The “What Ifs” are Hard to Carry

First of all I want to thank you all for your comments on my last few blog posts. I have not made time, nor have I had the energy to respond. I feel like I’m just going through the motions with a lot of things in life right now, and I’m ok with that.

Now onto the point of this post. Last Tuesday I met with my MFM to go over his thoughts on what the heck happened. He is a fabulous doctor, and he answered about 98% of my questions without me having to ask them. I wonder if that’s because he’s extra awesome or if that’s pretty standard for most people. Of course we don’t really know what happened. However, his best guess is that something was wrong with the placenta given that the placenta was on the smaller side and I had growth restriction in my pregnancy with A. But even with him saying that, he reiterated that we don’t know if Colton was growth restricted based on his weight (2lb 1oz, which was on the lower side of normal for gestational age) since we did not have a growth scan scheduled until 30 weeks.

There were no signs of infection, no blood clotting issues, no maternal fetal hemorrhage, or signs of a cord accident (there was a loose nuchal cord noted when I delivered him but this is very unlikely to be the cause of his death according to my MFM). I honestly wish there was a concrete answer, even if it was that my uterus sucks, because that would make it a whole lot easier.

Then we moved into the (scary) realm of trying again. If this is our decision, we should wait at least six months from the delivery, which puts us at late August. Getting pregnant too quickly increases the risk for growth restriction and pre-term labor, both of which I’m at risk for in general with my unicornuate uterus. Then we talked about what kind of monitoring I would need, and he basically said he wanted to meet with me early in my next pregnancy to come up with a plan I’m comfortable with. He offered to manage my entire pregnancy if I want, or we can co-manage with my OB, or I can just be managed by my OB (HA, yeah right!!). His recommendation is a growth scan around 23-26 weeks at least, and if I feel I need more frequent monitoring then he is happy to do it. He also said he would be happy to meet up and talk again before I am actually pregnant to go over any other questions I may have.

I asked the ever so important question of what is our risk of having another stillbirth, and both my husband and I were pretty shocked by the answer. He did the statistics in his head based on his knowledge of studies and experience and came up with 5-10%, but likely closer to 5%. His reasoning is that I will be monitored much more closely in any future pregnancy. That does not necessarily mean that I will have a term baby, but a 95% chance to deliver a live baby (meaning it’s possible that I may be induced early and have a premature baby). We both were surprised that the recurrent stillbirth prediction is so low (not 1% low like most people who have an “unexplained” stillbirth, but still low). He also calculated that my risk is about 50% to have another growth restricted pregnancy. This is way lower than my husband and I would have thought. Another related thing I wanted to know is how many times he’s seen someone have two stillbirths in a row and he said once, and both of this person’s babies had genetic defects as the reason for stillbirth.

Overall, this makes me reassured that if we do decide to try again, I will be monitored much more closely than with both Colton and A.

Something I asked him is if he thinks I’m crazy for wanting to try again. He said based on my risk factors and his analysis, he does not think it’s crazy at all for me to try for another pregnancy. I just have to make sure I can cope with the worst happening again.

My last questions was about using lovenox in a subsequent pregnancy. He does not think it’ll do anything (and he also does not think the aspirin does anything) but if I want to try it and can’t find someone to prescribe it, he would be happy to prescribe it for me. My husband does not want me to use this medicine and says it’s a deal breaker for trying again. I would like to try it if we do try again so I’ll have to figure out if I can convince him to let me do it.

I just wanted to add that my D&C showed that I had an infection in my uterus (endometritis) and no retained placenta was noted. The mass my OB saw could be a small fibroid (which has never been noted on any ultrasound or other test I’ve had so I’m guessing it’s a recent growth). We will follow up on this later, especially if I have long periods or bleeding and cramping in between periods. I finished a 5 day course of doxycycline and I am taking a 2 week course of Augmentin to hopefully get rid of it. My MFM says that endometritis is something the pathologist writes when they don’t have anything else to put down so it’s possible I’m taking the antibiotics for nothing. Awesome…

I don’t think I’ve actually written much about the events surrounding us finding out that Colton died, but I only noticed reduced fetal movement about 2 days before he died, and I have major regrets that I did not go in on Friday night after noticing the reduced movement. I was super concerned that night and I will always wonder if I would have gotten checked out if he would be here today. I am well aware that a 28 week delivery would likely have had some bad outcomes (including him dying anyway) but it’s hard to not wonder if he would be coming home soon (since this past Saturday I would have been 37 weeks). Both my OB, MFM and husband all say to not beat myself up over this, and I’m not, but the what ifs are hard to carry. I’ll leave it at that.

