Lien-Thanh's Blog: Labor, Delivery, and Max Iris's First Week

2023 Pregnancy:

I found out I was pregnant in April 2023, with a due date in January 2024. I enjoyed most of my pregnancy, but had to keep an eye on a few health issues:

1. Advanced maternal age: There wasn't much I could do about being 38 years old.

2. Overweight: Fortunately, morning sickness and a diabetic diet came with the silver lining of preventing me from gaining too much pregnancy weight.

3. Severe morning sickness, associated with a temporary rise in liver enzymes: I required multiple medications and IV fluids, and was relieved when my symptoms self-resolved around 15 weeks.

4. Gestational diabetes: I used a continuous glucose monitor to help keep me on track with a diabetic diet.

5. Chronic hypertension: This was diagnosed early in my pregnancy and was the most concerning issue because it raised my risk for preeclampsia. I took nifedipine daily, monitored my blood pressure at home, and was scheduled for an induction at 39 weeks.

My pregnant silhouette

Dec 24 (37w3d):

My blood pressure started to worsen between 36-37 weeks gestation and then hit 161/104 on Christmas Eve, which prompted me to be seen in the labor & delivery ward. Work up was reassuring, blood pressure trended down on its own, and I was able to be discharged a few hours later. It felt surreal to immediately put on my scrubs and go downstairs to work my usual hospital shift.

Not where I expected to be that morning

Dec 25 (37w4d):

On Christmas, my blood pressures were better controlled so I went to work as usual. Some of my coworkers predicted I may not be returning to work for a while, so we all took a Christmas photo together. It turns out that they were correct.

Merry Christmas

Dec 26 (37w5d):

My blood pressure jumped up to 160/103 so I was seen in the labor and delivery ward again, but this time the recommendation was that I double my blood pressure medication and be admitted to the hospital for an induction. The first day was spent receiving 5 doses of oral misoprostol, each spaced 4 hours apart, in an attempt to ripen my cervix. Sometimes I felt nothing and sometimes I had contractions that felt like heavy menstrual cramps. I was a little disheartened that I didn't make much progress; my cervix stubbornly remained 50-60% effaced with a fingertip opening.

The next couple days had some tough parts, but I was happy to be at Kaiser, where I felt supported and safe. Everyone was communicative, involved me in each decision, and did everything they could to make my experience as comfortable as possible. My care team knew I wanted to move around a lot during early labor, so they put me on a wireless fetal monitor, placed a peripheral IV in my forearm (away from the wrist or elbow), provided me with a yoga ball, and coached me through different exercises and positions. They also encouraged me to play music if I desired, put battery-operated candles on my side table, and set up an oil diffuser that made my room smell like lavender.

Remote monitor so I could get out of bed

Thoughtful IV placement that gave me more freedom

Suggested poses and exercises

My little exercise station

Dec 27 (37w6d):

My husband Bill and I were happy to see our favorite midwife Mabel, who coincidentally had attended middle school with Bill in Virginia many years ago. After not having much success with misoprostol, we moved on to the cook catheter, a device that goes through the cervix and is filled with water to apply pressure to the inside of the cervix. A sixth dose of misoprostol was also inserted vaginally at the same time as the catheter. Having had bad experiences with IUD insertions in the past and knowing my cervix was still not very dilated, I opted to be treated with fentanyl during the procedure.

The fentanyl helped keep my pain controlled initially but as it wore off, contractions started to become intense. The next 12 hours were the worst part of my labor. I started chattering and shivering uncontrollably. As the contractions worsened, they started to feel like out of body experiences. During an episode, I couldn't open my eyes or talk; it felt like I was hearing and even watching myself from the outside. In between contractions, I was able to open my eyes and reorient myself to where I was and who was around me. My doula Sydney arrived and provided invaluable comfort by massaging my legs with peppermint oil, applying counter pressure, and talking me through the painful contractions. Bill massaged my cheeks whenever my teeth started chattering, and I would focus on his touch to calm down.

Ice packs and Bill's touch

We filled the bath tub in my room but before I had a chance to get in, my blood pressures increased again and were sustained in the 160s/90s-110s. I was given IV hydralazine to bring down my pressures and started on an IV magnesium bolus/infusion due to concerns for preeclampsia. The IV magnesium made me drowsy, woozy, flushed, and nauseated. I vomited multiple times.

