Up to Speed

Tuesday, August 15, 2017

| JUNE |

Finished third year of medical school! (Whaaaaaat?)
Aviva turned 1! (Whaaaaaaaaaaaaaaaaat?)
Studied for boards
Family photos

All photos by Jessica Piva Photography
| JULY |

Aviva's 1st Birthday Party & Baby Naming
Studied for boards
Took boards
Applied for some residency programs (!!!)


Trip to Orlando
Stuck in the Philadelphia airport for 6.5 hours with a baby

Aviva's first time in a pool

Floated down a lazy river at Rock Spring Run in Apopka, FL
Started my Emergency Med rotation
Stapled a guy's head
Sutured a stab wound
Worked a week of night shift
Put in some IV's

To be continued...


Sunday, May 7, 2017

When I was getting married, I was determined to "not lose myself," in this new role as "wife".

The same thing happened when I got pregnant. I said I would never lose myself to my new role as a mom.

Well, here's the thing.


Yes, caterpillars.

We all know that caterpillars, at some point, go hang themselves up as chrysalises and when they wiggle out, a beautiful butterfly emerges. Or maybe a beautiful moth. Or a plain moth. Whatever. Regardless, a squirmy, wiggly, thing with a lot of legs goes into a tube, and when it comes out, it's an insect with 3 body sections, 2 wings, and a lot fewer legs and a proboscis that lets it drink nectar emerges. If you're like me, you've often thought WHAT HAPPENS IN THERE? Well, it's kind of amazing and completely insane. Here's a cool video:

Basically, the caterpillar releases a bunch of enzymes that turn it into a soup with a bunch of chunky bits, and then the entire thing rearranges itself into an entirely new organism that is made up of all the exact same DNA that was there when it was a caterpillar. NATURE IS WEIRD, YO.


So, how is this related to anything I was talking about at the beginning of this post? It turns out that I was wrong. It's impossible to not lose yourself, at least a little bit, to your new role. I noticed it less as a new wife than I have as a new mom, but it was still present, even then. My priorities shifted. I was no longer a single unit, operating with only my own goals in mind. I was part of a team, and the team's goals became my own goals. I still had goals that were just mine, of course, but most of the time, they were superseded by those of the team. That is how I wanted it. How we wanted it.

It wasn't always the case. Going back to medical school was a time when my own personal goal superseded what was probably "best" for the team, but any good team sometimes requires compromise. Ken fully supported my dream then and continues to support me now as we come slowly (ever so slowly) towards the end of this wild ride called medical school. (1 year to go, basically! Whaaaaaaaaaaaaat.) So now I'm a wife who also happens to be a med student, and even underneath those layers, I'm Alison, the woman who loves reading, cheese, and sleeping in on Saturdays. What I'm saying is that there's a definite give and take to marriage, and I haven't lost my old self. It's just there in a different form.

Motherhood has been even more of a trip. I refused to become the stereotypical caricature of a mother that we all know. Haggard, can't remember the last time she showered, slowly martyring herself every day and giving all of her energy to her children. Am I tired? Sure. We're all tired. Granted, this is a different kind of tired than I've ever felt before, but it's nothing exciting or earth shattering. I refused to give up what gives me personal satisfaction and meaning to have it replaced by being a mother. And yes, I love being Aviva's mama, and knowing what I know now, I wouldn't give it up for anything in the entire world. But being Aviva's mama is not my sole identity. It is but a part of the wife-med student-reading-late sleeping-cheese eating woman that I am (and then some).

I often joke that life with a baby is the same as it was before, just... with a baby. But it's not. Sure, our activities are largely the same. We go out to dinner, we do housework, we binge-watch Parks and Rec, and we do it all with Aviva in tow (usually). But something feels different. I can't put my finger on it, but I am feeling like that caterpillar that has turned into a butterfly. I was doing fine as a caterpillar. Life was pretty good most of the time, and I liked it. Then, for 40 weeks, I was in this cocoon of pregnancy, and then I gave birth.  When a butterfly is emerging from a cocoon, it is really hard work and it can take a long time! The 12 weeks after Aviva arrived were my emergence from the cocoon. Our little bubble of a new family was perfect to me, and managing it was also the hardest thing I've done yet. (Yes, even more difficult than boards.)

So, to continue this grossly extended metaphor that is bordering on conceit, now I'm a butterfly (or, maybe a moth, because let's face it, ain't nobody got time to be butterfly beautiful every day), Some days, I feel like I'm still emerging from that cocoon. Drying my wings and learning that not only am I completely different, I am also completely the same as I was before Aviva was even an idea. I'm not going to lie and tell you that it's not hard. It is. It's hard and it's amazing and it's weird, and I'm still not entirely sure who I am or how being a mom fits into the rest of my life. That's the thing about life that I'm (reluctantly) learning; you kind of have to live it to figure it out.