Ask Me How I’m Doing

I went back to work last Monday. It was initially really hard walking in and getting the hugs and condolences, and then it was just normal. Normal is so nice, and I have been wanting to feel some sense of normalcy since Colton died. One of the doctors shared with me that she also suffered a stillbirth. She said no one at our workplace knows and she only shares when it happens to someone she knows. In some ways I think it would be easier to have no one know. But since they do know, I think it’s appropriate to ask me how I’m doing. It allows me to open up if I’m feeling up for it, and it shows that people care. Another doctor did this, saying welcome back and asking how I was both physically and emotionally (physically almost normal and emotionally is day by day in case you were curious). I was really grateful that he did this, as I wouldn’t have expected it from him.

In my personal life, only a few people have been asking me how I’m doing. To be fair, I sent an email when Colton died saying I needed time before discussing it, so maybe I need to open up. But it makes it so much easier if my friends and family would just ask me how I’m doing. It’s hard to bring it up but I want to talk about it. My sister in law sent an email saying she didn’t know how to act and asking how she should act. I told her I wanted her to ask me about him and still be in touch with pictures of her kids. She has been texting pictures of her kids like we normally do, but then this past weekend when she visited, she said nothing about Colton. I even tried to bring up the delivery in a conversation and she just changed the subject. It’s so frustrating.

I have a couple of friends who have been texting and calling frequently and I am so eternally grateful for their support. It’s eye opening when you suffer loss to see who really cares. I’m not surprised by who has been in touch, but there are a couple of people I would have expected to be more present that have been missing. That’s life I guess.

In other news, at my follow up doctor’s appointment I still had the retained placenta. My OB was able to get me in really quickly for a D&C, which I had yesterday. It’s really hard to feel done with the physical part of birth when you’re still bleeding and cramping everyday. I was so incredibly scared to have this procedure done that I insisted it be done in the OR where I could sleep through it. Luckily this was accommodated. The OB who did it was fabulous and I even continued to advocate for myself by asking that the resident did not perform the procedure. After everything I’ve been through, if this procedure screwed up my uterus I certainly want to know that it was messed up by someone very experienced and not someone still learning. What a weird thought to have, right?!

I was so relieved to have the procedure over and done with yesterday that I was in a fabulous mood (after I napped for 3 hours). I had to have general anesthesia and a breathing tube due to heartburn, which was not something I wanted but it went fine so I’m just going to be thankful there were no problems. I am also so thankful that I didn’t lose my uterus. Being in the medical field, I just know way too much and I was so freaked out this would happen even though the risk is incredibly low. I certainly hope there is no scar tissue either.

Today I have no cramping and just light pink spotting. It’s glorious! I feel normal and it’s just so incredible to have my body be getting back to normal. Now I have to lose the last 10lbs of baby weight, but I can at least squeeze into a good chunk of my pre-pregnancy clothes. I’ve been running, walking and doing exercise videos with my husband to slowly get back into shape. It makes me feel so good. My husband and I both have noticed how we are in such better moods when we exercise. The mind-body connection is incredible.

Not a day goes by where I don’t think of Colton but I am no longer crying everyday. I do randomly have tears well up in my eyes and I also cry sometimes, but it’s much less frequent. I know that grief ebbs and flows and I’m pretty sure hitting all the milestones like the due date and birthday will be hard for me, along with lots of other random things. This is a part of me finding my new normal. It sucks that I have to do this, and I hate that I have to do this. Life is just so unfair.

Next week I meet with maternal-fetal medicine to go over the results of the stillbirth and figure out where to go from here. I already know there is no obvious reason for his death based on all the tests that were performed. However, I’ve crafted a list of questions to ask and I’m hoping to get something new out of our conversation.

Another date with misoprostol

As if the universe hasn’t dealt me enough shit already…

I passed some half dollar sized clots at 3 weeks postpartum, and had an ultrasound to make sure nothing was amiss at that time. I did not see my regular OB. Nothing was noted except a heavy uterine lining, which was expected. Relief overwhelmed me, because the doctor had to manually extract my placenta during my delivery, and I was expecting bad news.

