My Plus Size C-Section with pictures

When researching information about the c-section procedure, I realized there wasn’t very much out there specifically for the plus size folks. Which means I am going to step a ways outside of my comfort zone and focus on a part of my body that I have had the biggest love hate relationship with since entering puberty, my stomach.

Disclaimer: photos show post-op body

More specifically, I have what is commonly referred to as an Apron Belly. The medical term is Panniculus: a sheet or layer of tissue. The term panniculus is most commonly used in the lay press to refer to an abdominal panniculus adiposus, a sheet of fat tissue that is present in the lower abdominal area. An abdominal panniculus may be seen with obesity, following pregnancy, or after significant weight loss. In severe cases, the fat layer may appear to hang or be suspended and reach the level of the knees or lower.

My apron belly is the result of a combination of things, including: PCOS, obesity in my early 20’s, losing over 40 lb more than twice, and multiple pregnancies. The C-section incision is made just above the pubic area so I was concerned with how my stomach may get in the way during surgery and how I would keep things clean and dry post-op. I was able to discuss most of those concerns pre-op with my OB and prepare accordingly.

During surgery I had what we referred to as “belly suspenders”. They were two adhesive anchors that attached on my lower abdomen. These anchors were connected to long straps that went up over my shoulders. This effectively kept the apron belly pulled up and out of the way to keep the surgery site without any additional obstacles.

It is common to have a reaction to the adhesive used with the strap anchors. Thankfully, the placement and removal happens once you are fully numb. I had a reaction, more so on more side than the other, where my skin was bright red and blotchy for several days.

April 22nd

The other portion of my concern was specifically about hygiene post-op. How was I supposed to keep the incision area clean and dry? After talking to a few nurses, reading too much information, and watching several YouTube videos trying to find the winning combination, it came down to trying my hand at a few options to see which worked best for me.

Initially we went with 4 inch gauze. It was kind of like origami where we would unfold it one way, then fold it in half the other way. This would effectively transform it from a square to a narrow rectangle. Then we would place it against the incision and pin it in place with my belly and underwear. I say we, because the nurses and Brandon helped me with this in the hospital and through the first week at home.

In the hospital, a combination of things would happen when the gauze was replaced as it was the perfect opportunity to have access to the low abdomen. The nurse would do a fundal check/ massage, check the incision, and check vaginal bleeding. At the tale end of that check is when the gauze would be replaced.

Once I was moving more on my own, especially making solo trips to the bathroom, it was time to try a different approach. I had read somewhere that one mama was using a pad. The only problem was how to ensure a gentle edge. I took a panty liner, folded it in half along the length and removed the backing so it would hold its shape. Then I placed the folded edge against my stomach to make sure there were no sharp edges. Because the panty liner keeps its shape much better than the gauze, it made it doable for me to place on my own. This also gave me a good opportunity to document and keep an eye on my incision as it heals.

May 2nd
May 7th

I intend to continue documenting my recovery process and plan on doing a follow up post in a month or two. It is my hope that this information helps another mama going through a plus size belly birth, to do so with comfort and confidence.

C-Section Postpartum Recovery – Remainder of Week 1

As we left the hospital in a rush on Wednesday afternoon, lunch was also on our minds. Brandon pulled over briefly and I put in an order for each of us from Chi’lantro for pick-up. This is where I made a big mistake. Gas can be painful at the best of times, but if you have no abs, pain meds have worn off, and the internal pain of having a c-section… gas can be down right debilitating. I had been warned to avoid gassy foods, and still I couldn’t resist the house made kimchi. I paid dearly for that choice later in the afternoon.

The next stop was the pharmacy to pick up all of the prescription meds the Doctor had called in for me. As soon as meds were in hand I took my mid-day dose, a mere hour and a half after the time I should have taken meds. I also received a small emergency prescription for Oxycodone in whopping 5 mg tabs. Yes, I am being sarcastic. Ultimately it was prescribed in the event that I needed an extra helping hand to cut the edge. You better believe I included one of those to help catch back up. Once we got home with food in our bellies, it was time for a hearty nap.

From that point we kept pretty on top of my medication regiment of every 6 hours. One thing that made it much easier, especially for the middle of the night dose, was to prep the next dose in a plastic shot glass. That eliminated fumbling around half asleep or missing a med and made it easier for me to take. Brandon had alarms set to make sure meds were taken on time, it was a lifesaver.

Part of mobilizing the set up

Brandon kept in touch with our friends and went to pick up the girls after our nap. It was such a blessing to know they were in good hands and having a blast over the past few days. Another bonus was that all three kiddos (ours and theirs) were all virtual students on nearly identical schedules. Even though the girls were hoping to get out of school, it was good for them to maintain that routine.

Thursday was my first full day home. There was something about being in a home environment instead of the hospital that played some mental games and I quickly found myself struggling to be a good patient. I got out of bed on my own at least three times and it is Not the same as the hospital bed with its amazing stand assist button. My discharge papers also said that if I wasn’t able to have a bowel movement after 2 days home that I would have to call so I was trying to make that happen. Bearing down was another bad idea as it put a lot of strain on my shattered innards. By the end of the day I was a mess and asked Brandon to not leave for errands until I was more capable of moving around on my own. I asked him to please have a delivery service like GrubHub, DoorDash, Shipt, or InstaCart bring what we needed to the front door. What a blessing that those services exist now!

Friday I was very muscle sore from way overdoing it the previous day. I tried to be a better patient and ask for help. There were a couple of times where I found myself thinking about trying to get away with not bothering anybody, then I’d pause and reevaluate as if I was the caretaker in the situation… fiiiiiiiine I’ll text for help. That process got a little easier each time but still felt foreign and a little uncomfortable for me. It helped a lot to be able to text though because I discovered that a hearty yell was pretty uncomfortable. That evening I carefully made my way out to the couch with Brandon’s help for a family movie. It had been a while so that was a nice moral booster for me and Brandon. The girls didn’t grasp how big of a deal it was but they were glad to see me out in the middle of the home.

Saturday I continued to take rest seriously ended up getting in a few good naps through out the day. On Sunday swelling started to go down quite a bit, thank goodness. My hands, feet, face, and hips were all very swollen from a combination of my body healing from surgery and all of the fluids pumped into me. It was a relief physically and to look in the mirror and start to recognize myself again. I continued to take it very easy and kept my feet up whenever I was on the couch or in bed. Another thing I did to help combat swelling in my hands was to reach up above my head, then open and close my hands several times.