Unlike a butterfly, I think that throughout Aviva's life, I'm going to keep going back into the cocoon, remaking myself. After all, she's not a static force, so I have to change in order to best support and care for her. What she needs from me now is not what she will need from me in 2 weeks, 2 months, 2 years, or 2 decades. I think that any time our identity is threatened by change, even amazingly great change, we have a tendency to back away from it and to fear it. I know I do. But I'm trying to remind myself that it's okay to take all the time I need to get out of that cocoon, and it's okay for you to take your time, too. We don't have to know everything right now. And every time we go back into our cocoon, we have a new opportunity to learn about ourselves and change how we want to see ourselves in the world. It's scary, but hey, at least we don't have to completely liquefy ourselves to do it.

13 Reasons Why

Wednesday, April 26, 2017

If you have a pulse and an internet connection, then you've probably heard of "13 Reasons Why". Spoiler alert: It's about a girl who died by suicide after... a bunch of stuff happens. And she leaves a bunch of cassette tapes (who even has those anymore?), detailing how each person in her life contributed to her death. It was a book before it was a series directed by Selena Gomez. Apparently, it's pretty popular and addictive. I watched it. Well, most of it. I watched the first 9 episodes and then skipped to the end and watched pieces of the last episode. I'll tell you why.

You shouldn't watch it. No one should. Here are a few reasons (not thirteen, because who needs that many?) you shouldn't watch 13 Reasons Why. And, uh, spoiler alert, I guess.

No one is responsible for anyone's suicide.

Period. End of story. Suicide is a horrible cause of death, often following a protracted battle with depression or other mental illness. The people left after the suicide always, always, always, need to know why. They want a reason why their loved one chose to end their life. They want to know if there was anything they could have done. Or if they did something to cause it. The rest of their lives, some of these people will probably blame themselves in one way or another. The last thing we need is for mainstream media to purport the idea that one or many people can cause someone to kill themselves. Or perhaps more dangerously, the idea that if we're all just really kind to one another and we just love one another better that we can prevent suicide. Depression that ends in suicide cannot be prevented by simple kindness. Full stop.

Getting help is essentially not discussed.

The only time Hannah Baker tries to access the mental health system, it is through her guidance counselor at school, which turns into an unmitigated disaster. She can't and won't tell him who assaulted her, and without that information, he glibly says that she other option is to "move on". She leaves the office in a huff, saying that she "needs to get over it", finishes recording her 13th tape, and then goes home to kill herself. Not once was this girl referred to any kind of actual health professional. Despite the fact that she displayed multiple signs of needing help, including saying things like she wanted life to stop and that she thought she was a burden, her school performance dropping, withdrawing from friendships, feeling worthless, and withdrawing from hobbies and activities. No one hauled that girl into a doctor's office, no one sat her down and made her talk. No one tried to find out why she was in so much pain. No one. There are so many options. 1-800-CONTACT and 1-800-273-8255 are both 24 hour hotlines that anyone can call and talk to a real human about something going on in their lives. You can call 911. Your job probably has an Employee Assistance Program. Your college has a counseling center. Hell, leave me a comment here and I will personally help you find someone to talk to. You are not alone. 

It glorifies and glamorizes suicide.

When someone dies by suicide, there are things that you and others SHOULD. NOT. DO. One of those things is don't glamorize or sensationalize the suicide. This entire show violates this and makes it the centerpiece of many classroom discussions. Furthermore, in death, Hannah Baker received everything she hoped would happen when people listened to her tapes: sympathy, anger, regret, guilt, and lastly, most importantly, love. She was vindicated in these tapes. People realized how awful they had been to her, they all felt bad, things HAPPENED. Will things change? Probably not, because people, teenagers especially, are terrible. But in the show, Clay Jensen decides to be nice to that weird girl, and her parents get closure (???), and there's a court case in process. (Sure, there's also that lingering, terrifying, idea that there's a kid planning a school shooting, and that yet another kid has tried to die by suicide, but let's leave that for the moment.) Overall, the entire thing is just handled incorrectly, and really the exact opposite of how any suicide death should be handled.

The suicide scene is gratuitous.

It reads like a how-to on slitting your wrists. Not only does it depict the entirety of the act, it does so gruesomely and painfully. I have a strong stomach and an equally strong mental fortitude for things, and it made me nauseated. It chilled me. Maybe that was the point. But I'm also 30 years old and I know better than to try and die by suicide because I understand that death is FINAL and there is no coming back. In the novel, Hannah's suicide is vague, but it can be inferred that she dies by taking an overdose of pills. In an interview with Seventeen, Jay Asher, author of the book, was quoted as saying, "We worked very hard not to be gratuitous, but we did want it to be painful to watch because we wanted it to be very clear that there is nothing, in any way, worthwhile about suicide."

Welp, Jay and Selena, it was gratuitous. And you skipped the middle part. You know, the actual dying. You went from bleeding in a bathtub to totally dead. You didn't talk about how when your blood pressure plummets, your heart rate goes up to try and correct it, and you become starved of oxygen because there isn't enough blood in your body to get it to your brain, even though you're breathing just fine. In fact, you're probably hyperventilating. Feeling panicky because at this point, yeah, you're going to die, probably and now you can feel it. You forgot that part.

So no. There is nothing, in any way, worthwhile about suicide. You just certainly wouldn't get that idea from watching 13 Reasons Why.