I had my 6 week postpartum appointment today. Based on the fact that my bleeding has not lightened much, and in fact has become heavier and redder, I knew something was up, but I was hoping I was just one of the unlucky ones who bleeds a long time after birth.

As I undressed, I managed to bleed all over my legs, socks, and the floor. Glorious. Apparently there was a huge clot just sitting in my vagina making a mess everywhere. She removed it and took a quick look. Everything looked normal, and my pelvic exam was normal as well. Then she followed up with my gazillionth vaginal ultrasound.

The ultrasound showed I have what looks like some retained placenta. I have no idea how that was missed 3 weeks ago, but my OB said she looked at the previous picture and agreed nothing looked amiss there. My options are D&C or try misoprostol in hopes that it’ll cause enough contractions to get everything else out. I opted for the misoprostol, since I am intimately familiar with the workings of my body with this medication. I do not want a D&C if I can avoid it. At this rate I’m willing to bet my left toe that at my follow up next Friday I’ll still have some placenta in my uterus and I will have to have one anyway.

I had a whole host of questions about my stillbirth but the exam took so much time that I elected to save them for my follow up next week. We scheduled a 30 min slot before lunch to do a recheck and chat about the results. She provided me with the full report today so I can read over it and re-formulate my questions based on what I read.

Basically, there is nothing obvious that caused Colton to be stillborn. Maybe a cord accident, maybe placenta problems or a fetal arrhythmia. I wish there was a better answer. The ambiguity makes the next steps much harder for me.

I’m giving a huge F-YOU to my uterus right now. Feels like it just can’t do anything right.

The Worst Experience of My Life

Dear blog friends,

I am so sad to tell you that our beautiful baby, Colton, passed away and was born still on 2/24/2019 at 6:09pm. He was so beautiful and tiny, perfect in every way. My husband and I are devastated. I never in a million years thought I would experience this, even though I am intimately familiar with the risks of pregnancy, especially with my history.

I will be writing much more about the experience, the postpartum period, and what the heck we are going to do next in the coming weeks. It will hopefully be a therapeutic experience for me, and also I hope it will keep his memory alive.

Lastly, I hope with all my heart that if you have gone through this traumatic experience you know that you are not alone and I am so sorry to share this bond with you. The isolation is one of the most difficult parts, as no one knows him except my husband and I, and no one will ever get to know him.

Love,

RJ

Update and my mood

Hello everyone! Just wanted to say hi and that I’ve been enjoying all of your updates and commenting, but have not written one of my own due to sheer laziness. 

Baby A is 9 months and weighs in at 15lb 5oz…9th percentile. She’s so petite but super strong and has been crawling and pulling up since 7 months (she learned to crawl in Hawaii…so much for a relaxing vacation)! Now she has started to cruise and she can stand on her own for 5-10 seconds. She’s babbling a ton, says dadada but no mamama yet. We are eating tons of solids, and even starting to feed her from what we are eating. Still breastfeeding. All in all she’s so much fun!

Sleep in general has been difficult. This past weekend she took 2 1.5 hour naps in one day and that was a first! She sleeps 10-11 hours at night, and generally can put herself to sleep quickly after her bedtime routine with minimal crying. But we frequently get a wake up about 40 minutes after going to bed and she can scream and fuss for up to an hour and is incredibly difficult to console. Once we go to bed, if she wakes up we just bring her into our bed (as we are sharing a room in our 1 bedroom apartment and letting her scream doesn’t work for the neighbors or for our sleep). I just feel like the room sharing makes it really hard for her to sleep long stretches bc we disrupt her. But I’m just dealing with it bc there is no other option for now. I’m open to suggestions!

The sleep issues really get to me. I have such a hard time listening to her cry and I dread bedtime and nighttime. My back is also really sore all the time and I think it’s due to cosleeping bc I have to stay in the same position for too long. This makes me moody and cranky. I’m not exactly a pleasant person to be around and I feel like a bad parent bc my baby won’t sleep like a “good” baby. I’m also pretty lonely as it’s hard to make plans when you work almost full time and you’re obsessed with your baby’s sleep (I don’t like leaving to house bc I fear her not getting good naps and thus making nighttime worse for me than it already is). I have no clue if this classifies as mild PPD/PPA bc when I read about both of them I don’t feel I fit the description but I’m just not sure. 

