April 21, 2010

At first I did not have the time, then I did not have the courage to write Natalie’s birth story. I felt the blog was incomplete without it, so last night I wrote what I most remember.

Steve and Anneliese came to visit on the 20^th. I remember the shirt I was wearing; it is the same one I wore the day she died. I sat in the recliner holding Annie and thinking I should take a picture of my belly. Then there was the usual hurried energy of Steve needing to get Annie home to bed and I thought I would do the picture tomorrow, all while thinking it may be too late.

It was good fortune that my overnight nurse was one I especially loved. There was a student nurse as well, and the three of us chatted at my 3 am vitals check. In the last weeks of my pregnancy I found sleep especially difficult and was often awake until 3 or 4.

All was well, and I tried to fall asleep. I went to use the rest room one last time, and what had been minimal spotting was now enough to be concerned about.

(because there was so little amniotic fluid my uterus could not hold its shape the way nature intended. this leaves the mother very vulnerable to the placenta pulling away and leads to blood loss)

I called the nurse, there was the usual response of finding a doctor to check me, although I do not remember much of it. Mostly I remember feeling out of control and calling Steve in a panic. He was going to find someone to watch Annie and come in. Maybe it was 5am? They were moving me to labor and delivery, which we had already done several times during my time there. Nothing different this go around, yet my nerves were on edge.

I remember that the nurse I trusted most to do my IVs was there, just coming in for day. So relieved at yet another stroke of fortune. Actually all my favorite nurses would be working over the next few days and I will always be grateful for the timing of her birth.

Moved to labor and delivery and started the normal drill of being monitored. The contractions were picking up and it was getting harder to breath through them. Steve arrived. The nurse asks if I want an epidural for the pain, and I thought it absurd. The contractions were going to settle down as they always did, I would be back in my room by evening.

The resident is checking again, and can not tell if there is dilation, but she estimates at least a cup of blood. I remember now that there had been so much more bleeding than ever happened before.

The OB comes in, and she is one I trust and adore. One more bit of fantastic good fortune. She says it is go time and I lose my control. I sob, I can’t catch my breath. She says she is sorry, she thought I already understood this would be it, but I am not ready. She asks if we want to wait a few hours and see what happens, but there is no point. We are never going to be ready, and it is only days before the scheduled delivery. The bleeding is picking up and I am afraid of both waiting and moving forward.

I look at Steve and say I want to decide her middle name before we go in. He agrees to Evelyn and it feels just right.

I know I asked for the chaplain to come, and almost instantly two gracious women arrive, we talk, we pray, they tell me when she is born they will stand in the back of the room and pray while the doctors work. I don’t know it, but they will spend hours with me in the months ahead, helping us move through time in unbearable uncertainty.  I meet the anesthesiologists. They are saviors, they protect my RSD leg and arm, they are not emotional but they are competent and make me feel secure.

I learn later that the OB had to explain to the labor and delivery nurses why my reaction is so emotional. That unlike other 33 week old babies, Natalie’s future is very uncertain.  (We had been told as low as 5%)

Our first neonatologist comes in. They have been expecting Natty for months and this doctor in particular had spent a long time talking with me in the last week of bed rest. I had asked her to attend the delivery, which now I know is unusual-the delivery team of fellows, residents and nurses is as equipped as a team can be and the attendings have more pressing concerns. Somehow I felt having a neonatologist right there would give her the best possible chance. The doctor is kind, and she agrees to be there.

I take her hand, I say “Listen, when she is born, when you see her, her name is Natalie Evelyn.” She looks surprised and says “I thought you were not going to tell the name until she was born!”

“Yes,” I answer, “but when you meet her I want you to know exactly who she is.”

 The OR, and this bright white room whose image is stark in my mind. The doctor asks if I will want to see her when she comes out. I say yes. Thinking to myself, of course!

We have been given several scenarios of how things may go...

She will be born with a chest that is visibly deformed and there is no chance of lung development. If this is the case they will provide comfort care and try to keep her alive until we can hold her.

She will be born and need extensive resuscitation. Despite those efforts she may never turn pink, never come around.