So, why should we listen to you?

I mean, go ahead, don't listen to me. You're a grown-up. I'm only one person, shouting into the void of the internet along with millions of other people. But I can tell you this. When I was 16, I was suicidal. I spent 10 days in an intensive, outpatient program. It was hell. I was contemplating suicide a second time at 27. That time, I spent 4 days as an inpatient on a psychiatric ward of a hospital. It was also hell, in case you were wondering. For 14 years, I self-injured. For 4 years, I have been a recovering self-injurer. When my depression gets bad, it is a conscious choice I have to make to not hurt myself. It is not always easy. Depression is hard. It lies. Constantly.

While I can't say how I would have felt if I had read this book or seen this series when I was 16, I can pretty much guarantee that the answer wouldn't be, "Way better and way less likely to hurt myself,". What did help me wasn't books or shows about other teenagers dying by suicide and the dramatics that followed. What helped were my friends and teachers who weren't afraid to tell my mom they were worried about me, even after I "swore them to secrecy". Therapists I saw on a regular basis. Oh, and drugs. SSRI's are a huge part of why I'm here today. Better living through chemistry.

If you have already watched the show, or you're still going to watch it, then I want you to remember this. Suicide is not meant to be consumed as mass entertainment. 13 Reasons Why wants you to think it is.

If you've watched the show, how did you feel about it? Did you read the book beforehand? Let's chat.

Spring Cleaning

Friday, April 21, 2017

Hello! This has been a long time coming, but it's finally here! A rebrand! A new name! A new design! For awhile now, Simply A hasn't felt... quite right. Anyone who reads this blog (hi, hello, yes, you there!) knows that in no way, shape, or form does the word "simple" enter into the calculus of my life. Quite the opposite. (In fact, "Organized Chaos" was another new title option.)

When I started blogging, I had no real idea about where I would go or what I would do with it. I used it as a dumping ground for my feelings (of which there are many), life updates, and occasionally, opinion pieces on mental health, med school, or being married. Ever since GoogleReader died (RIP, GoogleReader), I feel like blog readership has been down, and the days of blogging about nothing are all but gone. To make it big now, you have to have a product, run courses, or work with sponsors. I've written a few sponsored posts here and there, but I certainly don't have either of the other two draws for people to read my blog. Essentially, I'm shouting into the void out here. 

Now though, I am involved in in-Training, an online magazine for medical students, as part of their writing interns for the year. I want to get serious about writing, because if I ever want to actually write that book I keep talking about, I'm going to need to hone some skills. Also, I wanted to narrow the focus of my blog from what was previously described as "life, the universe, and everything," to a few key topics: medicine, motherhood, mental health. 

Of course, I'll also be updating about the baby, general life happens, applications to residency, etc. The driving force though behind this blog are those three topics, though. So, if you have anything you want to hear about, check out the "Say Hello!" contact form on the lower right hand sidebar and let me know! 

I hope you enjoy the new look and feel as much as I do, and as always, thanks for coming around to see the place. Stay awhile!

Motherhood Is Just One Surprise After Another

Tuesday, March 7, 2017

Real talk: I thought I was going to hate breastfeeding.

I can distinctly remember sitting in my therapist's office, hugely pregnant, talking about the creature in my belly becoming an outside baby in the not-too-distant future. The subject of nursing came up, and I said, "I think breastfeeding is great, but I have no desire to feed a human off of my body." My therapist laughed and said that I might change my mind, that when the nurse hands you your baby, sometimes, something clicks. I am 99% sure I actually rolled my eyes at her and promptly changed the subject.

Every time someone asked (which was weirdly often), my answer was always the same. "I'll try it. We'll see." Even when talking to our doula before the birth, I expressed my concern that I might not like breastfeeding, and that I really wanted to start pumping early. I was entirely convinced that I was not going to a Nursing Mom. Full stop.

Spoiler alert: I was wrong. So wrong.

If you read my birth story, you'll recall that I had a very protracted labor, that ended in an emergency c-section. Because I wasn't feeling well, I wasn't able to do immediate skin-to-skin in the delivery room, so it was about 20 minutes before I was able to hold my daughter. I was still a little feverish, I was thirsty, I couldn't feel my legs, and I was exhausted from being awake and in labor for the previous 25 hours. Then, the nurse handed me our baby, and nothing else mattered. Aviva had been trying to nurse since approximately 3 minutes after she was born, including on Ken's clean suit that he had to wear in the OR, and this moment was no different. She immediately started rooting, and all of a sudden, all of my old feelings and worries were gone. I just wanted to nurse this baby. Our doula helped me get positioned and talked me through getting Aviva to latch. I was very fortunate, and this tiny babe was a nursing rock star. And me? I was blissed out. Was it a little uncomfortable? Sure. Was it weird? Yeah, kind of. But it didn't matter. From that moment on, I was hooked.