So I’m looking for a weekly yoga class to get myself out of the house.  I’m hoping to meet some nice people and also help out my back pain. I’m also making a effort to go on a Mom date once a month. I did one in June and there is one in the works for July. Hopefully this will help!

Lastly I’m wondering when your periods came back. Mine is no where to be found at 9 months out. I would be ok with one baby but my husband really wants another so I’m willing to try. Since my numbers were heading toward DOR when they were tested 1.5 years ago I feel that we should try again sooner rather than later but that’s kind of hard to do when you still don’t have your period. Im guessing the night nursing is the problem but see above about sleep to guess how I feel about stoping that…….

Hoping everyone is doing well in their lives. I love reading your updates so keep ’em coming!

I was never a very good blogger…

Hello everyone!

First off, I am still following all of your journeys! Unfortunately I have still been struggling with my comments not loading. I have an email into support that will hopefully fix it. I think they are being recorded as spam! Maybe I am spam, but I certainly hope not! If you have a way to check your spam comments (I don’t even know how you would do this) and un-mark me as spam that would be awesome, otherwise you just get likes!

Secondly, I plan to still keep blogging occasionally to update on baby A and our potential escapades on TTC #2 (if that actually happens). I love following everyone’s journeys so even if I’m blogging infrequently, I will still be commenting (if my wordpress comment issue ever gets worked out).

Baby A is 3 months old now. She weighs 11lb 5oz, so 10 percentile. I think she’s just going to be a little lady for the foreseeable future. I’m hoping she continues to grow and thrive. We are still EBF. She frequently spits up so I assume she has silent reflux. It doesn’t seem to bother her so as long as her doctor is ok with her weight gain at her 4 month appointment next month, I’ll try not to worry too much about it. From 2 months to now she is gaining an average of 5.8oz per week.

She’s started rolling over from tummy to back around 11 weeks, but it’s fairly infrequent. She also seems to be trying to roll from back to tummy as she will arch to either side while she’s on her back. We get tons of smiles and lots of chatter, she’s so much fun. Her favorite activity is flying baby, where we play airplane with her up in the air. She loves the view from above! She also likes tummy time and music/dancing with Mommy and Daddy. Another favorite is bath time with Daddy, especially since he blow-drys her dry afterward. She LOVES the blow-dryer.

Sleep has gotten better now that we are co-sleeping (my pediatrician basically said that some babies are super high need and the only way to solve that problem is safe co-sleeping. He then said they co-slept with 2/3 of their kids, and he was always against it until he had kids of his own and struggled with sleep. He says that their 17 month old is still in bed with them. I don’t think I can go that long, but i’m hoping to at least get through until we can sleep train around 6 months. But my feelings on sleep training wax and wane so we will see what ends up happening). We use a snugglenest so she has her own space. Before that, she would only sleep maximum 1 hour in her crib or in a bedside co-sleeper before waking up and taking forever to go back to sleep. Now we can get a solid 4-5 hour stretch out of her (usually 11pm-3am). I try to put her down drowsy but awake for naps but she will only fall asleep on her own about 10% of the time. She only naps for about 40-60 minutes with the occasional unicorn nap for longer than 60 minutes!

I go back to work in a little over 2 weeks. We found a great in-home daycare on the way to my husbands work. She is incredible and I am so thankful we have her, as I feel comfortable leaving my baby with her. I just wish I had more than 16 weeks off with her (I am saving 2 weeks of my bonding time otherwise I could have had 18 weeks). I feel fortunate to have had this long, and all of it is paid due to me saving a ton of vacation (although let’s be real, the reason I have so much vacation is that it’s too hard to get time off of work approved because of union seniority..grr). Going back to work sounds good because I am looking forward to some adult time and using my brain in a different way, but I really just wish I had more time. I am also applying for new jobs that don’t have a weekend requirement as I would love to be off with my family on the weekends. hopefully that search doesn’t take too long!

Baby A got a cousin on my birthday in November! I’m honored to share my birthday with my niece. And we are super excited to have girl cousins (baby R was a wait until delivery to find out the sex). It’s been fun having my sister-in-law going through pregnancy and motherhood at about the same stages (she also suffered 2 losses before her successful pregnancy so we are able to support each other there as well).

