Thursday, October 11, 2012

I wish I had written this sooner as I worry now that some of the details are getting a little too fuzzy, but looking back a year later it all still seems so surreal. I wasn’t strong enough till now to do this, so it just had to wait.

A little background about me, ever since I found out as a child that tiny preemies could be kept alive in safe plastic boxes, I was fascinated. I went to the library and checked out every book I could find, I poured over newspaper and People stories about every set of multiples featured and longed for more details of these mysterious NICU stays. I decided I was going to be a Neonatologist.

18 years later my dreams had almost come true. I was in my last year of Pediatric Residency, married to the man of my dreams, and finally expecting my own baby. My experiences had led me away from planning for a career in Neonatology (I had found my calling as a General Pediatrician instead), but I had loved every minute in the NICU in residency. I loved saving the day by helping a baby take those first precious breaths. I found meaning in those early am hours writing pages of medication and transfusion orders diligently trying to save a tiny patient. But nothing was better than months later when I found out they had gone home. I also witnessed loss first hand. Gut wrenching, heart breaking, sob inducing, loss. Way more loss than I knew I could handle on a daily basis. Neonatology was amazing, but not the career for me.

These experiences armed me with information but also fear of the unknown as I faced my own pregnancy knowing all too well the things that could go wrong. I put on a brave face and told my colleagues, friends, and family that I was staying positive and focusing on how well it was all going, but having faced an early loss with my first pregnancy I was not in denial about the possibility of complications.

Weeks 16-19 were blissful. Morning sickness had finally abated, my belly was growing, and my face was beaming. Residency was drawing to a close and I felt on top of the world. I began noticing tightening of my belly periodically which I attributed to early movements. Over the next few days these sensations got more rhythmic, and I started to worry. I spoke with the OB triage nurse and she sent me in for lab work. It looked like I had a UTI. A week of antibiotics later and the contractions had not abated, so I went in again. My midwife told me that she thought my cervix was shortened so they sent me over to L&D, I was about 22 weeks along.

I called my husband on the walk over. I calmly explained in greater detail what I had hinted about in our discussions over the last few weeks. Our baby was pre-viable, if I went into labor now, there was little that could be done. Forever my rock, he assured me that things would be fine but that he would leave work in case. It was the longest elevator ride of my life. My thoughts raced thinking about the little wiggly being inside of me and the what-ifs. My heart was heavy thinking of all the internet friends whose stories started like this and ended in loss and heartbreak. I was one of the lucky ones. The exam had been wrong. My cervix was long and closed. They told me that this was my “new normal.” They said that if things changed with my contractions I would know and should come in.

The next few weeks were full of excitement. My belly seemed to grow by the day, my pregnancy passed that precious viability milestone, and I started a new job. I was again on top of the world. Then one afternoon the contractions picked up. I started timing them and was having them every 3-8 minutes and at least 6-7 times in an hour. I called my husband at work. He left immediately and we drove in to L&D in the city. They checked me and confirmed the regularity of my contractions. This time I was 1cm dilated. They admitted me even though I wasn’t changing my cervix to be careful.  I received steroids to help with lung maturity. They ordered the standard NICU consult. When two of my favorite neonatologists walked in I almost lost it. It was so surreal. They were sweet and supportive and told me to get back home ASAP. They went through things in detail for my husband, I wanted to make sure he heard the full talk. They tried many different meds but nothing consistently worked. I continued to contract but stayed a 1cm. Because my tracings also looked good they felt reassured and sent me home after 2 days.

I stayed on bedrest for about a week, only leaving the house one time a day for less than an hour each time. Friends covered shifts at work sending worried email encouraging me to do everything possible to keep my baby inside. I busied myself ordering things online for the nursery and using my precious daily excursion to buy things for the “Preterm Labor” bag I was getting packed, just in case. My contractions continued unchanged. At my follow up appointment we discussed the risks and benefits of bedrest and decided that going back to work while limiting standing and drinking lots of water was the plan that made the most sense. I went back to work and felt great to be moving again. My contractions remained unchanged and I was relieved. I was so exhausted from the sleepless nights and days of worrying that working again was a welcomed distraction.

On September 9th I slept in late. I slowly got ready for my afternoon shift, pausing to take a bump picture to post to my board on The Bump as I had many weeks before. Work was a little busy, but I managed to finish early. At home I changed into comfy clothes, ate dinner on the couch with my husband and turned on some mindless TV. Soon after dinner I had 3 contractions in a row that seemed different. I was breathing though each one and they were concentrated lower than any of my contractions before.  I told my husband to start timing them. After an hour of contracting every five minutes I got up to go to the bathroom and get myself ready to possibly go in. I was bleeding… a lot. I screamed for James to grab the bag and camera and threw on clothes.

The drive in felt like it took hours. I was cursing every red light and praying for my little guy to move and let me know he was ok. We rushed in to triage and they seemed a lot less concerned this time. They confirmed my contraction pattern and did an ultrasound. My cervix was long and my little man was moving like crazy. They said they were going to send me home. Just before I started to get ready to put my clothes back on the resident returned and said, “I want to do a pelvic exam just to confirm, is that ok.” She lingered a while and finally looked at me and said, “You’re 3 cm dilated. I think we’re going to keep you.” After a long discussion that I could last many weeks at 3 cm they transferred me to an antepartum room. They started magnesium, which they never had with my first admission since I was never in labor.

