NICU Baby

Since my sweet Hannah was born 5 weeks prematurely there were 2 NICU nurses waiting in the operating room for her arrival. After Dr. Rodriguez pulled out a crying baby she was handed over to Kerri and another nurse whose name I did not catch. These nurses were specialized for Neonatal Intensive Care. After Andrew snapped a couple of pictures and I got a quick look and a kiss, Hannah was whisked away to the NICU for observation. Andrew was able to carry her from the OR to the NICU. Originally (from my understanding) they didn't think she was too bad off. Yes, her lungs were underdeveloped and they had her in an oxygen 'bubble' for about an hour after birth. I don't know if this was to buy them time to prepare a more involved set up or if they genuinely thought she didn't need more intervention. But when my mom and Kristina went to see her she had minimal wires and tubes, mainly just a bubble.

A while later Donna, the nurse practitioner for the NICU, came to our room to discuss Hannah and her situation. We were given the estimate of a 2 week stay in the NICU. Despite being a heavy weight for a 35 weeker (she was 6 lb 5 oz while the average for her gestational age is about 5 1/2 pounds), her lungs were severely underdeveloped. She fell into a category of about only 10% of 35 week babies that have Respiratory Distress Syndrome. This is a lung disorder where surfactant, the liquid that coats the inside of the lungs and helps them stay open and move smoothly while breathing, is lacking. Without surfactant the baby has to work harder to breath, and in Hannah's case this was seen in her rapid, shallow breaths, grunting while trying to breath, and severe pulling in her chest muscles where she was having to pull hard for a good breath and the lungs were sticking.

We were told she had been put on a CPAP to help push additional air into her lungs and was delivering about 45% oxygen to her. She was being watched closely and if her breathing became any more labored they would intubate her (tube down her throat into her lungs to help inflate them) and surfactant would be added through the intubation. Thankfully it never got to that, and babies generally produce their own surfactant about 2-3 days after birth.

In addition to the CPAP she had an OG tube (orgastric tube) [the orange tube in her mouth being held down with tape] that delivered food into her belly and also helped suck out some air bubbles and gunk that were in her stomach. She had an IV to deliver iv fluids that kept her fed and hydrated for first bit of life. I don't think they introduced colostrum or formula into her OG tube until she was almost 48 hours old. The IV started in her foot but preemie veins are very small and weak and don't last very long, so she went through quite a few iv locations. She also had 2 lines going into her umbilical stump, one in a vein and one in an artery. These made blood draws easier (they were testing her blood gas levels every few hours) among other uses. The UVC (line in the umbilical vein) began inching into her liver so it was pulled after about 24 hours. She kept the UAC (umbilical artery catheter) for a little over 2 days. We were advised and consented to the insertion of a PIC line if need be. This would be a central line going into a main vein in her arm that would be longer lasting than the regular IVs that don't last very long. Again, like with intubation, we were lucky and thankful the PIC line was never needed. She also wore leads that continuously monitored her heart rate, breathing rate and oxygen saturation. She was hooked up to quite a few things. She also went through 2 days of photo therapy for high bilirubin levels, but this is extremely common in preemies.

Because of the magnesium I was on and being unable to walk, I wasn't able to see her until about 30 hours after her birth. And when I did see her, we couldn't hold her and were barely allowed to touch her. They wanted to keep her as unstimulated as possible to give her a chance to rest, sleep and recover.

Seeing her was a shock to my system. She was on her back and her breathing issues were more pronounced since we were able to see the forceful breaths she was taking and hard rise and fall of her chest. Even though I had heard what was going on, seeing my baby hooked up to so many monitors, tubes and lines and the struggle she had to take simple breaths of air was just heartbreaking. I cried. I apologized that I wasn't able to stay pregnant longer. I hugged Andrew and cried again. He had been visiting her throughout the day so he had see the machines and strained breathing already. I wasn't mentally or emotionally prepared for it. I trusted the NICU staff and believed that she would improve, but was fearful in that the first 72 hours are the hardest, and most dangerous for preemies.