Speaking of couch and bed, I thought it’d be helpful to share what my set up was for each station. Thankfully, my pump is very mobile (big part of why I chose it) so I had two main set ups depending on where I was spending the majority of my day.

For the bed, I got a relatively firm husband pillow with a removable neck support that I would put forward or more on top depending on my position. For sleeping, Brandon or I would prop it into a drastic reclined position and put two normal pillows under my legs (one each under knees and feet) so I could sleep in a similar position to the hospital bed. This was a BIG lifesaver for fresh milk boobs and an incision. Side laying was out of the question with all of that swelling going on so I am very thankful I had a supportive option to sleep reclined in bed. Brandon also got me a single step stool so I could get in bed easier with his help by being a little taller than the bed as I sat down instead of climbing up.

More upright for sitting
Reclined for sleeping

My sweet friend brought me another husband pillow that is super soft and cozy and quite a bit smaller than my big guy in bed. It ended up being perfect for the couch. I was able to use it facing forward with my feet on the bench or sideways and my feet stretched out on the couch. Quickly, my preferred pumping station became the end of the couch with all of the things lined up on the bench and side table. There was a rope basket from another dear friend that became my snack station. I also had a bin of meds and wipes, a cozy blanket, and of course, my pump. My hospital water jug continued to get a lot of use and followed me wherever I was set up. There is something about the good sized straw and clear body that encourages me to drink the copious amounts of water my healing lactating body needs.

C-Section Postpartum Recovery – Remainder of Hospital Stay

After having successfully taken myself to the bathroom several times and being unhooked from IV fluids the next milestone to reach was the removal of my IVs. I was told that Laboratory was going to make a room call to collect some blood. They needed to test for signs of internal bleeding. If those numbers came back good, then the IVs would be removed. I thought how handy that I already had holes to choose from… but no, the lines couldn’t be contaminated so an actual fresh blood draw had to be done. I updated our group chat afterwards that I was officially “holey”.

This was also about the time that Brandon had to run off for an appointment. His second COVID-19 vaccination, which had been booked a month prior, was scheduled for that day. Thankfully, he didn’t have to drive a crazy long distance. The timing was a bit of a gamble but after several attempts to get through to reschedule the appointment and everything kept coming up cancelation, Brandon decided to take his chances of having an adverse reaction and keep the appointment. A huge praise was that he did not have any significant reactions to the Pfizer COVID-19 second vaccination. Allergens were pretty high so he had a hard time telling which was responsible for the effects he did feel the following day, similar to my second dose when I couldn’t tell the difference between pregnancy symptoms and vaccine.

Andrew volunteered to get lunch for all of us from a new to me place called Cabo Bob’s. It was delicious and quite a treat after my breakfast. We all had a family style meal and hang out in my room again, which was really nice. It threw the staff off coming into a room with more than a couple of people in it. Several times I would point out who was who so they knew how we all ended up in the same space. I can only imagine after more than a year of strict no visitor policy that it was pretty disorienting to see a gathering of any size. Raleigh was a little fussy and I asked to hold her. Soon after getting her to my shoulder for some back pats, she spit up. Oh well, the shirt wasn’t worth fussing over so I said to finish eating and not worry about it.

Dr Evans stopped by to check on me during the afternoon. She was very pleased with the way everything went and that the right decision was made. She checked on my incision and went over the red flags to keep an eye out for once I got home. Specifically, I was to call in right away if we noticed any red, weeping, or odor coming from the incision or a fever of 100.4 or greater. It was overall a really good visit.

Later in the afternoon I got both of my IVs out. Woo hoo!

All through the day I would nod off for a nap shortly after pumping and/or hand expressing. I went in to this hospital stay thinking I was going to have plenty of time to work on my blog and write thank you notes to staff, but my body had other plans. Rest and work hard on healing. Can’t argue with that.

That evening I was cleared to take a shower. Always a good thing to be able to wash off the funk. I took the shower by myself. In hindsight, I probably should have had some help or at the very least a reminder to not twist in any way. After putting on clothes, such a comforting feeling, I worked on getting a belly binder on with the help of Brandon and the nurse. My hope was to get some added stability from the binder and to go shuffle the halls with Brandon. I called it our turtle stroll.

About this time is when my pain level was spiking. I likened it to a two-day sore after an out of line intense workout. It was getting pretty darn uncomfortable and I was strongly considering the emergency pain relief option of Roxicodone. At this point my pain was being controlled by Ibuprofen, Tylenol, and Gabapentin (for nerve pain). In the end, I decided to try to rest while Brandon went to get a celebratory Sushi dinner for us to enjoy together from Tomo.

It was a fairly peaceful night with minimal nurse visits and only one hand expression session from me. The sleep was much needed and appreciated. After the morning shift change (changing of the guard) I ordered breakfast and waited for Brandon to join me again for the day. My day nurse was the same for Tuesday and Wednesday, Faith. She stopped by shortly before Brandon returned and said that I had already marked off all of my requirements for discharge and that the Doctor had filled out my orders so that whenever I felt ready to go home, to just let her know. There was no rush to me leaving.

I decided to wait until my next round of meds and make our way home afterwards. This was communicated to my team and agreed that was a good plan. The other most common piece of advice I had come across was the importance of staying on top of medications and not to let them lapse. I figured this would buy us some time to pick up prescriptions, and maybe some lunch on the way home.

Brandon and I gathered up our personal belongings in the room. I wrote out a few thank you cards for my amazing medial team. We double checked the room for phone chargers and the like. Then we walked down to Whitney and Andrew’s room for a change in scenery and to get in one more visit.

We headed back to our room shortly before 12 pm so I could go to the bathroom and do one more sweep of the room to make sure we were ready to go because my meds were due around 12:30. At 12:45 Faith came in our room to tell me that unfortunately she could not administer any medication because the discharge orders were for 12:05 pm and no more meds could be distributed on my behalf because the system no longer recognized me as a patient. Ummmmmm,,,, OK, time to go, like an hour ago. I told Faith we’d be ready in less than 5 minutes because we had already done the majority of our prep. I wasn’t upset at any particular person, more anxious about lapsing meds that long and the fact that had we known about the discharge time, we easily could have left in time for me to stay on track.