The contractions got steadily stronger and closer together. They checked me again and I was still 3cm but more effaced. This confirmed labor, but the team was still hopeful. The NICU attending came and talked with us, reassuring us that 29 weeks was much better than 27 weeks but still prepared us for a rocky start and lifetime risks of cerebral palsy, learning disabilities, and other problems. My husband stayed by my side squeezing my wrist to try to distract me from my contractions. I wanted to walk, scream, move, anything to make the contractions bearable but I was chained to my bed by the monitors and web of IV tubing. They flooded me with fluids and I dreaded to get up to go to the bathroom because every time there was more blood. I passed huge clots and panicked, my nurses tried to be reassuring.

Around 2am my husband hit his breaking point. He could no longer keep pressure on my wrist to distract me because his fingers were numb. He knew that my contractions were more frequent and lasting longer and he was worried. “They’re not doing anything. How long do they expect us to go on like this. I can’t take it.” We spoke to my nurse and she sent the team in. “You’re 6 cm dilated now” they told us, “there’s nothing we can do. Your baby is going to be born today.” I decided to get some pain meds and eventually an epidural so we could rest. They transferred me from antepartum to LDR. Reality hit.

We cried. We called our parents and asked for prayers. My dad and his wife promised to be on a plane within the next 24 hours. We slept.

I woke up with increasing pressure around 12:30pm. They checked me and I was 8cm. I cried some more. As I calmed I realized there was no changing the moment, no going back to the bliss of thinking this could all be stopped, that this wouldn’t be our story. I became resolved. I told my husband that we needed to cheer up and focus on our baby, this was his birthday after all. We talked to him, telling that he had to come out and be a NICU rockstar not a wimpy white boy (white males in the NICU have the worst outcomes). We told him how excited we were to meet him even though it was earlier than we had planned.

I stayed at 9-9.5cm for several hours. My water hadn’t broken and that was slowing my labor. I had lots of pressure and was freaked out that the delivery might happen quickly without the right people assembled. I had been to emergencies in the LDR rooms before and knew that they never went as well as when sick babies were greeted by a fully assembled NICU team in the safety of the resuscitation room that adjoined the ORs. My doctors agreed to move me into the OR and break my water there.
As they wheeled me down the hall, I yelled, “let’s go have a birthday party” and joked with the nurses about my “birth plan.” “I want immediate skin to skin, no bath for 24 hours, and exclusive rooming in. This ugly surgical cap was NOT part of the plan!” I knew if I wasn’t laughing I would be crying. As we settled into the OR, my thoughts raced to crash c-section I knew they were preparing for. I eyed the surgical tech in the corner of the room and willed her to stay put. They broke my water and his heartrate stayed up!

The pediatric team came in to say hi. The senior resident, who had been the year behind me in residency and the fellow, who had been my classmate, looked worried. “It’s ok guys!” I reassured them, “This little guy is going to be a rockstar!” The OBs told them to go and they would call them when delivery was more imminent, “We’re not going anywhere!” The senior resident said. I was immensely grateful. I knew how the minutes could drag by standing around waiting for a delivery while your mind raced to all the orders and notes waiting for you in the NICU, but their presence was reassuring. I trusted them.

The shrill ring of monitor alarms brought the OBs to their feet. My little guy’s heartrate had dropped as he was pushed further down the birth canal by my contractions.  “Time to push!” the high risk OB told me. As I pushed, the alarms sounded again, I backed off. “Harder” they yelled, and the contraction passed. This repeated 3 more times. Then they asked, “is there some reason you’re not pushing very hard? He’s very little, you should be able to get him out easily. He needs to come out now.” “But his heartrate keeps dropping” my voice quivered, “I feel like I’m going to kill him.” A look of recognition spread across their faces, they were treating a fellow healthcare professional who knew all too well what those alarms meant. “We’ll turn the sound off. We won’t let you kill him. Push with all your might and we’ll tell you when to back off.”

A few pushes later I felt his tiny body slip from mine. I looked down and my son, Henry Oliver, stared right back at me and then let out a scream. “Oh my God,” I cried, “He’s beautiful.” He let out one more tiny cry and was passed off through a window to the waiting NICU team.

The next few hours were some of the longest of my life. The NICU team worked to stabilize Henry.  He needed to be intubated and his blood pressures were low. James went to see him and came back with pictures. I was jealous. I went down to the NICU as soon as I was physically able, but the team was putting in umbilical lines so Henry was draped. I sat in my wheelchair for a while watching the numbers on his monitor go up and down, listenting to the familiar whoosh of the ventilator breaths, willing something, someone to tell me he was going to be alright. Heartbroken, I asked to be taken back to my room. I got there and broke down sobbing. He didn’t feel like mine, my baby. It felt like I was watching over another tiny patient.

Pumping became my solace, the one thing I could do, but even that was mostly discouraging. The next morning brought good news. Henry was doing better and would be extubated. Hours after being extubated his nurse lifted his tiny fragile body out of the protection of his isolette and placed him on my bare chest. As he wiggled into a position of comfort, I cradled his tiny bottom in my hand. Our heartrates both slowed and I knew it, he was mine. These were the tiny feet that kicked my ribs and this tiny bum was unmistakably the one that had been dancing inside me for months. I was his mom.

Update: After 38 days in the NICU, Henry came home. He has grown and thrived since and our lives couldn’t be better. Tomorrow we will celebrate his 1st birthday.

Precious and priceless so lovable too, the world’s sweetest littlest miracle is, a baby like you.

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