In between contractions, I no longer had a chance to recover because I felt so sick and nauseated. I became overwhelmed and requested a break from the magnesium, which was held for an hour. I was treated with IM morphine and compazine around 7pm and then a dose of IV fentanyl around 11pm, the latter of which gave me some much needed relief. After things calmed down, my doula Sydney and I had a late night heart-to-heart.

Dec 28 (38w):

Around midnight, my water broke with what felt like a very dramatic and sudden large gush of fluid. My painful contractions resumed and I started shaking and chattering uncontrollably again. I was disappointed that the cook catheter still wouldn't come out on its own, as I was hoping I would be more dilated by then (typically they fall out once someone reaches ~3-4 cm dilation). My catheter had to be deflated and removed to decrease the risk of cervical necrosis, since it had already been in place for 12 hours.

Bill comforting me while I was chattering and shaking

I was told that since my water had broken, my contractions may become even more intense. I was initially hoping I'd be able to avoid an epidural until I was a little further along in labor, but I was getting to a point of mental and physical exhaustion so I went ahead and pulled the trigger. My epidural was placed quickly and painlessly around 1am. Following the procedure, I suddenly became hypotensive (systolic blood pressure 70s) and bradycardic (heart rate 30s), and my baby's heart rate dropped to the 90s. I was extremely lightheaded and nauseated, and I vomited a large amount of fluid (800 cc's). I was given 2 doses of ephedrine which stabilized my (and my baby's) vitals.

Having an epidural meant 3 things:
1. I now required a foley catheter to collect urine. This turned out to be a good thing, as I later developed some urinary issues that required monitoring (we'll get to that a little later).

2. I could no longer get out of bed. I didn't mind because at this point, I was in too much pain to even want to move a lot. The nurses were great with helping me get into various positions in bed with a peanut ball every couple of hours.

3. My diet was changed to clear liquids. I had no desire to eat anyway; my appetite wouldn't kick back in until a couple days later when I was off of magnesium. In the 48 hours between Dec 27-29, I only managed to eat 1.5 jellos and drink some sips of water.

One of the photos our last-minute petsitter sent us
that we used to distract me in between contractions

At 2:45am, my uterine contractions were spaced apart so I was started on pitocin. My pain gradually worsened as the pitocin dose was increased. By 9am I was hitting my epidural button, but was not getting any relief. I was still able to feel and move my legs very well and wondered if the epidural was working at all. A cervical check showed that I was dilated to 4 cm. Following the check, I had bloody clots, worsening pain, nausea/vomiting, and recurrent hypotension to the 80s/40s requiring additional ephedrine.

My CRNA dosed me with precedex and fentanyl through the epidural which made my legs feel numb and heavy and quieted the painful contractions. During a moment of calm, Bill and I saw a beautiful rainbow through our window, and one of the RN's helped reposition me so I could see it better.

Bill and me looking out our window

View from my room

My baby's middle name would be Iris, which means rainbow

My rainbow baby was right around the corner

I developed gross hematuria (blood in the urine) with a decreased urine output. Repeat preeclampsia labs showed some abnormalities (uric acid level 6.9, protein-creatinine ratio 2.2), but it was unclear whether my renal issues were related to preeclampsia versus trauma from the baby pressing on my urinary system. Repeat cervical exam around 4:30pm showed 6 cm dilation with 100% effacement.

At 5pm, fetal monitoring was concerning for late decelerations (decrease in fetal heart rate following a contraction). An intrauterine pressure catheter and fetal spiral electrode were placed through my cervix to more closely monitor my contractions and my baby's heart beat.

Contractions gradually started to build again, and my doula Sydney arrived to provide support. I required another dose of precedex and fentanyl through the epidural. After my pain was controlled, all three of us fell asleep: me on the hospital bed, my husband on a pull out chair, and our doula Sydney on the hospital floor! It had been another intense day, but I was feeling more optimistic that I was making progress and would be able to meet my baby soon.

My doula Sydney

Dec 29 (38w1d):

I woke up in the wee hours of the morning to some contractions that felt different, like a pressing and throbbing sensation against my right groin. We had requested for Mabel to be the one to catch the baby, and she arrived to tell us it was time to start pushing. Pushing lasted less than an hour and was definitely my favorite part of labor & delivery. The lights were dim and calming, my pain was controlled, and I felt comfortable surrounded by my team of 3 people cheering me on: my husband Bill, our doula Sydney, and our midwife Mabel.

