Reboot: Return of the Blog

Yes, it has been nearly 2 years since I updated this blog- please forgive me...

Looking back on this missing time, it feels as though only a month or two has slipped past. But when I look at the last entry and see a baby version of my now BIG Sierra, it hits me just how much time has really elapsed. Ideally, I've been just too busy soaking it all in, enjoying every second, to write a blog post. Maybe there will be some magical, peaceful day in our future that will allow me to play catch-up and fill in some of that missing time... maybe.

But probably not. ;) 

Of course, Sierra's transformation into this amazing girl of 3-going-on-13 is not the only excitement our family has seen recently. Sierra also became a BIG SISTER a few weeks ago when we welcomed Mr. August James as the newest Pichot! And what an entrance he made! (More on that in a minute.) 

One last picture as a family of 3! Easter 2013, about 3 weeks before August's arrival. 

After Sierra's "long" labor, distress, and emergency C-section, I was really determined that our second experience would be different. Travis and I completed 12 weeks of Bradley Method classes, which we really enjoyed, and felt really prepared for a VBAC delivery at the new Pavilion for Women hospital, which is run by and connected to the world-class Texas Children's Hospital. After trying every old wives' tale you've ever read on the internet (except castor oil- I draw the line just shy of pooping my way into labor), I finally started labor 3 days after my due date on Monday morning. By Monday evening, labor was getting intense and our doula/Bradley instructor Monique came over to help out.

Breathing & timing contractions about 7 hours into labor.

We labored around the house, in the tub, walking the block until about 11pm when we decided to head to the hospital. My contractions had been 3-4 minutes apart for few hours, so I was hoping we were close. HA! Once we got settled at the hospital, the triage nurse checked and told me I was only at 5cm. Boooo! How disappointing! We settled in for a long night of hard labor- in and out of the tub, fighting the monitors (because they dont' work if you move!), and relaxing, breathing, breathing, relaxing, breathing. That's really all I remember of the next 12 hours or so. By the late morning, after 24 hours of labor (and still at 6cm) I was beyond exhausted... and finally caved and asked for an epidural so I could get a little rest. So much for the drug-free birth! Honestly, the epidural helped but wasn't super-awesome. I did get the rest I was looking for, but the coverage was spotty and only lasted for a few hours. It only took another 10 hours, but we finally made it to complete and were ready to push! Every thing to that point had looked great. Long, but all normal. The room transformed, a zillion people filed in, they broke my water, and we were ready to push!

The "crowd" just before we started pushing. The number of people in this room doubled before we were done.

Push 1: I have no idea what I'm doing! But yay this VBAC is going to happen!! I realize the contraction like pain in my belly isn't going away. Oooouch. Cue the unstoppable vomiting.
Push 2: The alarms go off. Baby's heartrate is really low (50-60 bpm) and suddenly the mood changes. Everyone is yelling at me! Like 20 people telling me to keep pushing- no breaks, take a breath, keep pushing, don't stop! Baby has to be out now! It took about 7 minutes of insanity and 3 vacuum pulls, but our little superhero made it out! (Really, he did come out like a superhero with his arm up by his head! Thanks buddy.) They immediately handed him off the the neonatology team, which had grown to about 15 people by this point. It was hard for me to understand what was happening at the time. There were so many people between me and his bed, I was still in a great deal of pain, and the OBs were all very concerned with me. Our little August James wasn't breathing. He did have a heartbeat, but his first Apgar was just a 1. The amazing team of neonatologists resuscitated him, intubated him, and prepped him for transport over to the big Level 3 NICU at TCH, just a pedestrian bridge away on the other side of Fannin. After about 20 minutes, he was stable enough to come say "Hi Mom" before he left for TCH.

Yes, we were as strung-out and exhausted as we look here.

