The Rest of the Story: Week One

During our childbirth prep class we did an exercise to rank the importance of different aspects of labor and delivery: c-section vs vaginal birth, pain medication or none, ability to move about freely, wear your own clothes, eat and drink, etc.  Obviosuly we all chose healthy baby as the utmost importance, and then most choose vaginal birth, then pain options, and so on.  As I stated previously I had my opinions on how I wanted things to go but knew that I had to be ready for the plan to not work out.  As I've already described it did not work out at all how I imagined or preferred!  After our last prep class I did decide that, more so than any aspect of labor and delivery, the most important thing to me was to successfully and exclusively breastfeed.  Maybe it is because the benefits of breastfeeding are numerous, or I knew that it was the one thing I, most likely, could control in a situation that often requires you to change plans.  I knew that I could make the best decision on how to nourish my daughter.  I knew it may not be easy, at first anyway, but I also knew that I was delivering in a Baby Friendly designated hospital (a rare designation to hospitals that adhere to the principles to successful breastfeeding) and that I would  have a lot of support both during my hospital stay and after.   I also came to the table well-informed from both my recollection from  nursing school, breastfeeding prep classess, and reading all my resources ahead of time.

So, fast forward to the arrival of my daughter and the first time I get to see her in the NICU, a few hours after delivery.  I'm desperately trying to get answers as to what caused this and what is exactly going on with her.  All I can  know for sure is that she is unable to maintain her O2 sats on her own and they are pretty sure that she has an infection from whatever I have been infected with.  She has an umbilical arterial line, a periperal IV, telemetry leads, continuous pulse ox, and O2 via nasal cannula (thankfully the Bi-pap machine didn't last long).  They have taken cultures of both my placenta and her blood and all we can do is wait and see.  We are both started on two IV antibiotic regimens. So I cling to the one thing that I thought I could control, "when can I nurse her?" knowing that we are already way past the first hour, which helps establish effective nursing.  Unfortunately the answer is, "as soon as the MD says it's ok, but not now because she can not maintain her O2 sats and suckle".  So that was my first blow to my breastfeeding dreams.  Next I zeroed in on the second nursing hinderence.  The dreaded pacifier.

All nursing resources will tell you to wait until breastfeeding is established to introduce the pacifier or bottle.  When I asked the nurses they said that of course they could not give it to her but it was used as comfort and also to give some glucose (which can act as an analgesic to newborns) while they were performing all there invasive tasks.  So, of course, my answer was "Yes, please, comfort her in any way you can". 

After our first moments together I return to my hospital room to try and get some rest (after being up for 30+ hours)  Of course that is easier said than done in the hospital, especially after the ordeal I had.  There were vitals signs and assessments every hour or so and once it was normal business hours, forget it, I was constantly being interrupted.  But, I guess it worked to keep my mind off of the fact that I did not have my baby with me.  Every sound of a baby crying out in the hall made me choke back tears as I was reminded that MY baby wasn't with me.  Then back to the business of breastfeeding, in they wheeled the hospital-grade breast pump and set me up with all the parts.  And thus commenced my first experience with breastfeeding.  Not cuddling my sweet baby while we tested the waters together but sitting in my hospital bed with sterile pumping equipment, feeling exposed and vulnerable and not unlike a dairy cow.  It was rough.  But, again, knowing that I could control how I would handle this I diligently pumped every 2-3 hours to help stimulate the colostrum and milk production and prayed that they would soon let Annalise and I practice together. 

As soon as I could stand again (walking was a different story) and had sensation in my legs we were back at her beside.  Things were stable for the moment but she was still not tolerating a reduction in her O2 levels.

 They did agree to let me hold her and do more skin to skin time despite her precarious umbilical line.  To have to ask to hold your own baby is an indescribable feeling.

They had started her on TPN (intravenous nutrition) and were watching her blood gases and labs closely (as well as mine) before committing to a diagnosis or plan of care.  She did have a small pneumothorax (possibly from the bi-pap machine) and fluid in her lungs from delivery (in a c-section babies don't get the squeezing of passing through the birth canal, which helps lung function) as well as heart murmer (which was not concerning at this time as it was most likely residual from fetal circulation).  I was then "instructed" that I needed rest too and took a few cat naps that day.

By day two things started to look up for both of us.  I got to take a shower and Annalise got to have her O2 removed, Way to breath little one! 

