Image One shows Jonathan holding Meri about an hour and a half after
birth, after her visit to the nursery for a bath, weighing, vitamin
Image Two is a full portrait of Kay and Meri, about an hour after birth. Kay brushed her hair, but is otherwise as she finished---glowing.
Image Three shows Meri on Kay's chest, about 5 minutes after birth. She was born in subdued light, and spent a few minutes cuddling before she got wrapped up in a blanket, to assist the cap in keeping her warm, and then she had some more cuddling.
Image Four shows Meri getting her cord tied off by Dad and a nurse. She was born so quickly and comfortably that she was "pink" (not blue), so the doctor said we should call her Rose (a name we like, it's a good thing we are not whimsically Californian, Two-dogs).
Image Five shows Kay and Meri coming home, Meri wearing her coming-home cap.
Image Six is a close-up of the beastie. You can see a blur of right hand because she is keen on flailing... perhaps 9 months of cramped conditions makes one restless. She has a tendency to (a) scratch herself and (b) get hands out of mittens, and you can see small red marks on her cheeks.
Image Seven shows her hair, plus her very awake look. Babies do not have personality, as some would have, but they have habits that are easy to personify, like a cat. Meri has this look, plus a real Basil-Fawlty, one-eye-open, look-left-and-right-madly, check-the-scene look.
Image Eight is Meri being weighed on Kent's precision analog scales which required her to rest in a plastic collander.
There are some more photos on Amelia's page.
On the third day I guessed that Meri was getting dehydrated. In the first few days breasts are supposed to supply colostrum, much lighter than milk, chiefly to get water into the baby. Babies are born with excess fat and water, to survive the period before breasts kick in, but they do need water sooner than complex molecules. We supplemented with a little sugar water, and she soon settled down from appearing hungry every hour and showing general signs of discomfort.
As time went on, Kay produced thicker stuff, colour correctly shifting. No more water supplement. However, it is not obvious what volume is going into the baby when it comes from an opaque container. We are struggling to have her get enough. There is a certain mechanical incompatibility between Kay (large) and Meri (small). Meri is a lazy feeder, meaning she is likely to doze off mid-meal. So far she does not seem to react well to formula, and there is a risk that formula usage will make mum lazy, you do not breastfeed or express milk, and presto, the milk production stops. So either way, it is hard on the owner of the milk factories.
Many people say that babies have a "personality" from the instant they are born. They have no more personality than a cat, just habits that are easy to personify, so if you think your cat is cute your baby will enrapture you all the more. Having said that, Meri has never done anything without due cause. She wriggles or cries or slurps or grimaces in direct response to basic sensations (wetness, hunger, alimentary discomfort, etc), and decoding this is the process to be learnt. On top of this, you have to figure out some basic infant biochemistry, and it all fits together. Example: She wriggles and tongues, the hunger signal. Kay puts her on a breast, she feeds 5 minutes, seems to doze off. Now, it would be a mistake to put her down. She has but a small amount of fuel, and digesting this has taken all the available energy. Shortly, however, 10 minutes, she will have converted enough to wake up, and is still hungry, so she will have a larger feed. This cycle might happen again. Books say tickle feet or something to keep her awake and feeding... we have had no success on that, but after a couple of these bootstraps she will take on fuel for up to 2 hours sleep.
After seven days of grappling with the feeding biz, we discover that she weighs 7lb... this is three-quarters of a pound more than she weighed at birth, and almost a whole pound above her discharge weight. (Babies drop weight in the first few days.) She is supposed to take a week to get back to starting weight, so this is enormous growth. Conclusion: Feeding is working OK. Half of the good effect from this is that Kay feels OK with herself, and the rest is that we can relax the effort to `fill her up', and use the post-suck awake periods for baths and things that would otherwise be more traumatic. I confidently anticipate that the feeding-fooling-sleeping cycle will come into Kay's control real soon.
It is late in the evening of Tuesday, 22 December, and I have just left Kay at the hospital. The problem is that there is not much amniotic fluid, so the theory is that it is better to induce than to leave things thus, with increased chance of the cord getting tangled because of the lack of buoyant suspension... suggested by the earlier indication of fetal "distress".
