41 weeks and was told that she should induce because she was overdue and the placenta would not be working as well any more. She was 4 cm dilated the day that she was induced.

At one of her last appointments, she shared her birth plan with one of the doctors in the practice. In her birth plan, she wrote that she would have a doula at the birth. The doctor who attended her birth did not know about this and seemed to react strongly when Mo wanted to talk with me before he broke her water and he started her induction. He left the room and Mo, Stefan and I talked. Mo seemed concerned about the doctor’s reaction and didn’t want to start her birth off by upsetting the doctor and possibly be treated in a negative way. I reminded her that this was her birth and her body. If she wanted to go ahead with the induction, that was her choice. She nor her baby were in any immediate medical danger, so I told her that she could choose to come back on a different day and have the induction with a different doctor if she wanted to. After we talked about her choices and how she was feeling, she decided that she was ready and felt confident about having her water broke and start the induction.

The doctor came back in and was calmer. He broke her water, which was clear, and they listened to the baby on the monitor for awhile (about a half an hour). The nurse came in and she said that Mo could get up and walk around. The nurse was supportive of Mo’s desire to try for a pain medication free birth. We were told by the nurse that they would be starting Mo on Pitocin in an hour if she didn’t start having contractions. Mo did not want to have Pitocin if she didn’t need to so she got to work.

We walked the halls in labor and delivery for awhile. The nurse said that we could go out and walk the stairs too, so we did. Mo walked A LOT of stairs. What a strong women with very strong legs! This technique was effective for getting her contractions going and soon her contractions started coming regularly. After an hour, we returned to have the baby monitored for about 20 minutes. She was having contractions often enough that the nurse told her that she did not have to start Pitocin yet. Mo was happy about that and after hydrating her up with some sparkling water, she was back to the stairs. We repeated this for a few hours, walk and climb stairs for an hour, return for 20 minute monitoring and sparkling water. During her contractions, Mo would lean forward and I or Stefan would rub her lower back. Before her birth, Mo said that she thought that she would like a citrus fragrance to smell, so I had a small bottle of lime extract that I had brought with me. She would take a quick smell of it and then we would walk more.

We visited the nursery and looked at the babies who where in there. I think that the use of gravity and motion helped keep the labor going without the use of Pitocin. We also utilized acupressure points on her legs and hands to help keep the contractions going while she sat and was monitored. She also tried nipple stimulation, but either it wasn’t very comfortable for her to do, or it wasn’t working for her. Maybe using an electric or manual pump would have been easier.

I can’t remember the timeline very well, but she was checked a couple of times and was making good progress. By the time she was 6-7cm dilated walking was not something Mo wanted to do any more because her discomfort was increasing and the contractions were taking more work to stay relaxed through. I think that her back may have been hurting too. We got her set up in the shower sitting in the chair and used the hand held sprayer on her back. She was in there for awhile, but it too was not helping very much any more and she was getting tired. She had not slept well the night before knowing that she would be having the baby the next day. I remember telling her that a lot of moms feel sleepy during transition and then get a burst of energy when it’s time to push.

While Mo was interested in an unmedicated birth, she was open to the use of medication. Mo was ready for some rest and some relief from the contractions. The nurse offered her Fentanyl. Once she received her dose, Mo rested in bed and was now hooked up to IV fluids for the first time even though she had a heparin lock from the start of her birth. She wanted to talk with Stefan in their native Romanian language and asked for privacy because she felt that it was not polite to speak something other than English in front of me. I told her that I had no problem with her speaking whatever language in front of me that she wanted to, but that I would be happy to give them privacy.

Less than a minute later, the doctor and his assistant arrived. He had Mo lay flat on her back and the nurse and I each helped hold one of Mo’s legs when she was pushing. Stefan was standing by the room door away from everything. He had tears in his eyes and I smiled at his and gave him a big thumps up. And when I told Mo how great she was doing, I would look at him and smile and nod too. At the time I was worried that he was doing OK, but if I remember correctly, Mo told me later that he was just very overwhelmed at the time. Once the baby was out, he came over and kissed and expressed his love to both Mo and Toma.

The doctor was shocked that Mo had “labored down” without an epidural. He was also amazed that she was having a baby without Pitocin and without an epidural. He said “we don’t see births like this”. Mo had only been actively pushing for 5 minutes when the baby’s head could be seen and in 10 minutes the head was crowning a great deal, but still easing in and out with a little more showing each time. The doctor said, “I’m guessing you don’t want an episiotomy?” I told you what he was saying because you couldn’t hear him and you said you didn’t yet. After two more pushes, he performed an episiotomy. Toma was born a couple of contractions later. He was beautiful and Mo couldn’t take her eyes off of him.