Over the next couple of days, Aviva and I learned more about this whole breastfeeding thing. My milk started to come in, which was bizarre, but also great. Ken and I went to a breastfeeding class that one of the lactation consultants led each day, and I had a visit with my own lactation consultant every day. Most of the time, things went really well. There was one night that things got a little hairy, of course. It was three in the morning and Aviva woke up and she was hangry. Her tiny, newborn wails filled the room and I hobbled over to the bassinet as fast as my c-section incision would allow. I scooped her up, brought her back to my bed, and tried to get her to latch. She was rage-crying at this point, her little face was so red, and she just would. not. latch. Panicking, I paged the nurse from the room phone and tried to explain what was happening over Aviva's cries... but of course, the nurse couldn't hear me. Moments later, she swooped into the room, an angel clad in navy scrubs, and, for lack of a better word, man-handled Aviva onto my boob. And just like that... quiet. Well, quiet except for the happy nursing noises of a contented newborn. Sigh of relief.

After we were discharged, I was nervous to go home. What if I couldn't get Aviva to latch at home? What if I didn't have enough milk? What if she didn't gain enough weight? What if, what if, what if. Astonishingly, none of that happened. In fact, I had a bit of an oversupply problem and a really forceful letdown, so I spent a lot of time apologizing to Aviva for shooting milk in her face. I had a few clogged ducts every day, so I showered to help work them out, used warm compresses and nursed as much as i could.  (Again, this is the part where I tell you how glamorous motherhood is and then laugh until I cry.) Things were going well until (dun dun DUNNNNN) I was struck down by mastitis. It was the craziest thing. I felt kind of tired and gross, got in the shower, and in the span of ten minutes went from "gross but manageable" to "chills, 102 degree fever, body aches, wishing for death". Oh, and my boob was KILLING me. Fortunately, my OB's office called me in a script for antibiotics and I was able to start them really quickly. Within 24 hours, I was no longer trying to formulate a plan to amputate my breast, and I no longer wished for death. It would have been so easy to give up at that point, but I knew that I would regret it, so onward I pushed.

Before I knew it, days turned into weeks. With the help of our doula, I was able to start pumping in between nursing sessions, so I built up a nice stash in the fridge. It was really important for me to do that because about two weeks after Aviva was born, I had to go back to studying for boards, which meant leaving the house for a few hours every day. Thank goodness Aviva was happy to take a bottle of expressed milk, so long as it was warm-bordering-on-hot, and Ken was more than happy to snuggle her while she ate. Keeping up with nursing and pumping while studying for the most important exam of my life to-date was definitely not easy. Again, it would have been so much easier if we had switched to formula. I wouldn't have had limits on how long I could be out studying, and Ken and I could have split the night feedings. Something inside me was able to help me persevere, though. When I was nursing, everything else melted away, and it was just Aviva and me in our own world.

When I went back to school at 12 weeks postpartum, I was terrified. I was going to have to pump multiple times per day, and I was going to be on a busy, general surgery rotation. On top of that, I was going to be getting up during the night to nurse, then I would be working 12 hour days. This was the hardest thing yet, for sure. It was kind of awkward to have to tell my almost-entirely-male surgical team that I needed to go pump. There was the time I was accidentally let into the incorrect call room to pump (before anyone had found the lactation room and told me where it was), and an OBGYN resident yelled at me and made me cry (those postpartum hormones are no joke). I was exhausted, and there were multiple times that I nearly fell asleep while driving to or from the hospital. And of course, I missed my baby so much it physically hurt. It would have been so easy to give up during that period, too, but the one thing I looked forward to was getting to snuggle Aviva while she nursed, even if that was happening at 11 pm... and 2 am... and 4 am...

And so it went. With every new rotation, a new challenge. Finding a new place to pump, navigating the pumping conversation with a new team of students, residents, and attending physicians, and stressing out about not having enough milk. Some days, I would get to my car and realized that I had been so busy that I hadn't pumped for 7 hours, and so then I started pumping in my car on my drive home. Real talk? I really do not like pumping. But, I do love nursing, so I will continue to pump. At some point, maybe it won't be worth the trouble to me, but I will cross that bridge if and when we come to it.

This is addressed directly to all the moms out there. I will never be a breastfeeding evangelist. I believe that however you want to feed your baby, so long as you aren't giving them Mountain Dew and Cheetos, is great. I know so many women who were made to feel inferior or like failures because they chose not to breastfeed, even if they physically were unable to do so. Being a mom is a hard enough job on a daily basis that the last thing anyone needs is another voice in your head telling you that you're not doing it right. If you're feeding your baby, you're doing it right. If you're breastfeeding and having doubts, maybe my story will help you realize your strength, or maybe my story will remind you that it's okay to not breastfeed, and that it doesn't make you any less of a mother. One of the most beautiful things about motherhood is that there are so many ways to do it.

Lastly, you are doing a great job, and your hair looks really nice today.

*This post was not sponsored by The Honest Company, but it may be featured on their blog as part of  Honest Feeding Stories. I did not receive any compensation for this post, and all ideas and opinions are my own.*

Life Lately

Monday, February 6, 2017

Well, it's been a minute. A lot of minutes. As you can imagine, medical school + infant leaves me precious little time to do anything, including laundry, eating, reading anything that isn't a textbook, and sleeping, let alone blogging. And so, without further ado, here's what's been going on.