Bill held my left leg, Sydney held my right leg, and Mabel coached me to push for 3 counts of 10 whenever I felt a contraction. I opted to have a mirror set up so I could see my baby's head, and Sydney placed my right hand against my baby's head during one of the pushes.

My baby girl Max Iris, which means "great rainbow," arrived at 4:12am on 12/29/23. She weighed 5 lbs 12.4 oz and was 18 inches long. We sang happy birthday to her as she lay on my tummy and then Bill cut the umbilical cord. I had a left-sided 1st degree perineal laceration that required some stitches. My placenta didn't want to come out initially, but eventually was delivered about half an hour later.

New parents

I enjoyed an hour of skin to skin contact with my baby, which was magical. We attempted baby-led breastfeeding. Max Iris started moving slowly toward my breast but wasn't quite able to initiate breastfeeding on her own. Since she was starting to get cold, I brought her in for her first feeding before she was placed in a warmer in my room.

Skin to skin

Love at first sight

With our midwife Mabel

Max's birth announcement,
engraved by our birthing class instructor Jenn
@auntyjennsgifts

Dec 29 (Day 0):

After delivery, I had to remain on that awful IV magnesium for 24 more hours. I took a shower while bleeding from my vagina/laceration, with a foley catheter in my bladder, a glove over my left hand IV which was still attached to the magnesium infusion, and a dressing over my right antecubital IV. After my recent epidural, I was still a little unsteady on my feet and had to use a shower chair. Needless to say, it was by far the most challenging shower of my life, but I really needed to rinse off after having vomited several times on myself over the last couple days.

My mother, maternal grandmother, and sister arrived from Texas the afternoon that Max Iris was born. Several coworkers also stopped by to meet my new baby.

Jae

Mau

Midge

Raquel

Mom & Ba (my maternal grandmother)

My sister Lan

Arun

Max Iris opening her eyes to look at us for the first time

Candles that our friends lit for Max Iris when she was born

Dec 30 (Day 1):

My OBGYN and Max Iris's pediatrician were initially leaning toward keeping us in the hospital one more day but agreed to let us go home in the evening with close outpatient follow up. We celebrated Bill's 44th birthday by eating rum cake, cuddling our 4 dogs, and sleeping in our own bed.

Vik & Sue

Homeward bound

Happy to be home

Happy birthday, Bill!

Dec 31 (Day 2):

My mother-baby follow up appointment raised a couple of concerns. Max Iris's weight had dropped 10% and she was now only 5 lbs 2.9 oz, so I started supplemental pumping. My blood pressure continued to run high and my nifedipine was increased.

The evening and night were tough between cluster feedings and new years fireworks scaring our dogs and keeping our baby awake.

Ocean meeting Max

Mabel especially hates fireworks

Jan 1 (Day 3):

On the evening of Jan 1st, my feet suddenly became very swollen to the point that I couldn't curl my toes, my face was flushed, I had a headache, and my blood pressure shot up to 184/95. I was admitted overnight to the hospital for postpartum preeclampsia.

Fat feet

Jan 2 (Day 4):

My nifedipine dose was increased and I was released from the hospital again. Over the past 8 days, there had only been one day where I hadn't spent at least part of my time as a patient in the hospital.

Back in the hospital

Here we go again

Zelah, Raquel, and Sze Mei

Tiff and Kat

Yuree

Jan 3 (Day 5):

Max made an appearance in our music video "Let's Start the New Year Right" with me, my sister Lan, and our friend Cynthia Lin. I used this video to announce Max Iris's arrival on social media.

Cynthia

Ron

Handmade rainbow blanket from my mom!

Handmade sweater from Aunt Marsha!

Handmade rainbow quilt from cousin Jess!

Handmade quilt from Sari!

Handmade blanket from KC!

Ukulele

Tap shoe

Jan 5 (Day 7):

At our lactation consult follow up, Max Iris showed she was gaining weight well and I could stop pumping, which was a huge relief. I also had an OBGYN follow up and a second antihypertensive (labetalol) was added, after which my blood pressures finally started to improve.

One-sided dimple, just like me and Bill

Jan 6 (Day 8):

We had a newborn photo shoot at Lanikai Beach with Lokeli'i Photography, which must have been the most adorable hour I've ever witnessed. I'll eventually post the professional photos separately, but here are some behind the scenes shots.

Welcome to the world, little Max Iris!