After Toma was born, the doctor left and his assistant repaired the episiotomy and cleaned up. The nurse checked the baby at the warmer and returned him to you and you started nursing him. Before the nurse left the room, I saw the nurse change the IV bag and then she said, “Now all I’m giving you now is a little something to give you energy to help you recover.” I looked at the bag and saw what was printed on the label and she said to me, “You saw what that is.” I said, “Yes.” She said, “I’m all about healthy moms.” I said something about understanding and she left. You both heard what was happening and asked what that conversation was about. I explained that the medication in the IV was called Pitocin and it is used to make the uterus contract and is usually given to mothers who’s uterus is not contracting properly after birth and/or if a mother is experiencing hemorrhaging. The nurse had given her 2 bags of it after birth not for excessive bleeding, but because the nurse gave it to all mothers after birth. Mo later complained of her legs being very swollen. One of the side effects of Pitocin is swelling of the legs.

Once Mo, Stefan and baby Toma were nursing and resting, but before Mo was moved to her postpartum room, I went to pick up Mo and Stefan’s mothers. They were very excited to come meet the baby! We met with Mo and Stefan and visited for awhile in the recovery room. Toma was being washed and observed in the nursery.

It was an honor to attend the birth of Toma. Mo and Stefan were a lovely family to work with. I wish that I could be a part of their birth when they welcome their new child, but I know that they will be in wonderful hands with Diane.

Best wishes for a beautiful and healthy birth,

Doula

Intalnirea lui Stefan cu Toma - I

Inspirata de lectura "Giving birth with confidence", in care se pomeneste ca istoria nasterii fiecarui om are puteri de legenda, precum si de frumoasa poveste a nasterii unui alt baietel minune, care imparte acelasi nume cu pisoiul meu, m-am hotarat sa rememorez venirea pe lume a lui Toma.

Toma s-a nascut intr-o zi de toamna, buimaca de ploaie si de vant, in Des Moines, Iowa. Fratele lui, pe care il asteptam in urmatoarele saptamani, se va naste tot aici, cand ii va veni cheful de lumina, frig si zgomot.

Deocamdata, am recuperat de printr-un email catre nasii nostrii de cununie, impresiile tatalui:

"Perspectiva mea desigur. Sunt fericit. Mo este minunata, ca de obicei. Va fi o mama pe cinste si sunt foarte mandru de ea. Sunt mandru pentru ca a avut intelepciunea sa ia deciziile cele mai bune pentru ea - in special angajarea moasei, care ne-a fost de un real ajutor. Zic "ne" pentru ca pe mine m-a ajutat pur si simplu prin faptul ca a stiut ce si cind sa ii zica si sa ii faca lui Mo in binecuvintata zi de marti 21 octombrie, cind ne-am infiintat de cu dimineata la aripa noua a maternitatii in care avea sa vina pe lumea asta Toma Rares (da, pina la urma ne-am hotarit ca, daca tot va avea de optat intre a fi roman european sau american, sa ii oferim optiuni si pentru nume). Am fost destul de linistiti si in afara de citeva mici contre cu asistenta si doctorul in legatura cu inducerea sarcinii, totul a fost ok pina la travaliu.

Din nou, mentionez ca este perspectiva mea - ok inseamna ca am putut sa o mangii si eu alaturi de moasa pe Mo cand contractiile o luau razna. Priveam uimit acele care inregistrau pe hirtia milimetrica ritmul inimii bebelusului si intensitatea contractiilor. Contractiile au un scor de la 0 la 100+. Cand am ajuns la spital, scorul era in jur de 40, ceea ce nu era considerat inca contractie. Ca dovada, Mo se putea plimba si vorbi. Da-i cu urcat-coborit scari, colindat holuri in speranta ca gravitatia isi va face datoria si contractiile isi vor urma cursul fara sa fie nevoie de administrarea pitocinei (traducere aproximativa a chimicalei care imita substanta secretata la comanda creierului pentru contractii naturale, oxitocina). Durerile au inceput pe la scorul de 60, si nu mica mi-a fost uimirea sa vad cum Mo s-a transformat intr-o pisica cuminte cuminte, pe care o mangiiam si o alintam cand trecea prin contractii.