Parks & Rec! I know that I'm about 400 years behind here, but man, so good! Ken and I needed something to watch after we finished Jessica Jones, and while we really want to watch Luke Cage and a few other things, we needed something to bring a little levity to our lives. We've been watching an episode or two every night and I am totally in love. I'm also still watching Scandal, How to Get Away with Murder, Law and Order: SVU, and Criminal Minds, and I'm part of the way through The OA. I am not 100% on board with The OA, but I'm giving it a chance. Anyone have opinions about it?

My Kaplan review book for OBGYN, which is about as thrilling as it sounds. I'm also reading The Girl Before by JP Delaney, which is (yet another book) billed as "the next Gone Girl," for whatever that is worth. So far, I am intrigued, although if it ends up to be disappointing, I won't be too upset because I received a free copy of it through NetGalley. I'll be posting my review on Goodreads, so feel free to follow me over there!

For Aviva to go back to sleeping (mostly) through the night. She's getting her first tooth and I think she's in the middle of a growth spurt, so she's been waking up at 2;30 and 4 am to eat, which is super fun when I go to bed at 10 or 11 and our alarm goes off at 5:30 (or 5, depending on where I have to be and when). The answer, I'm sure, is to go to bed earlier, but I'm apparently a terrible adult and cannot get myself to bed before 10. (As I write this, it is 9:57 pm and I am nowhere near bed, so... perhaps tomorrow.) And maybe it's neither the tooth nor the growth spurt, but rather just babies gonna baby, so I am trying to go with the flow. And drink more coffee.

About OBGYN and that I definitely do not want to be an OB. I was about 98% sure that I wanted to do peds, but was semi-prepared to fall in love with OB on this rotation. Don't get me wrong, I think delivering babies is pretty much the actual coolest thing ever, and if I could do just that in residency and as my job, I would be down. Unfortunately, that is not reality, and there is a lot more to OBGYN than bringing babies into this world. Also, as soon as the baby is out, whether vaginally or via c-section, I am over dealing with the mom and want to follow the baby to the warmer and get it all checked out, so I'm pretty sure that means I'm supposed to be a pediatrician. There is part of me that wishes I loved OB, because it's definitely a "sexier" field than peds (no pun intended), but alas, I have to follow my heart and my gut here. Peds it is!

To way too many podcasts to keep track of, let's be real. My current subscription list includes Welcome to Nightvale, Radiolab, Archive 81, Small Town Horror, NoSleep, Sword & Scale, My Favorite Murder, and Lore. I've also downloaded all of the second season of Undisclosed and the entirety of Someone Knows Something, Criminal, and True Murder, but haven't started them yet. Also, I swear I'm not a total creep, I just really love true crime podcasts. I basically have stopped listening to the radio and any music because apparently, I just love having people talk at me while I drive or grocery shop. I do want to listen to the latest Ingrid Michaelson album, though, and I'm WAY into "Shape of You," by Ed Sheeran... but if the radio and every single public location continues to play it every 27 seconds, I'm going to be over it RULL FAST.

On not losing my goddamn mind thanks to the 24 hour news cycle. None of this is normal and none of this is okay, and at least 4 times a week, I ask Ken if he thinks we're going to be nuked off the face of the planet by Iran/China/the latest country our illustrious leader has pissed off this week (Australia? REALLY!? It's Australia!) But seriously, I have a lot of anxiety about this and I'm a cis-gendered, heterosexual, middle-class, white lady, which means that, as Pam reminded me, "You're white. You're like, 4 rungs up from me. Doom spiral about something smaller than the constitution." (This conversation then turned into how I am anxious about strange things like the Grand Canyon, pinatas, and really large fish.... don't ask.) Anyway, I'm trying to walk the fine line between remaining engaged, realizing my privilege, and utilizing it to combat the injustices of the world.... and also remaining sane and not defaulting to "the world is ending, I am never leaving my house, where is my tinfoil hat" level of batshit-bananapants-bonkers. I'll let you know how that goes.

My monologue for my school's production of The Vagina Monologues, which is being performed this week! Shameless plug:

Who: The amazing women of Rowan School of Osteopathic Medicine
What: The Vagina Monologues
Where: Rowan SOM, Academic Center Auditorium
When: February 8th at 7:00 pm
Why: All proceeds from ticket sales will benefit the Camden Center for Family Services
https://www.centerffs.org/ )

This is the third year I've performed in the show, and every year, I am so impressed with everyone's talent. In a related story, I've been practicing applying the perfect red lip for this occasion.

.... my life? For one, trying to get this blog back up and running is on my to-do list but is proving more difficult than planned. I am also trying to organize all the crap I need to get done for audition/away rotation applications, as well as early prep for residency applications. I'm also helping to plan V's baby shower, which is more fun than work, and there's the endless task of trying to keep my house organized while being a full time med student and mama who also occasionally eats, sleeps, and leaves the house to do things other than go to the hospital or school. Let's just say... it's an uphill battle. 

