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The birth story of my son, born at 23 weeks

July 17, 2012  [warning: this post contains graphic birth details as well as dreadful looking pictures. Skip to the last paragraph or two if that sort of thing makes you uneasy.  Or skip this post altogether.]

The nurses and doctors had some serious talks with me today. About my water breaking. Did it really break? The test they normally do for this sort of thing would come back positive, because I had also had some spotting, probably because of loosening circlage stitches. But the volumes of amniotic fluid that they saw in an ultrasound made it look like I hadn't ruptured.  I still had lots of amniotic fluid.

No, I ruptured. I said. I was sure of it, I said.

Maybe I just peed, they suggested, it happens and it's nothing to be ashamed of.

But (without going into detail) the physics of that didn't seem right.  I think I muttered, "I didn't feel it in my pants..." I was sure I'd ruptured. What else would cause that pop and warm gush, even if it had stopped?

If you ruptured, they said, we have to let this pregnancy take its course at this point.  If contractions start up again, we'll have to let you deliver.  If you didn't rupture, we can perhaps consider other steps.

Maybe we should check, just to make sure I really did rupture. I said. Maybe I sealed back up.

They suggested an amniocentisus to put a dye into my amniotic fluid. It was a harmless dye. If it showed up in my bedpan, I had ruptured.  If it didn't, I hadn't, and my body would pick up the dye and I'd pee it out a few hours later.

At the thought of a large needle, I said, "well, but I'm actually fairly sure that I ruptured. So, is there any other reason we'd do this test?"

"It would allow us to look for an elevated white blood cell count in your amniotic fluid," she said. "It would give us early warning signs to see if you were fighting infection.  That would help us know if your baby is in a safe environment or not."

Maybe the leak had sealed and there was no sign of infection. That did it. Yes, I could handle a long needle. It meant that I'd have more information about my baby.  Maybe we could keep him in.

The needle caused cramping -- bad cramping. And any cramping was bad to me because I worried that it would throw me back into labor.  It didn't.  Just a few cramps that hour, and that was it.

The dye test failed. My body absorbed and voided the dye before we got a clear indication of output.
But the needle work was not in vain.

At around four or five in the afternoon they came back with the results. "You have an elevated white blood cell count.  We're discontinuing the magnesium sulfate." They unhooked the IV. Now my baby could come.

That's a bizarre situation. To go from worrying about every contraction to being told contractions were ok. I was going to have this baby. Probably in the next day or two.  I could have stood up and started walking around right then, but I didn't. It seemed odd, like turning on a dime when charging down a highway at 80 miles per hour.

My OBGYN dropped in. She told me I could labor naturally. I had wanted to have him naturally after a terrible c-section experience with my second. She also talked about possible c-section. She said that the high risk doctors were discussing my case and deciding what to do.

I asked if I could have food.  It had been two days.  If I was now going to birth this baby, it might be in a few hours or a few days and I needed real food in me.  I needed energy to endure it.

She chatted with the MFM doctors and came back with a "yes."  I ordered a large hospital meal and then, because I knew it'd take almost an hour for it to come, I sent Steve down to the food court to get himself and me some soup for a pre-supper snack.

The soup was great.  No sooner was it down my gullet than the door opened again and my OBGYN and the MFM doctor walked in.  They had just talked to the other MFM doctor, the one that had done my circlage, and he was not comfortable with the idea of waiting.

"Your baby is going to be born this week. He's in an infected environment, so the sooner he is born, the less likely he is to get sick."

"He's too little to get sick" I said. They agreed.

"We called the other doctor and discussed your case. He wants to do the c-section now, while the NICU staff is still fresh.  They just came on their shift." she said.

My flush face became even more flushed, I felt my skin prickle a bit, then I went white. We were delivering this baby. I looked at Steve.  He looked very brave and very worried simultaneously. He walked over and held my hand.

I've never delivered a baby because it was most convenient for doctors if I did -- but in this case, it made a lot of sense. Have a fresh, awake, alert team of people there to save my baby. I'd worked night shifts, and I knew that even though I got used to the schedule, at 2 am my brain wasn't at its best.  So, yes, I wanted the doctors and nurses to save my baby at 7 pm, not the same doctors and nurses at 2 am.

The OBGYN started talking to me.  Earlier that day he had been positioned head down, ready to deliver.  "If he's still like that," she said, "You have an option.  We can take out the circlage stitches and try to deliver vaginally, if it looks like he's coming. If not, I think a c-section would be the best course of action."

He had flipped.  He was now sideways, not ready to come out.

"I'm okay with a c-section," I told her.

"I think that'd be best," she said.  "We've done everything we can."

I'm not sure if it was said, but it was as if both of us had said "Let's get this guy out and give him a fighting chance."

"Have you eaten yet?" my OBGYN asked.

"Yes," I said, a bit downcast.

"What, and how much?"

"Soup," I said, "Just a small soup."

They discussed.  The risk to the baby was greater than the risk of me aspirating food after the anesthetic was administered.  I would be awake for the procedure, so if nausea hit, I'd be able to turn my head to the side.  Regardless of my small cup of soup, it was time.

We were going to have this baby.

The doctors left just as my food tray arrived.  The nurse suggested that Steve eat it.

"You'll have time," she said, "as they prep Laura.  You need your energy too."

He didn't feel he could touch it.  I didn't blame him.  Suddenly food didn't look so good any more.  After I left, though, it took a long time for them to call him back.  A really long time.  So he ate some of the meal.

They wheeled my bed away and put me on the surgical table.  Then they asked me to sit up for the anesthesiologist, so that he could put a needle in my spine. Sit up. I hadn't gotten out of bed in two days. The world seemed strange. If I sit up, then maybe this baby would come. But now they wanted this baby to come. The radical shift was difficult to comprehend.