Odata cu scurgerea timpului, s-a instalat linistea in salon si se auzeau doar susoteli intre Mo, moasa si asistenta pe muzica de fundal ("Bach for relaxation" - ti-o recomand in loc de somnifere :)). Si daca Mo mai putea articula ceva pentru durerile de 60, cand au inceput cele de 80, si chiar o suta s-a intimplat ceva in capsorul ei - nu pot sa uit cum mi-a devenit clar ca a depasit momentul psihologic in care ar fi putut recurge la epidurala. Dintr-o data am vazut-o respirand asa cum nu a avut motiv dar a invatat in acea clasa prenatala, trecand peste contractiile de 100+ si nestiind ce sa mai zica decat ca "sunt cuminte". Asistenta tot venea din cand in cand si cand am vazut ca incepe sa astearna unele altele in jurul patului am stiu ca se apropie evenimentul. Mo m-a trimis in antecamera unde am batut cei 2 metri de s-a facut sant acolo, probabil un sant sapat de nenumarati alti tati. A venit doctorul, jovial dar "old-school". Nu a lasat-o sa nasca altfel decat in clasica pozitie care se practica si acasa (atat moasa cat si clasa prenatala ne invatasera ca pozitia cea mai buna e cea in care mama se simte cel mai bine sa impinga) si era hotarit sa termine cat mai repede cu nasterea. Asa ca cu moasa la un picior, o asistenta la celelalt si doctorul care completa corul de incurajare a pornit travaliul.

Au fost 26 de minute interminabile. Moasa a dat ulterior verdictul de "nastere grabita de doctor" - a zis ca prin alte parti doctorii sunt mai rabdatori si te lasa sa impingi timp mai mult, ca sa iti poti aduna puterile. Pe Mo au indemnat-o de 11 ori sa impinga. Eu am rezistat cred ca la 8 din cele 11 contractii insotite de 2-3 runde de impins in care simteam cum Mo isi aduna toata energia ce-o mai avea prin colturile fiintei. A urmat negocierea deciziei de epiziotomie pe care am ascultat-o cu ditamai nodul in git, rugandu-ma la Dumnezeu sa ii dea putere. Si i-a dat. Mare minune la voi femeile, cu fabricuta asta si cu puterea incredibila ascunsa sub atata tandrete, frumusete si disponibilitate de dragoste. Cand am auzit patru voci zicand "there you go!! This is it!! This is the big one! Push now!" am pasit in camera si am vazut ceva mic si mov albastrui fiind depus la pieptul mamei - Mo mea minunata.

Una dintre maini era legata de cap cu cordonul ombilical, care se infasurase de doua ori in jurul gitului si a mainii :) - a iesit pe lume cum sar atletii la inaltime la olimpiada. De atunci ce sa zic - am plans vreo 10 minute ca altceva nu stiam sa fac, si ii mingiiam cand pe unul cand pe altul in timp ce doctorul si asistentele isi faceau treaba in jurul nostru. Pe mine, ca si probabil pe majoritatea tatilor, m-a lovit un sentiment de responsabilitate coplesitor pentru urmatoarele zile. A culminat cred acum doua zile, dupa prima noapte petrecuta in trei (am lasat mamicile sa doarma ca sa il poate prelua dimineata) cu o stare de anxietate si neputinta de a ma bucura: bucurie pentru darul acesta de viata sanatoasa, de nastere fara complicatii, de fat care suge tot ce intra in raza guritei mostenite total de la Mo, de mama sanatoasa si bucuroasa de pruncul ei. O mie de ganduri pe minut, si doar rugaciunile au avut darul de a ma linisti. Rationalul functioneaza, stiu ca nu este un sprint, e un maraton, nu este decat senzatia stupida ca nu prea esti in control, mai ales cand micul print de abia are 3 zile si esti cu el acasa (ceea ce de altfel e o bucurie pentru ca n-ai fi acasa cu el daca nu ar fi complet si deplin sanatos). Dar asa sunt eu la inceput de drum cu responsabilitati. Cred ca trecerea pe la doctor in ziua a 5-a si revenirea la servici au avut darul de a ma linisti. Am petrecut noaptea trecuta linistiti, cu somn dupa voia lui Toma, insa cu sentimentul ca stim ce facem si cu o crescanda constientizare a limitelor pe care le controlam si al algoritmului pe care putem sa il aplicam relativ la semnele lui Toma!"

Dupa care notam si eu, o umila contributie personala: "una peste alta, suntem bine, alaptam pana adormim cu lapte pe mustati si crestem ca Fat Frumos."

Zilele-astea o sa primesc si varianta doulei, pe care o sa o traduc sau nu, dupa care o sa "fill in the blanks" cu ce imi amintesc eu din acea zi memorabila si nu s-a spus deja.