Aviva, duh. She is 7 months old now and still remains the best thing ever in my whole life. I have posts detailing the first 6 months of her life and motherhood that will be published um.... eventually. Until then, here is a photo of my darling girl from her 7 month photo shoot:

And with that, I'm off to bed. With any luck, I'll be unconscious by 11:30 and I'll get to sleep until 5... but that's unlikely, so if you happen to be up at 2:30 or 4, Aviva and I may be around. 

What have you been up to lately? Fill me in!

PS: As usual, Chrystina's post about verbs and emotions to use for "currently" posts was extremely helpful!

Pregnancy Retrospective: A Birth Day

Sunday, October 9, 2016

Now that our darling girl is 3 months old (WHAT?), I suppose it's time to write her actual birth story. It makes me smile that almost exactly a year to the day that I found out that I was pregnant, I'm writing the birth story of that same baby. Here we go.

June 19th came and went without so much as a real contraction. Ken and I had plans to go to Ocean City that day, but I was just too tired to walk more than 5 minutes at a time, and it was HOT. Instead, we opted to do what any sane adults on the cusp of parenthood do; go see a Pixar movie. Obviously. After I obtained my required popcorn with extra "butter", we settled into our cushy, reclining, seats in the most deliciously air conditioned theater and prepared to watch Finding Dory.

(Note to self and all pregnant ladies, Finding Dory is very emotional and has lots of parent-related feelings and I cried... so you might cry, too. Ken only made fun of me a LITTLE bit, so at least there's that.)

In the days leading up to THE BIG DAY, I kept people updated on Facebook with the following statuses:

June 13th - Still pregnant. Send popsicles. Or watermelon. I will accept either.

June 14th - State of the Alison: Still pregnant

|June 15th -
Returns shipped ✔ License plates acquired ✔ Health insurance BS sorted 
 Still pregnant ✔ Next: Grocery shopping, Old Navy returns, maybe a pedicure?

June 16th - Late-breaking update: Still pregnant. Have attempted acupuncture as a way to possibly get things going. No signs yet. Contemplating making a key lime pie

June 17th - Captain's Log, Day 278: Still no sign of Baby Girl. Have eaten copious amounts of ice cream. That second part isn't really related, but it happened.

June 18th - State of #TheNotoriousBGB: Still contentedly hanging out in her uterine lodging.
State of the Womb-Haver: Very hot. Have made a trip to Lowe's and a thrift store for kids' stuff. May acquire water ice.

June 20th - For those playing the home game, still pregnant. The #NotoriousBGB is clearly on her own schedule. Eventually, she'll be evicted, but not today. Until that time, lots of Netflix, walking, and ice cream.

On June 20th, I had a scheduled OB check-up, during which I had my doctor attempt a membrane sweep. (TMI WARNING). "But Alison, what is a membrane sweep?" you may be asking. Well. It's when your doctor (midwife, nurse, whoever), inserts a finger through your cervix (ow) and sweeps it around (ow ow) to attempt to separate the amniotic membranes from the side of the uterus (ow ow ow). This causes a local release of hormones that can often induce labor. I knew it wasn't going to be fun, but hearing my OB tell me that he wasn't going to stop until I said "STOP," and would be ignoring all other sounds or words I said during the procedure did not inspire in me a feeling of calm. He ended up only being able to do the sweep for less than 30 seconds because I was going to crush Ken's hand, but the good news is that I was almost 2 cm dilated. The bad news is that I was 0% effaced. (Effacement is when your cervix shortens and thins out to prepare for labor. 0% effaced means no change, 50% effaced means the cervix is half of its normal thickness, 100% means the cervix has thinned out completely and just the uterine opening is there. Being 10 cm dilated and 100% effaced means you are "complete" and THINGS ARE HAPPENING.) After that, I scheduled an induction for June 27th, silently prayed that I would not still be pregnant by then, and away we went.

The rest of the day was uneventful. Lots of walks were taken. Lots of ice cream was eaten. Lots of sitting on the couch, talking to the bump, telling her it was time to come out. Finally around midnight, I started having some semi-regular contractions, and by 1 am, I was definitely sure that things were happening. My contractions were 12-15 minutes apart, and only about 30-60 seconds long, so I knew it would be awhile before we would have to head anywhere. I was having a lot of back labor since Baby Girl was still "sunny side up", so lying down was extremely painful. I told Ken to sleep and spent the next 5 hours on the sofa, half-sitting, half-lying down, sometimes walking, sleeping in between contractions. I hung out with the cats, texted my mom, and talked to Baby Girl. At 6:30, I woke Ken and said that it was probably going to be time to go in a few hours. At 7 am, I called Lee (our doula) and she talked me through a few contractions. Since they were still about 10 minutes apart, she told me to eat, shower, stay hydrated, and let her know when we were heading to the hospital. At 8:30, Ken decided it was time to go since he was worried about traffic, and so we packed up the car and started on our journey to Pennsylvania Hospital.