Brandon headed out a few minutes before me to take the bags to the truck and to pull around to the circle drive where I would be wheeled out in a chair. There was a wheelchair parked outside of my room that I went ahead and sat in until Faith came to shuttle me downstairs. We made a brief pit stop at the nurses station to cut off my medical bracelets then continued through the hospital maze. As we passed the NICU nursery window, there was a couple there looking through the window at their baby. The mama saw me being wheeled out with an empty lap and gave me a sweet but sad smile. I didn’t pay attention to a whole lot else during my ride as we were chatting away about surrogacy. With Brandon’s help I hoisted up into the truck. Seatbelt… how on earth are you supposed to navigate that with milk coming in and a lower abdominal incision?

The end of the hospital stay was a rather abrupt “peace out!” Thankfully we had already done all that prep and gathering so we could just pick up and leave, otherwise there’s no telling how long I would have lapsed between meds. As it was, I took my next doses at 2:00 pm, an hour and a half after I was supposed to. That also meant that I very much felt the bumpy ride home.

C-Section Postpartum Recovery – Fresh 24

Recovery

Brandon followed me and was able to stay with me every step of the way. After surgery I was wheeled into the Post-Op Recovery area. It reminded me of ER bays because they were curtained off “rooms”. We were the only ones in the area for the first hour or so which was nice and quiet. After that point, I could hear other patients start trickling in to the other bays.

Once my bed was in its parking spot, Nicole lifted the head of the bed so I was in about a 45 degree sitting position. Three EKG leads were stuck in their various locations on my chest and they remained attached for the time I was in the recovery bay. I also had a blood ox monitor on my finger for a while and still had my blood pressure cuff. [Side Note: The white blood pressure cuff was opened when I first arrive in Pre-Op and was the same one that was used on my for the duration of my hospital stay.]

This was about the point that I got to have an in-bed wardrobe change from paper to cloth gown. It’s the little things, ya know? When I took off my hair net I found my mask, it had been tucked away for safe keeping. We were told that as long as we were the only ones in the room/area, we could lower our masks. That was nice. It also meant we did the mask scramble quite a few times through out our hospital stay.

Through out my time in Recovery there were regular checks on my vitals, incision, vaginal bleeding, catheter, and fundal massage to keep an eye on uterine shrinking. I was also able to have ice chips and a little bit of water while in Recovery to test if I was going to keep down oral fluids or not. I had a sick bag on the bed and a collapsed one in the pocket of my gown, just in case.

A very awesome, and honestly probably the best one I have encountered, Lactation Consultant came by. She helped me learn the in-hospital breast pump, how to set myself up for success at home, and how to hand express colostrum. We determined that I would pump and/or hand express every 3-4 hours so as to create a demand but not alert the system to feed the entire neighborhood. She had Brandon do some hand expressing while I was pretty out of it. I made some jokes about getting to play with boobs, but really it was helpful to have 4 hands because we had to collect the colostrum with a little syringe as it beaded up on the surface of the nipple. It took one or two hand expression sessions before I had enough to start collecting and sending down to Raleigh. I’m so glad that I was able to get some of that liquid gold to her while in the hospital.

Typically, the goal is to be in the Recovery area for about 2 hours. Around 12:40 pm we were wrapping up checklists and expected about 20 more minutes until moving to our Postpartum room. We were given our room number and everything. Then we found out that Nicole was told to take her lunch, even though she tried to say not yet. It just meant that Brandon and I hung out a little longer before moving for reals.

During this time I started to get more feeling back in my legs. It was such a strange sensation! Feeling came back slowly from the hips down. When I got feeling back in my thighs, I was able to wiggle my legs. It reminded me of when you pull your arms inside of a sweatshirt and flop your sleeves back and forth. But I kept moving them every now and then and thinking this does not look like what my brain is telling me. Brandon said my legs were probably in a different position as the last of the feeling went out of them so my brain was trying to pick up where it left off which is why it felt so strange. I made several Princess Bride references “hey look, you just wiggled your little finger, that’s great!”

Postpartum

Around 1:30 pm I rode the halls in the hospital bed over and all around to the Postpartum (PP) wing. Once we got there, the bed I was in was aligned with the PP bed and all of the railings were lowered. As this was happening I got feeling in my toes! I made a big hooplas about it because it was the last extremity to come back… and just in the nick of time too. Nicole and Gianna (PP nurse) asked if I could carefully crab walk over to the PP bed. Somehow that was no big deal. There must have been just the right combination of numb and feeling to get the job done without pain. This was the part where Nicole went back to L&D and my care shifted to the PP nurses.

My goals were to get up and move, pain management, and Eat! I was soooo hungry. I don’t even know how many times I asked when I’d be able to have food. Thankfully, having the ice chips and water in Recovery meant that I could move on to the clear liquid diet which included Jello. After an hour or so of keeping the Jello down I moved on to the full liquid diet. Unfortunately for me, most of the food items available in both the clear liquid and full liquid diets were dairy so I was pretty limited on options. For my full liquid diet, I selected oatmeal (it was blended smooth and made with too much water), hot tea with honey and lemon, and a glass of soy milk. Originally I was going to put the milk in my oatmeal until I saw how runny it was, so I took a few sips instead.

I had to make it through the progressive reintroduction of food, keep it down, and pass gas before I could graduate to solids. The kitchen stopped taking orders at 7pm and dang it, I really wanted my post delivery tuna salad sandwich. My super awesome nurse said that as soon as I passed gas she would immediately change my diet restriction and personally come give me a high five. Brandon also promised a high five. Haha

Who knew farting could be so exciting?! I almost didn’t say anything out of habit when I did finally pass my first gas bubble, then I went “oh! Babe!” And promptly called the nurse to get upgraded to solid food in time to place an order with the kitchen. Everyone was just as excited for me to reach solid food too, because we were going to get some real food and eat together in my room.

Liquid gold
Celebratory tuna salad sandwich

The next milestone to hurdle was the removal of my foley catheter. It had to remain until I was monitored in PP for a minimum of 6 hours and another 5-6 hours after removal is when the nurse would help me get to the bathroom for the first time. I had heard from so many mamas and healthcare professionals how important it is to move your body as soon as you are able. Nothing crazy but get up and move your legs a little bit, go to the bathroom, move about your room, etc. Which meant I was determined to check off those boxes.

We had determined in advance that Brandon would go home overnight. The little guest bed situation in the hospital is not the most comfortable and I knew that if he was more rested he would be of better assistance to me. An added bonus to having him home at night was it meant he could take care of the morning feedings for the animals and he could pick up coffee on the way back to the hospital for all four of us.