The OBs discovered that we had suffered a placental abruption, meaning his placenta had separated too early leaving him without any oxygen supply until he was delivered. Thankfully I didn't experience the massive blood loss that typically goes with an abruption. But August definitely felt the effects. Medically speaking, he suffered from hypoxic-ischemic encephalopathy (HIE). It's still hard for me to grapple with the words 'brain damage', but that's really what we're dealing with. Once he was at TCH, the neurology team ran an EEG, noticed some abnormal patterns, and decide his brain might benefit from a novel cooling therapy in which they chill the whole body to 33.6C (92.5F) for 72 hours. So he was basically in hypothermia for his first 3 days. The goal is to minimize the more extensive damage that occurs due to apoptosis and chemical signaling after the initial trauma has passed. So far, the results from the clinical trials of this therapy have been very promising. And we could not be more thankful that it was so easily available within our own hospital less than 15 from our house.

The little superhero (holding Aunt Amy's hand). This is what he looked like by the time I made it to the NICU later that night. All the leads on his head are for the EEG. Thankfully, they were able to remove the vent pretty quickly after he made it to the NICU. 

As wonderful and amazing and effective as the cooling therapy is, it was torture to not be able to hold him at all! Because they were keeping his temp down, he just laid there naked and shivering for 3 days while we hovered around letting him hold a finger. He spent a good deal of that time on fentanyl (sedative) to keep him calm. He wasn't allowed any milk until he was warm again. Pretty miserable for everyone. But this kiddo has the world's most amazing family- he was rarely left without a family member there to lend him a finger, shush him, talk to him, or keep his nurses happy. During cooling he had his own dedicated NICU nurse, plus a second nurse shared with another baby nearby. And the NICU nurses at TCH could not be better. We were constantly impressed with the knowledge and experience his nurses had. The hours and stress that they deal with are more than I'd ever want.. they're now my favorite people!

The EEG was continuous throughout the whole 72 hours plus the warm up phase (an 8 hour process). A neurology team monitored him 24/7 by the EEG and a video camera set up by his isolette. The cooling must have worked- his EEG improved over the first 48 hours! He got all warmed up Saturday morning and Mama and Papa were right there waiting to get our hands on him!

Our first hug! Best feeling EVER. 

After he warmed, he was like a whole new baby! All of the reflexes that had been 'chilled' out of him came back (gagging, coughing, etc). He actually stretched out and it looked like he'd grown a foot in just a few hours! The EEG came off, he shed a few more wires and tubes. He finally got a hat and a blanket and we could hold him all we wanted- and boy did we take them to their word on that!  Over the weekend we got to start him on tiny bottles of Mama's milk, which had been dutifully pumped, labeled, and delivered to the milk bank all week. Kuddos to all Mamas who keep that up for months.
Sierra finally got to hold her baby- exactly what she'd been talking about for months. Such an awesome Big Sis!

Cuddle time with the Papa-Man.

Happiest Big Sis ever!

The next big hurdle was his MRI on Monday. The MRI was a surprisingly stressful event for us. Even though it wasn't much of an event for him- he just got a big bottle of milk and a sugary pacifier. But for us... just seeing him back in the transport isolette, plus a little stress from the nurses and doctors about his low heartrate, brought on some very real parental PTSD. I never thought it would feel so good to get him back in his safe little NICU bay. We had to wait until the next morning's rounds to hear the results. And then, on his 1 week birthday... NORMAL MRI RESULTS! Hallelujah! It seemed almost unbelievable when they told us- she had to show me the radiologist's notes on the screen before it sunk in. For the near-lifeless little baby we saw a week ago... what an amazing relief! Several doctors stopped by to congratulate us. It was obvious that they were equally as pleased with his response to the cooling.

After that, it was a relatively unremarkable 3 more days to discharge! He got the all clear to start nursing (currently his favorite sport), so Mama went on fulltime NICU duty, he finally lost his IV, and we moved over to the Level 1/2 NICU, which just feels like 24-hour daycare after the Level 3/4!  :)

Our first picture as a family of 4! 

On May 3, 10 days after he was born, we finally got to bring our little superhero home!

Sierra's classmates in the Green Room even made August a banner! Thanks friends! :)

Life at home has been remarkably routine after our crazy start- many more updates and adorable pictures to come. I promise it won't be another 2 years before our next entry. ;)