The commute to Pennsy takes about 45 minutes on average. I think that morning, it took 93 days. Every bump made me want to cry. I squeezed Ken's hand the entire ride, so major props to him for driving to Philly with one hand on the wheel for 95% of the time. By 9:30, we were upstairs in the triage waiting area. The nurses made me fill out some paperwork (note to self: FILL OUT THE DAMN PAPERWORK BEFOREHAND NEXT TIME), and I was shocked that I could even sign my name because I was so tired and not focused on the task at hand. Our nurse got me into a hospital gown and hooked me up to the monitor, and then a resident came in to check me to see where we were. I was still only 2 cm, but I was 70% effaced. Active labor is considered to be after 6 cm, so I was nowhere near that, and my contractions were only 5 minutes apart. I think they were about 27 seconds away from sending me home, but then Baby Girl decided to give us some excitement and her heart rate dropped... so they admitted me because they wanted to induce me.

Pause: I hadn't written out a "birth plan," per se, because I kind of believe that writing out a birth plan immediately guarantees you a c-section. Also, my plans were so generic. They were, "Avoid being induced, avoid c-section, labor as long as I can without an epidural, get an epidural when I wanted it, have a healthy baby." So, right away, less than 24 hours into this extravaganza, I was having to give up on my "avoid induction" plan. Could I have refused the induction? Sure. But then they would have sent me home and since BG was showing some signs of distress, I would have been freaking out. I agreed to the foley bulb insertion (to get me to 4 cm) and to be started on pitocin (synthetic labor hormone), with the idea that hopefully, my body would get the memo and we could remove the interventions once things got going.

(Ha, I'm adorable.)

By the time I got over to Labor and Delivery, I had gone from 2 cm to 4 cm, so no foley bulb (yay!), but they started an IV for a low dose of pitocin. I called Lee to let her know what was going on and that she didn't need to come over yet because I wasn't even in active labor. She was in the neighborhood, so she said she would stop by and see how I was doing. She got there around 11 and ended up staying because my contractions were getting stronger and I needed support. Because I was on pitocin, I had to stayed hooked up to the monitor, which meant no wandering the halls or getting in the shower, which made me sad. (Cross those off of my labor plans/desires...). Fortunately, I was allowed to get out of bed, walk around my room, and sit on the labor ball, all of which helped a lot. I labored with Lee and Ken until 3:30 or so, and it was rough, but manageable. Breathing, counter-pressure and massage, heat, and walking helped me get through each contraction, which were about a minute long and 5 minutes apart. Without Lee and Ken, I would have been a disaster.

At 3:30, my nurse and a resident came back to check me again, and I was 4 cm and 100%. BG's heart rate was still not ideal, so my OB wanted to break my water to move things along. I went back and forth on this, but in the end, decided that it was a good idea, since my body didn't seem to be getting with the program by itself. The actual rupturing of membranes didn't hurt at all; it was just messy. We also found out at that point that BG had gotten a little over-excited and pooped, as there was meconium (baby's first poop) in the amniotic fluid. As you can imagine, this is not ideal, as baby is still "breathing" amniotic fluid, so breathing poop isn't great. And so, do not pass go, do not collect $200, the NICU team was now invited to our delivery in case any poop was aspirated during the birth.

After my water broke, shit got REAL. My contractions were more intense, about 3 minutes apart, and almost 2 minutes long. There was yelling. There was crying. There was a lot of, "I can't do this, I can't do this, I can't do this," while I rocked back and forth on the labor ball, bent over into Lee's lap, while Ken rubbed my back and pressed warm compresses into my sacrum. Around 6:30, I asked for an epidural. Knowing that I had wanted to labor for as long as possible without an epidural, Lee reminded me, and asked if I wanted to have the doctor check my cervix again to see if I was close. We all figured that since labor had been so intense for the last three hours that I must be close to transition.

... I wasn't. I was still only 5 centimeters.

I couldn't even contemplate continuing what I had been doing for the last three hours, knowing it could be hours and hours more until I was ready to push. I needed the epidural, and I wanted it NOW. Of course, I had to wait about 20 minutes to get more IV fluids and for the anesthesiologist to arrive. I wasn't allowed to get out of bed and walk around or get on the ball at this point because my nurse was having trouble keeping the baby on the monitor, so I had to lie in bed, which was torture. I was having a lot of back labor, and every contraction felt like it lasted forever. They came on, one after another, with barely time to breathe between them. While we were waiting, I ended up getting sick and throwing up all over the floor, and then thought I had peed everywhere, but it was just amniotic fluid. Never in my life have I cared less about my dignity as when I was sitting, nude on the bed, soaking wet, crying, apologizing to the nurse (who kept saying that I didn't have to apologize), trying to get into a hospital gown, trying not to throw up. (This is the part where I tell you that pregnancy and birth are so magical and glamorous and you simply must cherish every moment, and then I laugh maniacally.)

Once the anesthesiologist arrived, things happened quickly. I swear that she had me prepped and had that epidural in within 5 minutes, but Ken maintains it was longer than that. I didn't care; I would have proposed marriage to this beautiful, amazing, pain-relieving angel if I wasn't already married (And if that wouldn't have been totally weird and also unethical for her. Details.) I feel bad, because I forget the name of the nurse who was taking care of me at that point (we had a few throughout our stay in labor and delivery), but without her, I would not have been able to sit still and get my epidural. I was starting to freak out and she basically grabbed me by the shoulders and said, "LOOK AT ME. LOOK RIGHT HERE. You are amazing! You are determined! You are strong!" and she coached me through contractions while I sat as still as I possibly could, knowing there was a giant needle in my spine.