Shortly before trying to get some sleep, the nurse checked on me. I asked about the itching sensations I was experiencing. The bottom half of my face, nose especially, hips, and belly were driving me crazy and I kept catching myself absent mindedly scratching. She said it was a side effect from anesthesia and asked if I would like Benedryl to help get some more comfortable sleep. I was worried the itching would keep me up, so I accepted the offer.

I was not prepared for how difficult it was to pee after having a Foley catheter removed. It makes sense once you find out how a Foley catheter functions. The bladder and urethra were swollen which dulled the sensation significantly. It took two lengthy tries involving running water, a peri bottle, visualizing, relaxing, etc. Still no dice. So they brought in this neat ultrasound machine that reminded me of calibrating joysticks on a game console. There was a circle on the monitor and once all 4 quadrants of the bladder had been scanned it let us know if the contents were low or high. Mine read low, so my IV line got hooked back up to fluids. After a little while longer of being pumped full of fluids I finally was able to pee in the toilet. I was told that I would be allowed to get up to go to the bathroom on my own after two successful trips with a nurse and measurements in the “hat”.

It was during all of these trips to the bathroom that I discovered the stand assist button on the bed and the hanging control panel. It wasn’t lit up like the other button so at first I mistook it for only being a little diagram. If you press and hold the button, it lowers the bed, flattens the leg portion back out and sits up the back rest. Essentially, it sets you up for success and ease of getting out of bed on your own. I miss that button. *sigh* Fun note, I taught at least three nurses about the button too.

One thing that I was given by the nursing staff was a little cough pillow made by a volunteer organization. What a thoughtful and useful item! It is called a cough pillow because when you are recovering from abdominal surgery, coughing and sneezing especially hurts and is really jolting to the system. If you feel one coming on, you press the little pillow into your incision area for counter pressure and to keep things held together.

Brandon came back with coffees in hand around 9:30 am. We were all very appreciative of that delivery and just in time for Raleigh to officially reach 24 hours old. The waiting period leading up to having a baby always feels so drawn out and then its like the clock is sped up once they are born. How is that so? Never ceases to amaze me.

Right about the 24 hour mark, an anesthesiologist stopped by to check on me and see if I had any questions. I asked when the itching would go away and he said that it should pass pretty soon because it typically doesn’t last past 24 hours. Thankfully it faded away so gradually and fast that I barely noticed. Good riddance!

Birth Story from my Husband’s Perspective

At 6 AM my alarm, aka my phone, sounded off. As my brain started coming out of the fog of sleep, I remembered that it was what I am now affectionately referring to as d – day (delivery day). Today is the day we get to meet Raleigh Tara Rove! Amazing joy quickly followed by dread and worry, because today was also the day that my wife Sarah, was having her first and only c-section. I realize that c-sections are pretty “routine” surgeries now, but I’ve had trouble shaking feelings of anxiety due to a constant recurring nightmare and thoughts that I’ve had since the pregnancy of our first child and every pregnancy afterwards. This was pregnancy number five. The nightmare is losing my wife and sometimes baby as well, due to complications during pregnancy, that resulted in an emergency c-section. I had just recently got over that fear when we got news that there was a serious medical complication (polyhydramnios) that would ultimately be the cause of having to have a c-section for this delivery. As alluded to earlier, the four previous pregnancies were all vaginal deliveries. Hearing this news brought all those fears right back to the forefront of my mind.

I pressed on, keeping my mind busy with the morning tasks of feeding the dogs, putting last minute things in bags, etc… On the drive down to the hospital, my anxiety was starting to spike and it became noticeable to Sarah. When we got to the parking lot and settled into an open spot, Sarah grabbed my hand and said “hey” so that I would look at her and told me “Everything is going to be alright”. When I didn’t respond, she tried again. This time I responded with something like, “I know”. To which she immediately called my bluff. We locked eyes and held hands for a couple of minutes before Sarah asked me if I would pray before going into the hospital. I prayed for a smooth and uncomplicated procedure, for Sarah and Raleigh’s safety, and for strength.

We got out of the truck and met with Whitney (IM) in the parking lot, while Andrew (IF), waited in the car.  Andrew had to wait because due to Covid restrictions, only one support person (me) and one IP (Whitney) was allowed in the OR with Sarah.  I took a quick picture of Sarah and Whitney with the hospital sign behind them and then we walked in to check-in.

After check-in, the three of us were taken to a pre-op room, where Sarah answered more questions, took vitals, and then received two IVs. She had to receive two because she was considered medium risk because of the polyhydramnios and it being her fifth pregnancy. One was for fluids and medications. The other was in case a blood transfusion was needed due to hemorrhaging. Polyhydramnios is horrible. Please take it serious if ever presented. After that, the visits just kept on coming. Sarah was visited by several nurses to take labs, etc… Dr Teng, who would be performing the surgery, dropped by to introduce herself, walk through the process, and answer any questions. Then the nurse anesthetists showed up to explain what their role was and answer any questions. After all the rounds were made, Sarah was taken to the OR to be prepped for surgery and to have her spinal to numb her lower body. Whitney and I donned our very stylish paper overalls, booties, and hair nets. As we were waiting to be taken back to join Sarah, I noticed that Whitney appeared very nervous. She was rocking back and forth and just generally seemed antsy. Which I completely understand. Right there with you! To help take our minds off a little, I tried to create some small talk and then asked if Whitney wanted to take a selfie with me, showing off our stylish garb. Soon after that, the nurse came to get us to bring us down to the OR to be reunited with Sarah.

Walking through the OR doors was a bit of a sensory overload.  First, the room was huge!  There were so many people in this room.  The room was sterile but also humming with energy.  At least that is the way it felt to me.  I immediately saw Sarah on the huge operating table covered by blankets and what looked like huge chuck pads.  I locked on to Sarah’s eyes as Whitney and I were led over to some stools to sit on that were around and behind Sarah’s head.  I snapped a picture or two and then heard Sarah’s voice saying, “Where are you?  I can hear you, but I can’t see you.”  I stood up and bent over so that she could see me.  We locked eyes again and she said, “You can kiss me through your mask.”  So, I bent down and kissed her on her forehead through my mask.  Not nearly the same as skin to skin but the sentiment was there.  Plus, it was what she wanted, and I was there to help her and be her partner.  So, what she wanted, she got.  Soon after the procedure began.  It was an amazing orchestra of doctors and nurses, all working together seamlessly.  Like a well-oiled machine.  It was quite amazing. 