On Friday, 9/12, they started giving her my breast milk through the OG tube. They gave her 10 cc of whatever I could provide and supplemented with a preemie formula for the rest, every 3 hours. She immediately seemed more relaxed and happier. The next day it was 20 cc. Then Sat night it was 30 cc. Sunday it was up to 40. I couldn't keep up! She was handling the feedings so well they increased her to what a full term baby would be eating at her age.

I finally got to hold her Saturday evening. We weren't expecting to be able to hold her for a while, but they removed the UAC Saturday morning, and transitioned her from the CPAP to a nasal cannula that evening. With these changes they felt she was stable and strong enough to be held. Andrew was taking a milk delivery down to the NICU for a quick drop off when the nurse asked if he wanted to hold her. Knowing I hadn't held her yet (and he had) he told the nurse we would love to, but he needed to get Mommy first! I was so surprised and excited it took everything I had to not run down the hall to her. And with a 4 inch incision and a bunch of stitches, that would have been a bad idea. I collected my emotions and we headed down.

I was discharged on Sunday, Sept. 14. Leaving the hospital without a baby was one of the hardest and most emotional things I've ever done. I cried, multiple times. It was great to be home, but a major piece of me was missing. We hung out at the hospital for the day and got as many cuddles as we could before leaving.

The entire NICU stay we were warned that it was all on her time table. She could do great breathing, but then get to the eating part and take weeks to learn it. One of the hardest things for babies to do, preemies in particular, is suck, swallow and breath at the same time. For a baby with lung issues, this can be a real hurdle. Not for our Hanny. This girl had plans of her own. She sabotaged an iv one day, so they decided to remove it and monitor her. She kept her glucose levels up for 3 feeds so they decided she no longer needed the iv fluids. They introduced a bottle a day or so later to see how she did. They moved her OG tube to her nose (making it a NG tube) to faciliate bottle feedings. A day later she pulled out the NG tube when a nurse had her back turned. Again the practioner decided to go with it and see how she did under close supervision. Hannah took every bottle feeding like a champ, showing she didn't need the NG tube anymore.

Wednesday, 9/24 when she was 1 week old they decided to let me attempt breast feeding. Getting milk from the breast requires a lot more work than from a bottle, so we didn't expect a whole lot. The hospital Lactation Consultant (LC) came to help us and worked with Hannah and me to have a successful first feeding. I came back that night to try again and she had no interest, but that was ok. We knew she wouldn't do perfectly every time. Thursday morning I returned and tried again with minimal success. But she had been doing so well they offered us the option to 'room in' with Hannah that night. 

Rooming in meant we stayed at the hospital in a room next to the NICU, with Hannah in our room as a trial run. She still had her heart rate and breathing monitors (3 small leads attached to her chest that ran to a small monitor), but we got to experience having a baby around! She also got to meet her grandparents from Florida, Andrew's dad and step-mom.

Mommy's 1st diaper change

 We got very little sleep that night, as expected. Partially because we had a baby with us, and partially because her monitors were acting up and going off all night for no reason. I thought Andrew might throw the display box out of the window! Despite a rough start with me getting the chills, running a fever and general flu like symptoms (yay engorgement/mastitis!) things calmed down and we made it. We took Hannah back to the NICU nursery early the next morning so I could go to the doctor and we could spend some time with Howard and Tammy.

Andrew had to work a double the next night so I returned alone for night 2 of rooming in and we had a girls slumber party. We both got more sleep that night. We also got the exciting news that she would be released Saturday afternoon! After a visit from Howard and Tammy that evening we tucked in, got some rest and geared up for an exciting Saturday! The NICU was really busy with an influx of babies so they didn't get her discharge paperwork ready until about 2:00 pm. We waited around to see if Andrew would be allowed to leave work for a short while to be a part of baby going home. Sadly CCF was understaffed and he didn't get to make it, so around 4:00 pm Hannah and I loaded up, and headed home.