In sad news, my grandfather and my husband’s grandmother passed away. My grandfather passed away in November and he had transitioned to hospice so it wasn’t a huge shock, although it has been very sad because of his passing obviously but also because my mom moved to southern California to care for my grandmother, and it’s hard having her away. My husbands grandmother passed away of a presumed heart attack on Christmas Eve, so Christmas was pretty awful this year. It was shocking that she went as she was only 76 and seemed to be in pretty good health. These things bring to mind the circle of life, in that we had our beautiful baby but life does not go on forever.

I hope you are all well.

 

A Cause for the IUGR

I had my 6 week postpartum appointment yesterday. Baby A came with me and screamed a lot. I ended up breastfeeding her while walking into the appointment room and during my pelvic exam…surreal. Everything looks good on my end!

We discussed several things throughout the appointment. 

•I expressed to her that I do not wish to be on birth control. Firstly, I am not convinced that it didn’t contribute to our difficulties TTC. Secondly, we plan to try again (although I cannot imagine that right now…more on that in another post). Lastly, I have switched to all natural products and I am not interested in introducing hormones into my body at this point. 

•She said that since I had an uncomplicated vaginal delivery we could try again as early as 6 months (I think that’s crazy).

•When my cycle returns and is regular, she can order a follow up FSH, AMH, and E2 so I don’t have to go back to my HMO fertility clinic right away. I am relieved about that (even though I had a pretty great experience with our RE). I’m wondering how those numbers will have changed a year or so after having them drawn. I also hope it will give us an idea of what to expect. 

•And now the main point of this post. The results of my placental pathology. It was small (as we already knew from looking at it after delivery). This could have been due to the UU (meaning the smaller size of my uterus) or uteroplacental insufficiency. The placenta showed signs of chronic uteroplacental insufficiency. Basically this means that the blood flow from my uterus to the placenta was insufficient for a good chunk of the pregnancy. Thus the IUGR diagnosis. I have lots of thoughts about this. 

Firstly, the baby was in the 38th percentile at the 20 week anatomy scan. That is normal. Then, right before 30 weeks at our growth scan, she was less than 3rd percentile. So things went wrong somewhere between 20-30 weeks. I stopped taking the baby aspirin at 28 weeks (which I was taking to hypothetically increase blood flow to my uterus…who knows if it helped. I feel it did help). I don’t think that would have affected growth that drastically in 2 weeks but I can’t help but wonder if I had stayed on it (or restarted it) if her growth would have been less restricted. 

Secondly, I wonder if the less than ideal blood flow had anything to do with my 3 miscarriages. I did not take aspirin until before the 4th pregnancy (which actually worked). I do have signs of poor egg quality with high FSH and boarderline AMH. All the miscarriages were missed, with no growth each time past 6-6.5 weeks. Could that have been due to poor blood flow and not egg quality? My gut says its egg quality. I guess we will never know but I wish we could. Too bad we were unable to test the embryos that miscarried.  

Thirdly, I wonder if the pregnancy being successful is because the embryo implanted in an area of the uterus that had better blood flow and the majority of my uterus has poorer blood flow. Those with a unicornuate uterus can have poor blood flow due to the abnormal formation of the uterus. Am I doomed to have tons of miscarriages? That remains to be seen.

Lastly, I wonder if I am lucky enough to get pregnant for a second time (and not miscarry) if this will happen again. And if not, how much more will my uterus grow? Can I make a bigger baby in my half uterus? It obviously stretched a ton this time but not like a normal sized uterus did. 

I made my OB cookies and wrote her a thank you note because she was so incredibly kind and supportive throughout the entire pregnancy. I know I was a high needs patient (for good reasons I think) and I wanted to let her know how thankful I am for her care. I ended the card saying “I am so thankful for my beautiful baby”, and I teared up as I wrote that. The gratitude I feel toward having her is immense and I don’t think I could put it into words. 

Our First Week Home

We had a lactation appointment and weight check the day after discharge. I was again in tears as I could not get her to latch once we got home. The lactation nurse weighed her, and she was 4lb 10oz, so gaining quite well and almost back to her birthweight. Then we tried to latch her. She was so frustrated and just wouldn’t latch. So the lactation RN gave me a nipple shield and baby A latched on immediately and transferred just under an ounce! I was so happy. 