I was taking video and pictures of the process, which is fascinating, but not for the squeamish. Apparently, we were not supposed to take video of anything before the baby coming out of the uterus. However, no one said anything about that, so I didn’t know. Leave it to me to get yelled at for breaking the rules though. Once Raleigh was about to be pulled from the uterus, Sarah was able to see as well because the doctors and nurses pulled down the curtain so that she could see. Sarah had a smile from ear to ear and was just so happy that the parents finally get to see their baby that they have been so patiently waiting for and so desperately wanted. It was such a beautiful moment to see Whitney and Sarah holding hands and just elated. Once initial introductions were done, Raleigh was taken over to the baby warmer to get cleaned up and vitals taken. Sarah told me to go over and take some good pictures. Which I did. Then returned to Sarah and talked with her, held her hand, and caressed her forehead while the doctors cleaned up Sarah and stitched her up. This was the longest part of the process. This is also when we got to be a little goofy with the nurse anesthetists and one of the baby nurses, who kept coming over every time someone mentioned food. Interesting that we were in an OR where the final steps of a c-section were being performed, and we were talking about food. Squeamish? What’s that?

Once Sarah was done being put back together, Whitney and Raleigh met up with Andrew in their postpartum room. Sarah and I were sent to the recovery room where she had to remain for two hours for observation before she could be released to her own postpartum room. During recovery, Sarah was checked on often to make sure that her uterus was shrinking and firming up. Also, to ensure that there wasn’t too much internal bleeding, indicating there could be an issue. At one point, it felt like The Princess Bride because we were all so excited when Sarah could finally start to move her legs. The two hours quickly passed,and Sarah was chauffeured to the postpartum room, and I followed behind to snap some pictures and stay out of the way.

We ended up only being a few rooms apart.  Which was very nice.  Sarah continued to get checked on to ensure her uterus was continuing to do good things.  

Over the next two days, Sarah continued to reach milestone after milestone during the recovery process that is just astonishing.  She was up and walking the day after the surgery.  Got her catheter removed within just six hours of being moved to the postpartum room.  She also got both IVs removed the following day!  This is major surgery mind you.  Whitney and Andrew brought Raleigh over to our room where we would all hang out, talk, and eat food together.  It just felt like family.  That’s really the best way to explain it.  Sarah got to hold Raleigh several times, which we are both very appreciative of.  

Sarah did phenomenal throughout the entire pregnancy but really shined in my opinion, during pre-op and the actual c-section surgery. She was calm, collected, and in great spirits. She made jokes and was just making it a relaxing environment for everyone around. She truly had made peace with the way the events unfolded. What amazing strength, courage, dedication, and commitment.

Belly Birth Story – Detailed

Baby Day

By 5:30 am I gave up the ghost and decided to clear out my email inbox. I checked a few last messages before waking up with Brandon and our 6:00 am alarm. We got ready as we attempted to be functionally awake. Two (?) night owls that have had to attempt to adapt to earlier mornings sometimes makes for a rough start. A few last minute things were tidied up and put away before Brandon loaded up our bags in the truck.

The drive down wasn’t too bad and we made it to the expected mothers parking lot with 15 minutes to spare. As the engine was cut I took Brandon’s hand and told him everything was going to be OK. I could feel the vibrations coursing off of him while I was blanketed in peace. He tried some platitudes and motioned like he was going to get out of the truck, but I held onto his hand and said “look at me… hey, everything is going to be OK. I love you.” After some tender moments I asked if he would pray over all of us and the medical team. About the time we wrapped up I saw Whitney’s car pull into the parking lot. I text her and we met up on foot for one last picture on our way in. There were strong vibrations coming off of Whitney too, but I registered them more as excitement.

Check-In

After getting all of our temperatures read, the first official stop was with the registrar. One good thing that came out of the L&D stay was that Whitney and Andrew already had the opportunity to fill out their paperwork. We had a pretty well oiled machine, I walked up and announced that I was a gestational carrier checking in for a scheduled c-section at 9:30 am and that I was accompanied by my husband and the intended mother. She was very friendly and pulled out our stack of paperwork for initials and signatures. There was going to be more paperwork along the way but this step helps the hospital know that baby is under Whitney and Andrew upon birth. Every step of the way I had a document jacket in my bag with a full copy of the Gestational Agreement and Pre-Birth Order and offered to present them to anyone handling paperwork. Thankfully all of my communications with Aimee ahead of time and Whitney with the social worker meant that there were already duplicate digital copies on file with the hospital.

Our trio shuffled around the corner to the L&D nurses station for a quick check-in. I asked about when we were supposed to get the intended father’s information to someone so he could be notified when the postpartum room was ready and they said our nurse would take it during pre-op paperwork. This was a short stop to alert our nurse and the medical staff that we were officially checked in.

Pre-Op

Nicole, our wonderful nurse, gathered up our trio and ushered us to the pre-op area. It was a curtained bay with a few seats and a hospital bed set up. I went to the bathroom and changed into my bear hugger hospital gown. It’s a dual layered paper gown with all kinds of port access points, and is surprisingly warm for being paper. I asked if I could keep my bra on to keep the girls wrangled and Nicole said that was fine.

All of pre-op flowed with pretty constant activity in such a way that it flew by much quicker than any of us had anticipated. I did have to get a bit of a pubic trim as that area needs to be bald for surgery and mine was merely short.

I got all hooked up to the blood pressure cuff and to the belly monitors attempt to keep an eye on the very active baby and contractions. I warned Nicole that it tends to be a game of “chase the baby” so at least she knew what she was getting into. Haha! Nurse Rachael came in to place both of my IVs. Because I was a moderate risk for hemorrhage there needed to be a second IV port in the event a transfusion was needed. Unfortunately for me, this time I didn’t have lidocaine. Now that I’m forever spoiled having experienced it both ways, I will be requesting lidocaine with any future IV placements because that is a game changer. Rachael also administered my COVID-19 test… this time I’m pretty sure it did touch my brain. There was an after burn and tangy sinus drip.

Now that I was more bionic I had some final authorizations to initial. My arms were sore from the fresh IV placements and the blood pressure cuff kept going off at the most opportune times, so I held my arms out straight and inked mid-air. I also got decorated with four party bracelets. Lots of jokes were made about my partying but really they were my medical ID, fall risk, etc. Fluids went in one port and kept flowing for the rest of the day.