After 10 long days in the NICU, our girl was being released. I was so excited and nervous all at once. Since Andrew had to work it was just us. When I got in the car a song by Drake was playing and the chorus goes something like "just hold on,we're going home. Going home." It was so fitting.

So there ends our NICU journey. 10 long days. Hannah dominated every obstable she encountered and did it faster than most of us expected. The nurses and doctors who took care of her when we couldn't changed our lives forever, and we are so grateful to them. She came home Saturday evening, just in time for my 29th birthday that following Monday!

Her Birth Story

I better get this in writing before any of the details slip away. This will be detailed. 

When my memory fails I want to be able to look back and remember.

On Tuesday, Sept 9, 2014 I had one of my routine, twice weekly prenatal appointments. I went in knowing my blood pressure had steadily been creeping up. My doctor said she was becoming less comfortable with me continuing the pregnancy. I was at risk and as we would be 35 weeks the next day, Hannah should have reached a point in gestation where most risks would be behind us. I told Dr. Rodriguez that if we were going to call it and be done I was ok with it. It had been almost 6 weeks since my hypertension problems started. We had gone farther than most people, including my doctor and myself, thought was possible. If it was time to graduate from pregnant to motherhood, I was at peace. I knew I would never make it to 40 weeks, but I was satisfied with 35.

The decision was made, I was instructed to head to the hospital, but given the ok to go home to get my final things together and wait for Andrew to get off work. A few hours later he got home, we loaded up the car, and headed to Shelby Baptist Hospital in Alabaster. We were assigned to room 10 in the back corner of the U shaped L&D unit, which we came to love because it was a quiet spot on the super busy unit. We settled in around 5:00 pm, met our nurse, Cathy, who is actually my friend Michele's step mother. We had a built in friend and person looking out for us which was great. Once we were in they started an iv for fluids, drew blood for lab work, fetal and contraction monitors were attached to my belly, blood pressure cuff on my arm and filled us in on what to expect.

Because my blood pressure was high (averaging about 160/105) I would be started on magnesium sulfate to prevent seizures. I would get a large initial dose called the "loading dose," then be on a continuous "maintenance dose" for a minimum of 24 hours after delivery. Because I was being started on the 'mag' I would have blood work done every 6 hours to make sure I wasn't getting too much. Magnesium can have a lot of side effects, and they are all pretty awful. During the loading dose I felt like I was on fire. I would feel a heat wave started at the base of my neck and travel down my body stopping at my butt. This continued for the duration of the loading dose, probably about 15 minutes. Because I felt like I was burning up I was shedding covers and still uncomfortable. Once the initial dose was administered and I was on the maintenance drip I thought, 'hey, this isn't too bad.' That would change quickly. One thing about magnesium is that it builds in your system. The more you have, the more you'll begin to feel the effects.

In order to get my body ready for labor since it was not prepared at 35 weeks, I was given Citotec, a cervix ripener, 3 times with each dose 4 hours apart. The first dose went in about 6 pm Tuesday, and by 6:00 Wednesday morning it was time to start Pitocin. Part of starting pitocin was being cut off from food and anything more than ice chips starting at midnight. They start Pit on the lowest dose (I think it was 2) and slowly increase it to the max dose, 30, depending on how your body and baby respond.

After being on magnesium for so long I was in what I've heard termed 'mag drag.' I had to have a catheter because I was a fall risk and no longer allowed to walk. I couldn't keep my eyes open. I could barely carry on a conversation. I fluctuated between burning up and freezing cold. I looked and felt like a heroin addict going through the nods. My mom and sister came to visit and I apologized and had Andrew explain that I could have about half of a conversation, but I couldn't keep my eyes open. Doctors and nurses would come in to check on me or explain something and I probably looked like I was totally unable to make an informed decision. In part this was true. Andrew was pretty much in charge and my go-to. I often pointed to him and asked him to speak for me. I have to say the worst part, by far, of my entire labor experience was being on magnesium. It was a game changer.