My husband and I were confused as to why that wasn’t offered in the hospital. Well I researched nipple shields and realized that they are very controversial. If you don’t use the right brand, size, and place it correctly, you can actually decrease your milk supply. Also, babies can have a hard time weaning off of it. Still, it allowed me to breastfeed. Our schedule once she was nursing was for me to feed her every 3 hours (at least) and them pump after the feed to make sure she “emptied” my breast. She was also allowed to be supplemented with formula or expressed breast milk afterward. But she seemed satisfied after breastfeeding so we didn’t bother with supplementing. 

We went to the doctor for some discoloration around her lips and eyes. She looked blueish there and I was pretty sure she was ok, but I was so scared I had to get her checked out. Apparently it is normal in newborns due to thin skin and increased vasculature in those areas. She was weighed again and was 5lb 1oz! Passed birthweight at 1 week. I was very relieved. 

We had a follow up lactation appointment at the end of that week and she was 5lb 5oz! We were also able to latch her without the nipple shield, although it was a shallow latch and caused me some pain and nipple compression. The plan was to do some feedings without the nipple shield (as much as I could tolerate) and cut the pumping from after every feed down to 4 times a day. What a relief!

My husband also though it would be a brilliant idea to have his wisdom teeth removed in the 3 weeks he took off from work to be with me and our baby. Not the smartest decision we’ve ever made as he was in a lot of pain! And he refused to take the narcotic pain meds because he was getting a drug test the next week before he started a new job. Yup, that’s right, let’s make 2 huge life changes at one time…have a baby and make a career change! But his new job is way better, closer to home, better pay, better benefits, better hours, so it was the right move.  

Our Postpartum Stay

I’ve been wanting to write about what’s been going on but I have not made an effort! Here is an attempt to update on the last 5 weeks. The post was so long that I am going to break it up into several posts. This is probably fairly boring to anyone who is not me! But I would like this to remember the early days!

After baby A’s delivery we were transferred over to the mother/baby unit to work on breastfeeding and recover. Because of her low birthweight (4lb 13oz) she needed frequent temperature checks and blood sugar checks. Her sugars were on the low side of normal. The nurses said that my colostrum would be enough to sustain her sugars. Well, breastfeeding was a different story. Since she was 3 weeks early and quite small, she could not latch on effectively to transfer the colostrum, and she was jus biting my nipples. Ouch!! She had a sugar of 37 in the early evening. I nursed her and also expressed some colostrum (like 0.3ml) and fed that to her. Then nighttime came. Baby A screamed and screamed throughout the night. The kind of scream that hunger brings about. Now I know colostrum is suppose to sustain babies through the first days of life. The nurses tried to reaffirm that. But I truly believe our baby was starving. Remember, she was IUGR. She had not met her growth potential in the womb. She was ready to grow and to do that, she needed to eat. It was so difficult to listen to her scream and for me to be unable to sustain her. I was in tears for a large part of the night.

The icing on the cake was when they checked her sugar around 4am and it was 28. That is a scary low blood sugar. I know what happens to babies and kids when they blood sugar is low, that’s part of my job. I demanded formula to feed my screaming, starving child and the nurses were so hesitant to provide it. They took awhile to bring it which only made me more upset. It was incredibly frustrating to be made to feel bad for doing what was medically necessary for my baby. Hindsight tells me I should have demanded to speak with the pediatrician but I was so upset and sleep deprived that I wasn’t thinking straight. 

After feeding the formula she slept. It was such a relief. But then she woke up screaming again in a couple of hours. That was when I lost it and was just continuously crying. When the nurses came in for change of shift, they told me I would be the first patient to be seen by lactation that morning.

The visit from the lactation nurse was just what we needed. She watch baby A try to latch and agreed that she was too little and bite-y (is that a word?) to latch properly. So we developed s plan. I would try to latch her 2-3 times a day to practice. Then I would use hand expression to get out as much colostrum as possible. My husband would then finger feed her the colostrum and give her about a half ounce of formula while I double pumped to help bring in my milk supply. I was given a hospital grade pump to take home for 2 months. I was so incredibly thankful that we had a plan that my husband and I could agree with. I felt like my concerns were heard. The pediatric nurse practitioner was on board with us as well. 

We ended up staying an extra night to make sure she gained weight, as on the morning of our original discharge she weighed 4lb 7oz. We continued our feeding plan, and the next day she was 4lb 10oz and we were free to go. 

Overall the nurses were fantastic and I feel like we got great care, aside from the formula issue.