Whitney got to step up to the paperwork bat with some baby related docs. They prepped the in hospital birth certificate, gave consent to immunizations and other items for immediately post delivery, etc. Some of the paperwork required finger prints too which was entertaining to watch because they used the baby foot print ink pad.

This is when we had a revolving curtain as we started receiving visits from the rest of our medical team. Dr. Teng stopped by to say hello and check on pre-op preparations. It was so reassuring to see her and have Whitney and Brandon officially meet her too. I thanked her again for everything she did ensuring this was the right course of action.

As Dr. Teng exited the bay our Nurse Anesthetists came in. There were two because there was a supervising CRNA and a student making the final transition from 7 years of nursing to CRNA. They were both amazing and reassuring about what to expect from the spinal.

Meds were administered between visits. There were antibiotics, anti nausea, a mild sedative to calm, anti inflammatory, and a few others that I honestly don’t remember now. Two of them were liquid medications that came pre-dosed in sealed little plastic cups. Nicole called them “birthday shots” because it was about to be someone’s birthday and you knock it back like a shot because it isn’t tasty at all.

Aimee from the Special Birth Team stopped by to say hello. It was nice to meet her in person after our emails and to be able to say thank you for all of her help preparing us for the big day.

I got to go to the bathroom one more time. The IV fluids were clamped off and I just had a short line hanging off for my waddle to OR. Yup, you walk yourself down the hall and into the Operating Room.

OR

The actual room was much bigger than I was expecting. My awesome CRNA started off with jokes. He said “This is the part where I get to see your butt.” Haha I said “Too bad for you” They had me walk around the operating table and sit down. This part gave me another chuckle because the CRNA asked me to scoot to the edge of the table. I did an OB edge of the table, you know the one where you are about to fall off the front edge? Well, he meant an anesthesia edge which was the very back edge of the table. Whoops. Once that was straightened out, it was discovered that my bra had metal on it. Unfortunately for them that meant some serious maneuvering to get the bra off over lines and under gowns. Thankfully Nicole was skilled in the art of taking a bra off without the clothes and was able to work it out.

For the spinal, I was instructed to spread my legs a little bit and let baby (belly) hang low between my legs so that I could open up my lower spine. It was a matter of curling just the lower back. I thought it was going to be a much more exaggerated pose so that wasn’t too bad. He did some finger probes to practice feeling where center was on my spine along with feedback from me. “Little poke” and in went the lidocaine. It was expressed how important it was to get the spinal dead center so the needle was going to probe along with my feedback until we found it. This part felt like a few minutes but in reality it could have been a few seconds. It was a lot of slightly left, now slightly right, and so on until “center”. Once center was found, he talked me through saying that meds were about to be pushed and I might feel some warmth in my legs. It was like a wash that instantly went down my right leg to the tips of my toes.

Things started to move pretty quickly as the spinal is almost instant. I laid down on the table and scooted into position best I could. This felt really strange because I was basically willing my lower half to move because the numbing was almost instant. They put up the drape and started prepping me for surgery.

This was about the time my blood pressure dropped. It was difficult to breathe and it felt like the bottom side of my arms, hands, and lower face were partially numb. I said out loud that I was struggling to breathe and anesthesia was on top of it. They said the feeling should pass in just a moment and they made some kind of med adjustment. The sensation was getting stronger and was soon accompanied by nausea. I said again that I couldn’t breathe and they asked if I felt like I was going to vomit. Normally I manage mind over matter and breathe through nausea but I couldn’t breathe, so I said yes. They put a cool wash cloth on my forehead, took off my mask, and set a sick bag to the left of my face. It was another strange sensation, getting sick, because I didn’t have feeling or control of my abs and hadn’t eaten anything in over 12 hours at that point so it was almost like drooling. Someone started petting my head and said that the sensation should pass any moment now.

Thankfully the feeling did finally pass but it left me feeling a little out of it. I remember hearing Dr. Teng ask me if I could feel this or this as she tested parts of my abdomen with the forceps, thankfully it was a nope, not at all. Shortly after Whitney and Brandon came into the OR. Whitney sat on a stool to my left and I could easily see her. I could hear Brandon but not see him so I said “Where are you? I can hear you, but I can’t see you”. His face popped up over mine, he was sitting right above my head. Seeing Brandon’s face was like being home. Pretty much as soon as Whitney and Brandon were settled was when the actual procedure started.

I had grown so a custom to having an active baby bouncing around in a baby pool that the jostling of a belly birth didn’t phase me at all. Really not sure how I didn’t feel more drastic pressure when a grown man had all of his weight pushing on the top of the uterus. Right before AROM time was announced, someone asked Whitney if she wanted to stand up to get a better look of baby being born. She said, right where she was would be best, sitting. Poor thing.

Raleigh Tara Rove was born at 10:06 am

Someone helped me see by pulling down on the drape. Raleigh did not approve of being removed from her warm baby pool. But really, who would? They lowered her back down to suction out airways and get ready to clamp the cord. I heard that the cord had stopped pulsing for 30 seconds which was the cue to clamp off. Raleigh was brought around to Whitney and after a brief hello they both went over to the baby warmer to clean up and get stats. I told Brandon to follow to get a few good pictures then come back.

It was quickly confirmed that c-section at 38+2 was the right decision. There was mild meconium in the water, high fluid that tsunami onto Dr. Teng, and the cord was all wrapped around Raleigh’s legs like she’d been playing skip hop. During the closure and clean up process, everyone behind my side of the curtain was chatting away. I wake up very hungry so food came up several times. Yes, in the middle of surgery we were talking about food.

Once Raleigh was cleaned up and tightly swaddled, Whitney brought her over to say hello. What a precious little baby doll! She was making these little mewing sounds that were absolutely adorable and unlike any other newborn I had heard before.

Some time later, once I was closed up and clean, it was time to transfer to a hospital bed on wheels. I was told it would feel like I was going to fall off the table but not to worry they wouldn’t let me fall. They were right. As I was staring at the ground I said that I trusted them. At this point Whitney and Raleigh went their own way to a postpartum room and to join Andrew, while I was wheeled to Post-Op Recovery with Brandon.

Note

When I was researching c-sections there was a lot of blanketed statement type information out there and I wanted to provide as much of a complete picture as possible for anybody else needing to take the route of planned c-section. From preparations to procedure to healing, it’ll all be covered.