We also got to try nursing for the first time! I'll spare you the photos of that endeavor.  It didn't go amazingly well, but it went OK, which was more than I could hope for at that time.  If anything she had a voracious appetite and was just frustrated that there wasn't much happening in the way of production at that time.  I continued to pump and was ecstatic when those first drops of colostrum appeared in the pump.  I carefully extracted each drop with a syringe and proudly presented my 0.25ml to the nurses knowing that this was the "liquid gold" that would help to nourish my baby back to health.  I finally felt like I was successful at something as each pumping session yielded a little bit more each time.  AND we got to have our fancy surf and turf meal that night (a wonderful perk to having your baby at our local hospital!)

But, as with most difficult things in life, progress often seems two steps forward and one step back.  That night was probably the toughest for both Eric and I.  As Annalise became more alert she was also hungry from expending such energy during those first 48 hours and our nursing sessions were less than successful , as anyone who has tried to nurse a screaming infant can attest to.  It was after a particularly rough screaming patch that one of her nurses broached the subject of the 3rd dreaded encroachment to breastfeeding: Supplementation.  She said they can do either formula or donor breast milk.  I declined at that time rationalizing that "normal" babies wouldn't be getting full milk yet either so what was the big deal?  We would get through this.  In the meantime she would continue to get fluids and TPN through her lines.

The next day I dived right in to nursing, determined that I would be all she needed.  There was a saintly nurse that shift that really got me through the tough parts and frustration as well and we both improved with each try.  Things were looking up, until her IV came infiltrated and her glucose was below acceptable parameters.  At that point the choice was to immediatly get in a second line and resume the TPN that we had been trying to wean that day, or accept the fact that it was time to supplement.  The nurse gently reminded me that Annalise wasn't a "normal, healthy baby" and that she, although improving daily, still was probably feeling pretty crumby, based on her irritability.  So we consented to the use of donor breastmilk, and, again, my heart broke as we gave her a bottle filled with milk that wasn't mine.

Thus began our new routine to try and get her to nurse.  We would start with nursing, if she was calm, if not we would give 10-20ml to "Take the edge off", then nurse again, followed by more supplement if she wasn't satisfied.  Then I would pump.  This whole process could take an hour and half, only to repeat no more than 3 hours after the start of the previous feeding.  Needless to say we spent many hours in that 8x8 cubicle.  This day we also received the results of her latest CRP, which would dictate her need for antibiotics.  Much to our dismay it was 44, less than 10 is acceptable for newborns, so it was now set in stone that she would stay in the NICU until her 7 day course of antibiotics were complete (mine were completed after 48hrs since I had no further symptoms).  So that day was filled with ups and downs.  My emotions were all over the place and I had to force back tears and the urge to just cry my eyes out for hours anytime someone would ask how I was "holding up".  Having a baby in the NICU is HARD, even when you know she is getting better.

I was discharged two days before Annalise was scheduled to be but, luckily, the NICU has parent sleep rooms available as there was no way I was going home yet, especially considering the crazy nursing schedule  we were on.  So I moved from one hospital room to another, although the latter had a double bed and felt more like a hotel room.  I think we actually got some decent sleep that night (despite being awoken every 3 hrs or so).  My recovery was going fine, although my own well-being was furthest from my mind, my poor husband had to remind me over and over to get some rest, manage my pain, and take it easy.  Nurses are the worst patients.  I did have to start a course of oral antibiotics due to my incision developing what looked like the start of cellulitis, but it resolved quickly, thank goodness.

Each day Annalise got perkier and perkier.  She seemed like a completely different baby as her antibiotics started working and she started to feel better.

We all started to let out our collectively held breath and we neared closer to discharge day and things kept improving.  We even had fewer and fewer feedings that required supplementation, and when we did have to give a bottle it was of MY milk!  She passed her hearing screen, her next CRP came back within normal limits, and we got her car seat safety check completed.

All we had left to wait for was her last dose of antibiotics and then she was a wire-free baby for the first time since birth!

Annalise goes wireless

And then we tearfully thanked the nurses for taking such good care of both Annalise as well as her parents and set out to show her the world outside her nook in the NICU.

She didn't seem too upset by this turn of events.

Clothes!

So after the most traumatic week of our lives to date, we were finally home with our daughter, safe and sound.

I still don't have answers to what caused all of this in the first place.  All of our cultures came back negative, I never developed further symptoms after delivery to provide clues as to what the infection was.  I'll never know what caused my body to halt the progression of labor or what caused my daughter to require a week long stay in the NICU.  Here are the things I do know: I will be forever grateful towards the excellent team of nurses and doctors who cared for both Annalise and myself, I have never been more in love with my husband as I am now after weathering this storm together and seeing what an amazing man and father he is already, and our lives are forever changed by this amazing little girl, and I suppose that is enough.