I'm having this baby.  The little guy that's been kicking around the last few days. I'm going to meet him. He's too small.

The nurse helped me to a sitting position.  The anesthesiologist explained the procedure.

"I want to see the c-section" I told the anesthesiologist. A girlfriend had said she'd watched hers, and I thought it sounded like a good idea.  I needed to know this baby as much as I could. And besides, I was way curious about the c-section process.  Since I wasn't in med school, this was my only option for seeing one in person.  He told me he could get a mirror set up so that I could see my belly over the blanket they'd have up.

I'm going to have this baby.

They gave me a pillow to hug.  I put my head down, curved my back into a "C" and hugged the pillow.

I'm brave, I can do this.

No, I can't.  The world is spinning. I can't breath. Help, I can't breath. Maybe it was the food on an empty stomach, maybe it was nerves, maybe it was the sitting up.

"I don't feel good. My heart is beating too fast," I said.

"You're fine," my OBGYN assured me. "Your vitals look great."

"No," I said, "I'm not fine.  There's something wrong. My heart's racing. I can't breathe. I don't feel so great. I'm faint."

They told me I could lay down for a second. I did.  I felt a little better. And then the soup issue solved itself. My stomach was empty again, and I felt a lot better.

The anesthesiologist decided administering the medicine while I was in a laying position was probably the best course of action.

"I'm not sure I have it in me to watch the c-section after all," I told him, as I lay curled in the fetal position, clinging to a pillow, face white.

In the end, after I was opened up, as Steve was walking in, I changed my mind.

"I want to see the baby born," I said. He positioned the mirror so I could see.

Out came the tiniest baby I'd ever seen.

He let out a small, barely audible, squak as with jerking movements he flung his arms to the side.

"What's his name?" a nurse asked.

"Jonathan Amos" we said.

"Take pictures!" I said to Steve, "Lots of pictures."

I couldn't see Jonathan. Just doctors and nurses in blue surrounding him, a whole team talking to each other in a medical language I couldn't understand, and working busily on my son.  My husband was two steps behind with a camera, alternating between taking pictures and holding my hand or showing me the pictures.

My OBGYN came to my side of the sheet.

"Congratulations" is what she said.  "I'm sorry" is what her face said.  The sorrow in her eyes.  She didn't want this for me, either.

At that moment I was so glad I had such a good relationship with my OBGYN. I took her congratulations as genuine, her hope as sincere, her sorrow as deep and true. He weighed 1 pound 5 ounces.  He was about a foot long.

His APGAR score at birth was 2. Only his heart was beating.   HIs APGAR score at five minutes was 6. Everything was working, but barely.

Those five minutes were crucial.

Once he was stable, they put him in a transport to take him to the NICU.

Steve looked torn.

"Go with him!" I said, "I would feel so much better if I knew you were with him."

"We can lead you back down to her once you see him settled." the doctors told him.

After my son and husband left, the OBGYN came back to my side of the sheet.  She squeezed my hand. I was rolled off to the recovery room. I wasn't as shaky this time.  I couldn't even hold my second child after her c-section, I was shaking so hard. I was shaky this time, but not as shaky. I could have held him. But there was no baby to hold.

In the same recovery room four years earlier, I had attempted to breast feed my little girl.  I couldn't even feel my chest, but shakily I'd held her.  And then I'd laid her down in a baby bed next to me and stared at her as my body recovered from the c-section.  Steve would pick her up and hold her when she was awake. Or he'd hold my hand and feed me ice chips and bring me drinks.

This time I was alone, except for a nurse or two.  They brought me something to drink and held the cup for me.

Steve came back with pictures as soon as Jonathan had been settled in to his new room.  He wanted to be with me. He wanted to assure me.

He's still alive. He's doing okay.

"Do you want to see him?" the nurse asked.

"Yes, can I?" I said.

They wheeled my bed over to the children's hospital through back door passage ways and up to his room.  They pushed machines aside so that I could pull up along side his isolate in his room. The isolate looked like a plastic coffin to me. I told myself it was a womb. A womb outside my womb.  It would hold him for a few more months.  It was not a casket.

The neonatal nurse talked me through his breathing machine, how he was doing, his monitors, the booklets in the room, etc.  She explained that to him touch was too much.  It felt like fingernails on a chalkboard to his system, so they'd be touching him as little as possible over the next week or two.

Then she asked if I wanted to touch him.

I thought I'd break him. I didn't want to hurt him.

But I also didn't want him to die overnight without having touched him.

Steve brought me some hand sanitizer. There was no way to wash my hands. I lathered the sanitizer on and let it dry. I put my finger into the isolette and touched his knuckle.  His fist was the size of the tip of my finger. His skin translucent , stretched and shiny.

Hang in there, little guy, I thought, as I pulled my hand away.  Make it through the night at least.

They finally transferred me up to the maternal fetal medicine ward.  Steve stayed with me overnight. I tried to pump to start my milk going.  The pumping led to contractions which caused an alarm in my head "oh no, more contractions" - which I quickly silenced with "it's okay, he's out now."

Pumping while reclining is very hard. Pumps aren't made for women who have just had c-sections. Sitting up was very painful.  But my baby would have food. Colostrum was the best thing to start his digestive system working. I had to have some for him.  We put it in the fridge in my room and Steve brought it to the NICU the next time he went to visit.  The neonatal nurses were impressed that the colostrum came in without a problem. But my body had been in labor. It knew what came next. After labor comes milk. I wasn't so surprised.

I woke up to my nurses coming in to check on me at two in the morning.  I sat the bed up and pumped again. And I called the NICU. They said I could call any time. Jonathan was still doing well. He was still alive.

Maybe he'd make it after all.
Posted by Laura Maikata at 7:50 AM 


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