Dr. Rodriguez came to check my progress around 5:30 pm on Wed, 9/10 and said if I had progressed to even 3 or 4 cm we would continue forward and try for a vaginal delivery. I told her I hoped I hadn't made progress because I knew that I did not have it in me to attempt a vaginal birth. I was worn down both physically and mentally. And it's not like I'd been pushing for hours, but I was drained. She checked me and I had done aboslutely nothing. I was barely 1 cm. The magnesium is a fine muscle relaxer, given to relax the brain and prevent seizures (it's also given to prevent or stall preterm labor) and it had been cancelling out the pitocin I was being given to begin labor. My nurse said we could do this all night long and likely see no increase in dilation. It was like banging our heads against the wall and expecting a different result. With the news that my body was not moving foward, the decision to do a c-section was made.

From the time my doctor said c-section to the time I was on the operating table was less than an hour. Things went into hyper drive. A nurse anesthetist came in to explain everything involved with the spinal block procedure and to have me sign paperwork. Andrew was handed scrubs, I was taken off all of my wires and attachments and they started wheeling my bed out of the room. That ride was so surreal. I was so out of it, it was happening so fast, and I didn't fully know what was about to happen. I didn't really understand we were about to meet Hannah. Andrew was left out in the hall while they prepped me for surgery. I was wheeled into a brightly lit room that was much smaller than I would have expected. The sun was shining through a window high on the wall. "A beautiful day to have a baby," someone said. I had to transfer myself from my bed to the operating table. I thought they were joking. I hadn't moved from my bed in 24 hours. And now I had to scoot my dead-weight body one foot to the right. It seemed a monumental task. At this point I started asking where my husband was. He was still waiting in the hallway. Thankfully I managed to transfer to the table and was then instructed to hunch forward to receive the spinal block. This is similar to an epidural, except instead of a catheter being inserted and delivering continuous medicine in the lower back this is one shot of super powerful medicine that lasts about an hour to an hour and a half. It also numbs from breast down instead of waist down. They found the right spot, administered the shot and then laid me down rapidly. Pretty much immediately I felt a wave of heat come over my legs, then numbness, then nothing. It's like they were no longer there. My arms were laid out on either side of me and lightly taped down so I couldn't grab the blue curtain or sabotage surgery halfway through. Once I was numb and in place they let Andrew in.

I was prepped and ready. It was go time. I'd been warned in my groggy state that I would feel like I couldn't breath since my chest was pretty much paralyzed. They were right. I couldn't breath. Except I could. I was mentally telling myself, 'you're ok. you can breath.' They had an oxygen mask on me and I laid there, so out of it. Andrew was on my left side holding my hand and rubbing my palms. I was so tired I couldn't even rub his hand back. The anesthetist talked constantly, keeping light hearted banter going to calm Andrew and myself. He would have me squeeze his hand every now and then to make sure I could. My blood pressure was checked every 2 minutes or so. A few times I felt like I was going to throw up because of a blood pressure drop. They were giving me medicine for it and monitoring me so closely they knew I felt sick before I did.The incision was made and they told us it was almost time.

"Lots of pressure." Then crying. Lots of crying. I heard Hannah make her debut at 6:24 pm on September 10, 2014 with forceful cries. They called Andrew over to see her. I laid there listening to my baby and felt tears streaming down my cheeks. Through the haze of magnesium I could hear her. She was here. And she sounded healthy. Just replaying the sound now makes me cry again. They brought her over to me and let me look for about a minute and give her a kiss. She was beautiful. She was all bundled up and smooshed and so sweet. I have to admit the sound of her crying and that emotion sticks with me more than seeing her. I don't know why, probably thanks to the magnesium, but hearing her was more real than seeing her.