Truth be told, there was not much distress (inspection of several hours of the monitor printout showed no abnormal heartbeat, but regular mild contractions, almost too mild to feel, spaced about 4 minutes apart), and Kay will not get much of a night's sleep with the monitors attached, so she is probably in more distress than anyone! Still, she needs to stay put as the shock absorbing fluid is low. If there is no action soon, they will try to induce labour proper tomorrow. It is thus likely that all will be over in a day.
The ultrasound pointed towards the beastie being a girl.
The labour had been "long", although the first 12 hours were only mildly discomforting, so propably should not count as labour. By 19:00 the contractions started to hurt, really starting the work, as she was only slightly dilated by then (<2cm); by 22:30 Kay's energy ran out, and her ability to stand the contractions dissipated. She elected to have an epidural, which was a good call. (In fact, it was probably a certain necessity as she had been awake for so long.) By 00:30, curled up on a dressing gown, under a blanket in the corner of the room, I went to sleep to the sound of her snoring. By 4AM she was fully dilated, so we woke up, organised ourselves, and had the first practice push at about 20 past 4. By 04:51 Meri was out and looking about like a suspicious alien. (Well hey, her parents ARE aliens!)
In summary, if Kay had not had a 12 hour artificial ramp-up, the labour would have been 8+0.5 hours, damn slick for a first go.
The ECG and the X-ray came up clean. My god, she hears the lawyers sing, what if really is HCM after all?!? The best cardiologists are at UCSF, she tells us, "but they have an occasional clinic here... I'd like them just to have a look". So far we are purely amused, but we'll draw the line the minute they suggest anything invasive!
What triggered Dr Stokes panic? The "weight loss" from the last reading at
her clinic, to the visit by the nurse (last RED triangle to Green triangle).
Let us do a calculation: A baby on full formula drinks about 26oz of
formula per day, and 2oz of formula contains 8.5g of non-water content, about
8g of stuff that can be made into flesh and bone, giving about
3.7oz/day mass intake. If they were 60% efficient (say 10% lost in poo
and pee, 30% spent breathing and sucking), the absolute max weight
gain rate would be just over 2oz/day... but books suggest a mean of 1oz/day.
Now Kay had no milk for about Meri's first 3 days (hence the
dehydration episode); however, let us pessimistically suggest that she produced
full milk from the moment of hospital discharge.
The purple dotted line is the weight gain under those conditions.
The graph also shows the expected weight for a baby of Meri's size,
taken from a textbook on such matters (thank you Joyce).
The reader is left to draw their own conclusions from the graph.
If one of my students had based a decision on that result I would have told them to go home and do their calculations again! Having made that comment, I still think Dr Stokes is on the ball. She hears something (correctly), she knows there is a history, she sees an apparent weight loss... and she was not in a position to collect all the data I have, observe that Meri was in no distress at all, and she has, or presumably had, confidence in her clinic equipment and her assistant (who did all the weighing). Like the Obstetrician, she took the zero-liability trajectory.
Anyway, we visited the cardiologist at UCSF, and he proved to be a wise man. No cause for alarm, though Dr Stokes was hearing something. Merinda has a small hole in her ventricle, about 3.5 to 4mm, which is too small to cause her any risk or distress. This is called VSD (for Ventricular Sidewall Defect, I think), and it is the most common heart defect. Merinda's hole is in the muscular base of the dividing wall, a location in which it is likely to simply heal itself. It would not bother her, we are assured, even if it did not heal over. VSD is not in any way connected to HCM, so it has nothing to do with the Ramsbottom genes. This has produced enormous relief in Kay. She has now managed to breast feed in front of two (2!) people, Virginia and Dr Brooks. I confess to not having been unduly worried; I have a lot of faith in the human body, little in the attitudes of modern medicine. I wager Dr Stokes' insurance agent felt more anxiety than I did....
One interesting observation from the above graph, is the short-term weight fluctuations I am observing. These are real: I have scales good to better than 0.25oz (thank you Kent), and I am allowing carefully for clothes and diapers, etc. I am even weighing all Meri's used diapers, just to measure the outgoing mass. It has been difficult to measure ingoing mass, chiefly because the scales register such small force that I can obtain an accurate reading only when Meri is asleep, which does not happen at both ends of a feeding, and frequently at neither. Anyway, any reading is subject to an error of +/-2oz on "true mean". I have standardised readings to be her weight, with diaper, but less the dry weight of a diaper, obtained by subtraction of clothing weight. I expect this to minimise the fluctuation.
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