Para los que hablan Castellano...

Siento mucho el hecho de que no he podido detallar los párrafos anteriores, pero siendo papá ocupa bastante tiempo. Aquí voy a repitir en Español las cosas más importantes para entender la significancia de las fotos.

Las fotos ultrasonográficas empiezen desde el primer mes del embarazo. El el tercer mes descrubrimos con el ultrasonido que tenia parte del cuello muy agrandecido--algo que indica un posible defecto en las cromosomas (como el síndrome de Down) o un defecto en el corazón. En los meses siguientes tuvimos varios examens por ultrasonido que nos probaron que no tenía ningún defecto ni en el corazón ni tampoco en las cromosomas.

Hay algunas fotos de tres dimensiones que nos enseñaron su cara muchas semanas antes del nacimiento.

Las fotos del nacimiento se explican sin muchas palabras, así que no voy escribir descripciones aquí. Si alguien tiene pregunta alguna, envíeme un email y le enviaré la descripción.

Lauren es una mujer muy increíble. Habiendo sido el médico para más de dos docenas de partos durante mi capacitación de médico, tengo la experiencia para decir que Lauren sin duda soportó el parto mejor que cualquier otra mujer que he visto. Cuando empezó a empujar sólo necesitó 26 minutos para dar a luz--increíble por ser su primer parto.

Cuando era más joven, nunca entendía a las mujeres. Siempre me preguntaba como las mujeres pueden existir sin vivir constantemente con celos a los hombres--los hombres son más fuertes, más masculinos, más divertidos (en mi opinión inmadura). Hoy día me di cuenta de que las mujeres poseen algo muy especial que nunca entendía--algo que es más especial que cualquier atributo que pueda poseer el hombre. Este algo es la conección especial que tienen las madres con sus niños. El hecho de sacrificar el bienestar de su cuerpo y 9 meses de su vida para hacer crecer el niño es algo que los padres nunca podemos comprender completamente. Después del nacimiento las madres pueden alimentar a los niños al darles pecho, que es otra conección especial que no tienen los padres. Para ser muy honesto, tengo un poquito de celos de que no puedo alimentar a mi hija y que no tengo la misma concección con ella como mi esposa. Las madres son seres muy especiales--el sacrificio que ofrecen durante el embarazo y durante el parto es algo que los hombre de verdad no podemos apreciar completamente--algo que quisiera entender sin poder. Desde mi punto de vista, es un poco triste no poder compartir el sacrificio que mi esposa dió porque quiero compartir esa conección especial.

Para todas las madres, especialmente Luzbi y Carmen quienes son madres muy especiales para mi, les agradezco su sacrificio, y siempre tendré celos de lo que han podido hacer como madres y lo que nunca podré hacer como hombre.

Estadisticas del nacimiento de Ella Joyce Richardson (pronunciado Ela Yois)

Nació a las 7:36 de la noche el 29 de Setiembre del 2008 en la ciudad de Denver en el estado de Colorado en los Estados Unidos de América en el hospital Presbyterian-San Lucas

3685 gramos de peso

19 pulgadas (appx. 48.25 cm) de largo

Circumferencia de cabeza de 13.5 pulgadas

Y muy bonita--es mi preciosa

Birth Stats:

Born at 7:36 pm on 9/29/08 in Denver, CO at Presbyterian/St. Luke's Hospital

8 lbs 2 oz

Head circumference 13.5 in

19 inches long


Labor:

Lauren was awesome! When admitted for induction we were excited to find out that she was already dilated to 2 cm and was 80% effaced, -2 station (which we attribute to walking, swimming, and acupuncture). Her membranes were stripped upon admission at 8 pm on Sunday 9/28 and regular contractions started. At midnight she was given 1 misoprostol. By 4 am she was dilated to 3.5 cm and still 80% effaced, -2 station. The Pitocin drip was started and she received an epidural catheter for anesthesia after being given 2 liters of lactated Ringer's solution. Lauren's blood pressure had been high during the last trimester of pregnancy (the indication for induction) and in spite of the fluids it fell to 100/50 with the epidural anesthesia. With the Pitocin stimulating contractions the baby's heart tracing became less reactive and she had some late decelerations (a sign that the baby isn't getting enough oxygen through the placenta). The pitocin was stopped at about 5 am and she received another 2 liters of fluid. Her blood pressure increased to about 120/70 and the fetal heart tracing was more reassuring at about 6 am and she was dilated to 4 cm and still 80% effaced with -2 station. Even off the Pitocin she was regularly contracting so it was left off. At 7 am on 9/29 external monitors were changed to internal monitors (water broken at that time) and we were able to see that the contractions were of sufficient strength and number, so Pitocin was left off. At 11 am she was still 4 cm and 90% effaced in spite of adequate labor--the NPs started talking about C-section (which we emphasized we were not enthusiastic about). Contractions had decreased in strength and number and the Pitocin drip was started again, this time with excellent blood pressure on Lauren's part after almost 5 liters of fluid. There were no signs of fetal distress, so the Pitocin drip was titrated upward and by 1 pm she was dilated to 5 cm. She continued to dilate at 0.5 cm/hr until 7 cm. At 5 pm she started dilating faster and the station had changed to -1. Between 5 pm and 7 pm Ella descended to a +2 station and the cervix continued to maximally dilate to 10 cm. At around 6:15 pm the epidural catheter plugged and the anesthesia started to quickly fade. In spite of numerous attempts to fix the catheter, there was little that could be done. By 7 pm Lauren was feeling most everything and had complete motor control. The nursing staff encouraged Lauren to wait to push until the baby had moved farther down into the pelvis. Nevertheless, at 7:10 pm Lauren (who was feeling every movement) had the urge to push. The pushing lasted only 26 minutes before our beautiful little Ella was born. Having helped to deliver 2 dozen babies (and seeing many more delivered by others), I can say that Lauren did the best job of almost anyone I've seen. One consequence of pushing the 8 lb baby through the birth canal so fast was pretty extensive tearing of her perineum. The epidural was gone, so the obstetrician suggested that she be taken to the operating room and given general anesthesia for the repair. The anesthesiologist talked the obstetrician into trying a spinal dose of anesthesia first; the anesthetist's work was effective and the obstetrician took the next 45 minutes in completing the repair.

During all of this, Ella was quick to recover from traversing Lauren's pelvis with APGAR scores of 7 and 9. She was taken to the nursery for her initial assessment, meds, and her vitamin K shot. I was in between the nursery and the labor room supporting both of my girls the best I could.

Julie (Lauren's Mom), came to Denver to aid in the childbirth process. She was in charge of photography during the birth and did an excellent job (we have many more photos, some of which are rated R, but will be valuable to Ella as she gets older). Afterwards, she was a huge support to Lauren while I was running between rooms. She has been very sweet and supportive and we have appreciated having her here with us very much.

We're now doing fine. Lauren stoically has endured the extensive repair without any narcotic analgesia. She and Ella are napping now while I am writing. We'll keep everyone posted on progress in the coming days.

Ella and Grandma Julie















































Mama, Papa, and Ella with Jenny (our OB) nurse

In the newborn nursery for initial checks













































Hearing screening exam


















With Mama

These photos are pretty self-explanatory and in a logical order so we will provide little if any commentary...




1 week pre-partum













Just admitted--dilated to 2 cm and 80% effaced















Contractions and fetal heart rate monitor














Oxytocin drip at 8 miliunits/min, oxygen mask to keep enough O2 going to Ella...
















The big yellow shoulder is mine (Dusty) and the bloody hand is in the process of clamping the umbilical cord

Intellectualization and increased nuchal translucency

I tend to use intellectualization as a coping mechanism during stressful periods. I admit that having potentially devastating news delivered to me about my unborn daughter was one of the hardest moments of my life, and the four days waiting for results were equally as excruciating. I felt for the second time in my life what it was like to receive bad news from a physician (the first time I was 10 and was informed that I would have to undergo surgery after stepping on a nail). Whether due to increased maturity, education, fatherly instinct, or a combination of any of the above, it was harder to hear bad news delivered about my daughter. Important events have a way of remaining etched vividly in memory regardless of the passage of time. It was a huge blow to hear the obstetrician say that there was a high likelihood of a poor outcome from our pregnancy, feel my wife clutch my arm while listening to her sobs, being forced to be the support even though I wanted to clutch onto someone else for support. There was no one else to clutch of course. I would be ultimately responsible along with my wife for any adverse outcome of our pregnancy. I fully realize that intellectualization didn't lead me to acceptance of the possibility of a poor outcome from our pregnancy, but it sure helped me pass the time. Only prayer and sincere discussions with my wife really helped me to accept whatever the outcome might be.