Andrew was able to take a couple of pictures of her and follow the nurses down to the NICU. Because she was a preemie the nicu nurses were on hand and ready for her. Off they went and I remained on the table, open, feeling like I couldn't breath and needing to throw up. I tried to throw up multiple times. But when your abdomen is paralyzed, you can't really vomit. My throat tried and I ended up just doing ridiculous motions that probably looked like a frog trying to catch a fly. They stitched me up, assured me the scar would be beautiful and barely noticeable and that I would be in a bikini in no time. Luckily I was not responsible for transferring back into the bed! I was put in bed, wrapped up and wheeled back into my room. My mom and Kristina were in the room when I got there, but I don't remember if I beat Andrew or if he was already there. We had decided no matter what he would stay with Hannah during her transition to the NICU. By then the magnesium had started to let up so I got about an hour of a semi-clear head. I had the shakes and was shivering uncontrollably and it felt really weird to not feel my lower body, but I'd take that over the mag.

She was here. I couldn't see her yet though. She was admitted to the NICU and I was left in my room to recover, be rehooked to the magnesium drip, and heal. Andrew, my mom and Kristina went down to peak at her in the NICU and assured me she was beautiful, brought back pictures and bits of information. Her lungs were underdeveloped, but her size was good. 18 inches and 6 lb 5 oz. That weight for a 35 week baby is big! I'd be scared to know what her full term weight would have been. It would be a few hours before we got a real update on her health from the nurse practitioner for the NICU.

I stayed in the hospital for another 4 days, allowing myself to heal and be as close to Hannah as possible. Her NICU stay is an entire other post, for another day. My birth experience isn't what I was expecting, but it brought me Hannah. The c-section wasn't bad and recovery has really been fairly easy. The magnesium was the only real negative to the birthing aspect (not counting NICU issues). But we are 2 weeks in with a healthy baby and how she got here just isn't as important as her being here with me as I type this. She was not concerned with blog posts.

Pregnancy: 34 Weeks and Bed Rest

Today we hit the marker my doctor didn't think we would make -- 34 weeks pregnant. When the GH (gestational hypertension) started almost 5 weeks ago she was highly skeptical that I'd make it to this point. The earlier in pregnancy that GH strikes, the faster it usually develops. We got about 3 really good weeks where I maintained at an almost normal blood pressure, then in the last 1.5 weeks it's started creeping up again so I was ordered to official bed rest. Bummer. But it really makes a big enough difference that we are hopeful we can keep Hannah incubating a while longer. My blood pressure measures about 155/100 when I'm sitting or standing, but if I lay down on my side or recline it drops to about 130/90 or less. So as of last Tuesday I am off work and off my feet until the little lady makes her debut. Thank goodness for Netflix and HBO!!

At the doctor this week we discussed our long term goals and decided that if anything changes in my symptoms (blood pressure increases, won't stay below 160/110 for any period of time, lessened fetal movement, protein in urine, headache, seeing spots, etc) we would induce immediately. Because we are past the major danger zone of preemie-hood there is much less risk in her coming now. If my situation worsens she would benefit more from being delivered rather than living in hostile conditions inside me. If nothing changes we will induce when I hit 37 weeks which would be Sept 24, give or take a day, depending on the doctor's schedule. We will set an official date this Friday. So as of now we know that Miss Hannah will be joining us on the outside within 3 short weeks. Holy cow. Didn't I just find out I was pregnant?!? Cue mini freak out.

Of course we are extremely excited, but faced with the reality of such little time it's a little surreal. This pregnancy has gone by really quickly. Especially since we will have 3 less weeks to prepare than most people. But we are so grateful we have made it to this point when many thought we wouldn't. The difference in her growth and development between now and when GH started at 29 weeks is huge. If born at 34 weeks she would be looking at a NICU stay of about 2 weeks instead of 2 months. We are hoping I can go to 37 weeks and almost assuredly be able to bring her home immediately, but we will roll with whatever happens. 2 weeks is a manageable amount of time.

How far along: 34 weeks!

Symptoms:  I walk really slowly these days. Partially because my body just doesn't move fast, partially because I'm trying to take it easy. It's close to being considered a waddle. I have very little room left in my body for my own organs so I get full very fast and never quite have a good deep breath. I can also feel my heart beat, almost like it's racing. The doctor assured me this is normal and due to cramped space and not high blood pressure. I get heartburn pretty easily, but a few tums usually does the trick.