And then... relief. Magical, wonderful, blissful, pain relief. I sat and watched the monitors as my body handled contraction after contraction, but now I could sit still and not scream and know where I was in space and time. It was odd. After a couple of hours, Ken went to get dinner and when he got back, we told Lee to go home and rest and that we'd call her when I was closer to pushing. That was around 9:30. Ken took a nap, and I tried to nap. Instead, I started having incredibly bad breakthrough pain, and the anesthesiologist had to come back to my room twice to bolus me with pain meds. Then, I spiked a fever. And the baby's heart rate was too high. And then I threw up again. I was having so much pain and pressure that I couldn't get away from, it was torturous. One of the OB residents came back to check me again since I was feeling a lot of pressure, so the team thought I must be getting close to pushing.

I was barely 6 centimeters.

At this point, things are a little fuzzy. It was 1 am. I had been in labor for 25 hours and my water had been broken for 9 hours. I had a fever. My OB was actually the physician on call that night, which was nice, because there were at least 17 different doctors who could have been on call. He came into my room and asked how I was doing, and then told me that he had been trying to give me as much space as possible to have this baby with as few interventions as possible, since he knew that was what I wanted. But... the time had come. Her heart rate was too high, I had a fever, and now there was some blood in the amniotic fluid, so he was concerned about a placental abruption or an infection. He suggested it was time for a c-section. I immediately consented, because I just wanted our baby to be okay. I woke Ken and told him what was happening, and then I called Lee and told her I would be heading back to the OR shortly. By 1:30, I was being wheeled back, and Lee met Ken in our room.

As I lay on the table while the OR nurses prepped me and the room, I tried not to think about the fact that in mere moments, my abdomen would be incised and stretched open to accommodate removing a human from my body. I chatted with the anesthesiologist and waited for Ken to be brought back to the OR. My doctor and a resident came in and made sure I was numb, and then it was go time. There was a lot of pulling and pushing and pressure, and I listened as my OB talked to the resident, pointing out anatomy and guiding technique. It was kind of surreal, knowing that right now, I was a patient, but in a few months, I could be standing on the other side of the drape, assisting in the same surgery I was undergoing.

They had told us before they started that our baby wouldn't cry right away because they wanted to suction her fully to make sure she didn't aspirate any meconium. The neonatalogy team was there to check her out, just in case, too. Before she was born, my doctor announced that it was time, and that she looked like a pretty big baby! Then, they took her out, and the first thing someone said on the other side of the drape was, "You're covered in poo!" We all laughed, and they held her up over the drape so we could see her. She was, in fact, covered in a greenish-brown sheen, and she had a look on her face like she knew she was covered in her own poop, too. She was quickly whisked away to the warmer, and even though it was just a few seconds, it felt like an eternity until her tiny wails filled the room. I exclaimed, "Happy birthday, baby!" and tears filled my eyes. I kept craning my neck to see if I could catch a glimpse of her on the warmer, and I started to get really anxious because she was suddenly quiet. I asked if everything was okay, and the pediatrician replied, "Yup! She's just checking everything out!" Ken went over to take some pictures, and he showed them to me on his phone when he got back. Once she was cleaned up a bit, they swaddled her up and handed her to Ken. I wanted so badly to hold her, but as my abdomen was still open for the world to see, I had to wait. Meanwhile, Baby Girl was busily trying to nurse on Ken's "bunny suit" scrubs (no actual bunny ears or tail, just a pull-on "clean suit" for the OR). Honestly, I don't really remember what happened after this or how long it took to get back to recovery. All I knew is that our baby was here and healthy and just like that, we went from being Ken and Alison, to Mama and Daddy.

First family portrait!
In recovery, I got to hold our baby for the first time. I looked into her chubby little face, and marveled at her tiny hands and feet. Her eyes, large and blue, were open and she seemed to be taking it all in. She also was hungry. VERY hungry. With the help of Lee and my recovery room nurse, I was able to nurse her, and she latched on right away. I really, really, really wanted water and ice chips, but they had to wait to make sure I wasn't going to have to emergently go back to the OR for any reason. By the time we were taken up to our room, it was 4:30 in the morning. I was exhausted and thirsty and sweaty and gross, and I just wanted to sleep. As the sun came up over Philadelphia, we stared at this tiny, new, human and picked out her name. And then, for the first time as a family of three, we slept.

Aviva Jane, our Rainbow Baby
7 lbs, 8 oz, 20 inches long
100% perfect

From Facebook:

Finnal state of the womb address for this term: Aviva Jane is here! Born via semi-emergent c-section on 6/22 at 2:26 am. Ken and I are overflowing with love, and we can't believe this tiny miracle is ours. Thank you to EVERYONE who has called, emailed, texted, visited, sent congratulations and good vibes... you are all the best. We can't wait for Aviva to meet the people who have been waiting for her and loving her since day 1!! 

Pure bliss

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