It was during this time that I realized the futility of quoting statistics for comfort. I wonder how many times I've spoken with patients about a test or condition and quoted a statistical measure from some study or textbook in an effort to quell their fears and concerns. When it's you or a member of your family who's at risk of having a condition, the statistics only matter for the intellectualizers (and only as a temporizing measure for this subset of the population). It doesn't matter if the risk of having a condition is 5% or 50%. The fact that a medical professional has a reason to believe a test is necessary is anxiety-provoking and often leads the patient to believe that the pre-test probability must be much higher than the normal population. What really matters in the end is the result of the test, and what really counts in the time test results are pending is support from family and friends.

For those who are interested in nuchal translucency and the implications of an abnormal screening ultrasound followed by a normal chromosomal analysis, here are some references I found to be helpful.

If you don't have access to the journals, post a comment with an email and I'll be happy to email a .pdf

Yoshida S, Miura K, Yamasaki K, Miura S, Shimada T, Tanigawa T, Yoshida A, Nakayama D, Masuzaki H. Does increased nuchal translucency indicate a fetal abnormality? A retrospective study to clarify the clinical significance of nuchal translucency in Japan. J Hum Genet. 2008;53(8):688-93. Epub 2008 May 24.

Souka AP, Von Kaisenberg CS, Hyett JA, Sonek JD, Nicolaides KH. Increased nuchal translucency with normal karyotype. Am J Obstet Gynecol. 2005 Apr;192(4):1005-21.

Souka AP, Krampl E, Bakalis S, Heath V, Nicolaides KH. Outcome of pregnancy in chromosomally normal fetuses with increased nuchal translucency in the first trimester. Ultrasound Obstet Gynecol. 2001 Jul;18(1):9-17.

Souka AP, Snijders RJ, Novakov A, Soares W, Nicolaides KH. Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks of gestation. Ultrasound Obstet Gynecol. 1998 Jun;11(6):391-400.

When you sing you begin with Do-Re-Mi

We were relieved to know that at least her chromosomes were normal, but were wary of the high resolution cardiac ultrasound that was scheduled for 20 weeks, knowing that it might reveal a major cardiac defect.

The date of the ultrasound arrived, and she laying was spine up, so no reliable images of her heart could be obtained. But, we were able to visualize nearly every other part of her anatomy, which revealed normal development. Another ultrasound was schedule for two weeks later.











The next ultrasound showed no cardiac defects. And got a really nice 3-D image of her sucking her thumb.


















Another surveillance ultrasound was scheduled which also led us to believe there was no cause for concern...but an ultrasound around the 4th of July did cause some alarm. The obstetrician performing the ultrasound was highly convinced that he saw a transposition of the great vessels (aorta abnormally originating from the right ventricle and pulmonary artery abnormally originating from the left ventricle). I received another emergent page and ran to the other hospital where we were scheduled for a fetal echocardiogram. We waited for a couple of hours while the Pediatrix group weaseled us into their busy schedule (much appreciated).

During the fetal echo, we were able to see quite clearly that there were no sonographically identifiable defects in Ella's little heart, which was functioning as perfectly as could be expected.







And along the way we got some really nice high-resolution 3-D images of her cute little face and arm.


















We're currently awaiting her arrival now. Lauren is at 39 weeks and 1 day. We had a clinic appointment today and were sent to the labor deck for a non-stress test due to some mild hypertension and protein on urinalysis. Non-stress test was textbook normal as were the other tests, so we went home with an anticipated date of induction for 9-28-08.