Sleep: It takes a long time to fall asleep. I've started taking a half dose of benadryl the last few nights to help knock me out. Restless leg syndrome is about the most annoying thing ever. I have to pee every 1.5-2 hours, and getting in and out of bed and comfortable is no easy task. Rolling over is like an inchworm movement. Little by little. I never bought a pregnancy pillow so I use multiple regular pillows. Sadly this pushes Andrew out of bed most nights. He says he has more room on the couch. I feel bad but there's not a lot I can do to help it. Since I'm on bed rest I usually sleep in now because it helps pass time and I'm on my side, so double win. Figure I better sleep while I can before she's here!

Clothes: Another side effect of bed rest is less reason to get dressed in presentable clothes. Hence pajamas and house clothes. I try to put on a little makeup to make myself feel better and a little nicer to look at for Andrew. Figure if I'm laying around all beached I should try a little to look semi-attractive while doing it. haha

Cravings/Aversions: I don't get a whole lot of my cravings fulfilled these days since I'm stuck at home, but that's probably for the best. Andrew ran me up to the bank today and I did request a chocolate cake pop from Starbucks, so we stopped, got one for each of us and left. 2 bites in I realized there was wax paper inside of it. So we turn around to exchange it. Bite into the new one while sitting there and there's paper inside it. Bummer! Best guess is the batch was messed up somehow. So they trash the rest of the chocolate cake pops and I got a birthday cake one. Well it just tasted bad, so I never did get my craving fill of cake pop. That's what I get I guess! No aversions to anything really. Cold water is amazing, particularly around 5 am when my bladder needs it the least. But I wake up so thirsty and figure my body needs it so I chug away.

Movement: My body might not agree with pregnancy, but it does not seem to make a difference to this little girl at all. I have to get non-stress tests every week to check Hannah to make sure it isn't putting stress on her and every week the doctor comments on what a happy and active baby she is. Dr. Rod said, "She's always so happy and cheerful, just like her momma." Awww, thanks doc. But she's definitely a mover and shaker. She knows when the monitor is on her or when an ultra sound is going on because she starts moving and kicking the machine. Lots of wiggling, pushing out, tickling and hiccups these days. When she's pushing out I can push back at that spot and she'll pull back, then push out again. Stubborn already or just playful? She is very easy to feel from the outside these days. Last night Andrew and I were kind of cuddled on the couch and his forearm was resting against the side of my stomach. He could feel her kicking from just barely touching me. She's a strong little thing!

Random: She has started responding to the water hitting my stomach in the shower. We don't have a bath tub (2 showers instead) so I'm not sure how she'd act with that, but the warm water hitting my belly gets her going. She's had the hiccups a lot in the last 2 weeks. Guess she's practicing lots of breathing and sucking in there. That's a good thing!! After my baby shower last weekend there were about 8 of us hanging out talking in the living room at my moms so it was kind of loud. Despite it being a time when she usually sleeps the action woke up her. She knew there was a rowdy crowd hanging out and she wanted to be a part of it so she started going crazy. Everyone got a chance to feel some really strong kicks. Kristina held my stomach for about 10 minutes in amazement at how strong and active she was. Also the ultra sound technician is still saying she has lots of hair!

Her immune system started really developing last week and is no longer relying solely on the placenta, so if she comes now she has the basis to protect herself. We are past the point of requiring steroids to develop her lungs for early delivery. At 34 we are really passed the real danger zone for preemies. What a relief!! She would still be considered a preemie until 37 weeks, but she would fair pretty well from here on out. Woohoo!!
 
Baby Size: She's measuring about 5 to 5.5 pounds and approximately 18 inches long. One app said honeydew and one said cantaloupe. Either way, that's an oddly shaped baby!

Just under 3 weeks until we meet our little girl!!!