To keep this from being even more of a novel, I have decided to break up the rest of the postpartum recovery into a few blog posts. There will be the fresh 24, remainder of hospital stay, remainder of first week, and second week. Brandon also wrote his perspective to help fill in some gaps and help me know what all happened behind the scenes.

Final Preparations for Baby Day

The night before was full of final preparations. We dropped off our girls at our generous friends’ home in the late afternoon before going to dinner. I got to fulfill one more craving by eating Ramen at the delicious Tatsu-Ya in Austin. Another treat on our way home was a decadent vegan shake from Sweet Ritual. I purchased one of their rainbow straws and was delighted to discover it will be perfect for boba too because it has an angled bottom edge. This impromptu date outing was just what Brandon and I needed to fill our cups and bellies before returning home to tasks left to be done and facing the day ahead.

I decided to take a shower with my special color shampoo then blow dry and touch up with my flat iron. It’s more than I normally do but my fingers were crossed that it would be enough to wake up with presentable hair and not a major rooster ‘do. Thankfully, it worked!

Unfortunately, after being very tired for most of the afternoon I ended up with a big second wind from 9:30 pm – 1:15 am. I knit away with blurred needles on the crib sized baby blanket and watched episodes of The Crown. When there were no more episodes to watch that was my queue to attempt some sleep.

Through the night I woke several times to check my watch or painfully waddle to the bathroom. Between our three large dogs and Brandon, there was a serenade of the “allergy-induced-snoring-type” surrounding me. Thankfully I have a trusty Amazon Music playlist that helps me to fall asleep pretty quickly, Coffee Shop Folk. I pulled that up and popped in ear buds to be lulled off to dream land… for the time being.

Last Prenatal OB appointment and US

Thankfully on this day, Whitney drove me to the doctor’s office for the appointments because they ended up being doozies that required some processing.

We had the incomparable Emily for our last ultrasound. The neat thing was she didn’t even have to call my name, just walked toward the end of the hall and waved with a big smile. It’s kind of like seeing an old friend. She commented on how beautiful baby was and that she’d love to see her in person once born. BPP was great and marked all of the boxes. Then we measured the AFV (Amniotic Fluid Volume). And double checked to make sure it was indeed 4 different pockets being measured… It was just under 24 cm and had been 31 less than a week prior. Interesting. That was a real head scratcher, especially because Emily is so thorough and takes her time so we knew it wasn’t user error. I don’t know if baby can get into a position that effects the pockets or not but I do know that I still felt like there was a baby pool.

Then I had a conversation with Dr. Teng, the OB/GYN that was scheduled to perform the c-section on Monday. She started off by saying that they don’t recommend scheduling a c-section prior to 39 weeks gestation for a variety of development reasons without a qualifying event/diagnosis that shows there is a health risk to carrier and/or baby if they were to continue pregnancy beyond 39 weeks. This instantly put me in a mini panic of hoping that I wasn’t going to be pushed out a week after the week we had just had. It became apparent that there was some missing information in my chart from the conversation I had with Dr. Sebestyen.

One more time, I advocated for the reasons why I believed this was the right plan of action. I was so tired and almost second guessed if I was doing the right thing to be standing by my intuition conviction so strongly. We discussed my prodromal labor combined with precipitous labor and delivery, and how those two things had led me to an overnight stay in L&D already and subsequently a week of bed rest to keep from going into labor early.

In the end, after discussing the risks involved with c-section vs. vaginal delivery for both baby and me, Dr. Teng asked if she could discuss my case with her colleagues and call me by the afternoon. I agreed and thanked her for wanting to weigh the risks and make the best decision for the well-being of both me and baby.

Whitney and I went to lunch and attempted to process the ultrasound and Doctor appointment over some Thai food. There were several pockets of silence. Typically, when I’m attempting to process disappointment or bad news I seek out solitude so I wasn’t much of a chat. I wasn’t upset with any one person, more disappointed that we were going through this at the 11th hour and left with unknowns so close to when we were anticipating baby. What it really boiled down to was, I was tired. I was tired emotionally, physically, mentally. There was so much piled on.

After lunch, Whitney dropped me off at home and I promised that as Soon as I knew anything, they would know too.

A few hours later I received a call from Dr. Teng. She said that after discussing my case with her colleagues they all agreed that it was in our best interest to move forward with the scheduled c-section on Monday morning. I thanked her for her due diligence and going above and beyond to make the decision collaboratively and without a shadow of a doubt. We ended the call on a funny note because Dr. Teng said, “You know, we could go through all of this and then she could decide to come on her own Sunday.” I told her to hush her mouth haha.

L&D – 37 weeks

Over the past 2-3 weeks I have put myself on modified bed rest to keep this little lady growing away in her environment as long as possible. Every time I really get moving around or bending over, it kicks contractions into gear.

Up until Saturday, April 10th those contractions were primarily really good Braxton hicks. On Saturday they graduated to prodromal. *shakes fist at the sky* I took a nap, had a warm shower, ate a healthy snack (extra crunchy pb banana whole grain toast), drank water, laid down… I started getting really restless and Brandon’s spidy senses went off. He made our room dark and played nature spa music. As I breathed harder through them, he supported me and encouraged me through it.

When the contractions were consistently 3-5 minutes apart and getting stronger for over 2 hours, I asked Brandon and the girls to ready their bags while I made some phone calls. I was told to come in to be checked. When I asked about the c-section, they said that once active labor was established and proven that I could go back to OR if that was what I really wanted. Not my choice of words but yes, let’s do this.

We activated the “potentially go time” protocol and contacted the support team: our friends that are hosting our daughters, my boss to take care of the animals, Whitney and Andrew to be on baby watch, and Brandon reached out to his boss and church team manager to let them both know he was going to be out of contact. There was some flustering but overall not too bumpy of an exit as most of us were at least partially packed.

Arriving to St. David’s Women’s Center I was surrounded by my entourage of Brandon, Whitney, and Andrew. Especially in these COVID times, it felt like a crowd to the poor fellow at the temperature check-in station. He tried to say I could only have one person, I calmly said, “this is my husband and these are the parents, we are all going up to L&D.” Even though he let us up I still don’t think he understood what we were trying to tell him because he said OK, they’ll just send you back down.

Whitney and Andrew waited in the waiting area just outside L&D while Brandon and I went in to triage. Several things happened with small breaks between, including: gowning up, having an IV placed, blood drawn, a bag of fluid, urine sample, COVID swab (the one that touches your brain), a BPP ultrasound, and cervical checks.

Part of the “establishing labor” that I wasn’t aware of, is that they don’t consider you in active labor until there is cervical change. It has always been my understanding that when contractions get longer, stronger, and closer together is when active labor is established. Add it to my learned something new list. At 6 pm I was 1.5 cm dilated. And each subsequent check thereafter. In the meantime, even with sitting on a bed being pumped full of fluids, the contractions kept coming and gradually getting stronger. So I opted for overnight observation.

We moved to a labor room and contractions went from breath heavily through them to guttural possessed cow noises while I smashed my face into Brandon. The Dr. said she wouldn’t do any more cervical checks unless I started to feel pressure. There were a couple of contractions that I felt really squeezed baby into my cervix and made me want to get into a better position so I said “pressure!”. No change. That brought on the tears of frustration and exhaustion. I didn’t think that I would be in this situation and was worried that all the fluid was bobbing baby like a giant cork which wasn’t allowing my cervix to dilate as efficiently.

It was at this point that the Dr. asked if I wanted a little something to help me sleep. I said yes, please. This whole process was over 12 hours and running at this point, I was so tired. I wasn’t with it enough to ask more about the drug chosen to be administered. It was Tramadol and it did not help me sleep. Instead I was high as a kite and annoyed that I was still having contractions but struggling to articulate. The one thing I do remember is feeling like I had to remember to breath and that I felt really fuzzy. Neither of which I liked. By the time that finally started to wear off it was past 2am and I started to doze off. Sleep came in bite size pieces, more like nodding off with two one hour stretches in the wee hours of the morning.

At 7 am or so the day shift came in to say hi and check on me. At that point contractions had calmed back down and spread out enough that I was ready to go home. Dr came in for one more quick chat and agreed that she was comfortable with me going home but that if things picked back up I was to return. At this point I got to have my IV removed (hallelujah!!) and got dressed while we waited for discharge orders.

Brandon and I went to brunch on the way home and it was a gloriously euphoric meal after all of that physical exertion and only clear fluids.

Now, I take each day at a time and try to stay as relaxed as possible. We have one more BPP ultrasound and OB check-up this Friday before surgery on Monday morning.

Polyhydramnios is the Devil

About a month or so ago, I remember telling my husband that I felt like I had skipped a few weeks of pregnancy. At first he thought I meant the end was flying by, but it really felt like I was approaching term. Historically I have been much more active and able to continue with relatively normal activity until go time. Turns out, carrying excessive amounts of amniotic fluid means you are carrying a larger uterus and feel much further along. To put it into perspective, at my most recent appointment in the Dr’s office at 36 + 4 I was measure 43 weeks. Fuuuun.

Between the growth scan ultrasound and Dr’s appointments mentioned in the previous post at 33 + 5 and today at 37 + 5 we have had an MFM ultrasound and appointment, three monitoring ultrasounds, three OB visits, and one overnight stay in L&D.

We’ve seen more of this sweet chunky baby girl that we normally would have and each show has been such a joy. She seems to be thoroughly enjoying her baby pool and is typically Vertex (head down) for the ultrasounds, but always moves around and shifts once things are underway. We’ve gotten to see her trying to put her foot in her mouth, stick her tongue out, swat at the ultrasound wand, do big dramatic back bends, blow raspberries, and all kinds of things.

Across the 6 ultrasounds, my AFV (amniotic fluid volume) has averaged right around 31 cm. It has been as low as 28.4 and as high as 34. Some of the research that Andrew and I have come across, point to the majority of the risks taking place during the actual delivery. The risks are similar in any vaginal delivery but with the added fluid and my fast and furious labors, it increases their likelihood significantly. The most concerning for baby is cord prolapse, which is when the umbilical cord enters the birth canal before the baby’s head and is pinched, like a kinked hose, cutting off life support to the baby. Baby can also move a lot more freely through labor until the fluid drains which means she could easily change position at any time. One of the risks for me that is increased due to poly and 5th pregnancy is hemorrhage. This could result in a blood transfusion and in very extreme cases where the bleeding can not be controlled it leads to a Caesarian hysterectomy. With my history of hard fast labor and all of the risks listed above (and more), my intuition was strongly telling me to advocate for a scheduled c-section.

It took a little bit of time for everyone to be on board with me because it came as quite the shock that a four time natural birthing person would want to push for a c-section. But in my mind that should put that much more weight and seriousness to my decision. When Dr. Sebestyen asked me to tell her more about my decision it made me emotional, not only because she was willing to truly listen, but because of my reasons. I take my responsibility seriously for the health, wellbeing, and safety for each baby I have carried. And I would be utterly devastated if my desire to have a 5/5 vaginal delivery record caused a catastrophic event for either one of us. My role as care giver for this baby doesn’t end until she is safely in her parents’ arms. So if I can take steps to keep us both safe and mitigate what I consider to be very real risks, then I am going to do that.

There were some difficult appointments with convoluted information that has thankfully since been straightened out. During my appointment with Dr. Sebestyen is when a lot of the details finally came to a head and I was able to have a clear conversation. One such fact was about the timing of delivery. As you can already guess, I am indeed still pregnant, which means there wasn’t an induction or c-section at 37 weeks. Any type of birth augmentation that early has to meet a specific set of guidelines for medical necessity. Generally without a medical diagnosis that is high risk, induction or c-sections are scheduled around the 39th week of pregnancy. Dr. Sebestyen gave me the option of closer to 38 or 39 weeks. I chose 38, not only because it will be nice to no longer have a baby pool attached to my body, but because the longer I carry, the risk of me going into labor increases and I really don’t want to push it (hahaha accidental pun).

We were able to schedule a c-section for April 19th with Dr. Teng, who I saw during my previous pregnancy at her old practice. A lot of my frustrations and anxiety about not being heard or advocated for were soothed significantly after that appointment. Feeling heard, having a plan of action, and validation of my concerns was… priceless. I slept so well that night.

A running joke has been that this little Mouseketeer has wanted to make sure I went out with a bang. Experiencing new things and learning new pregnancy related diagnoses after 5 pregnancies and being fully immersed in the surrogacy/fertility world, has been humbling. Hopefully all of this information will help someone else navigating their way through the unknowns.