She may respond to their efforts and turn pink and vigorous. Then within an hour her first blood gas test may reveal that while she can oxygenate her blood she is unable to release the CO2 and she will not survive.

We have read so many stories from other parents. Particularly difficult were the times a baby oxygenated well, had great blood gases and then after 8 hours their lungs proved to be too rigid to keep up and the baby suddenly dies.

They place the spinal, despite my phobia of needles in my spine I don’t register the fear or discomfort. I drink something to reduce the acidity in my stomach. Minutes have moved quickly once the decision to deliver was made. I don’t know how I moved through that time and endured it.

I had wondered for months how I would survive her delivery. As much as I tried to prepare, in truth there is no way to prepare for meeting your child and not knowing if she will live or die. Somehow, I keep moving forward, keep following instructions. I am learning and learning that for your child you can do anything.

I am holding her inside; I have done more than anyone knows to keep her safe, protected from possible infection, trying to hold on to give her as much time as possible. Constant and steady.

Now I have to let go. I can no longer breathe for her. It is, up until that point in my life, the hardest thing I have ever done. I am letting them place her in harm’s way. I have no choice, yet I feel I am failing her deeply. All this time in the OR I am screaming silently in my head-begging them to stop, begging to be let back to my room so I can place my hands on my belly and be alone with my daughter.

Steve is on my left. The doctor has reached her and says “Oh, Jennifer, we made the right call. She is surrounded by a massive blood clot. They pull her free, lift our child up and clamp the cord. Natalie squeaks. I know it is at least twice. Then she is in the other room and Steve follows.  

He tells me she is pinking up. The neonatologist comes out, tells me what has been done so far, and her eyes crinkle above the surgical mask. She is smiling, Natalie is pink, she responded well to the surfactant, she is vigorous.

In my mind I am so acutely aware. I know this is the start, and it is exactly the best start we could have been granted.

Steve comes back and forth between his wife and his daughter. The chaplains come to speak to me. They tell me how strong she is, how beautiful.

The OB is talking about my uterus, it won’t contract the way it needs to for the bleeding to stop. She is massaging it, telling them to give me a shot to make it contract. He gives me the shot, and then maybe one more later. I am vaguely wondering if I will need a hysterectomy, if I will hemorrhage. I don’t care.

I am vigilant. My mind is so aware of my girl, always always always aware, monitoring, thinking ahead, trying to hold on to what there is. This is my life for the next 6 months. No matter where I am, what I am doing, my mind is with my daughter, always aware of her.

And now she is next to me, on her way to the NICU. Do I want to see her face? They pull the oxygen mask away for a few moments and we are on the moon. She is exactly as I imagined her to be, exactly who I knew was inside me. And she is pink. And moving.

Steve goes to talk to family. I am being stitched up, the anesthesiologist is remarkable and somehow knows just what I need.I am surrounded by people yet feel very alone, another feeling that will continue in the months ahead.

When Annie was born I held her on my chest and Steve walked beside me as we went to the recovery room. This birth I am alone. I remember one of my favorite nurses coming to sit with me, and I hope I told her how much that meant. I’ll never forget her kindness. She had tears in her eyes, and this is the first of the emotional responses to my incredible daughter’s incredible birth.

I am waiting....waiting for the CO2 results. Oh, if I had known. If I had known how these numbers were going to come to rule our lives, that this was only the first of hundreds.

But today, on her birthday, her CO2 is just what it needs to be. These lungs that have been the center of our world for months are going far beyond what anyone predicted.

I am wheeled by family on the way back to the room. There is joy. Annie sees me and doesn’t understand why she can’t come be with me. Her hysterical crying as I am being taken is one more piece of my heart being broken, of hating not being in control.

Steve and I sitting in my room. Natalie’s name is written on the white board, along with the number to the NICU. We are saying “it’s been 2 hours. 2 hrs 40 minutes. 4 hrs” We are waiting, because as much as we have been delivered a miracle we know there is no promise yet.

I am waiting to feel my legs so I can make the trip to the NICU. After 70 days of being an inpatient, I want to pull out the IV, pull out the catheter, get dressed and lock the doctors out of my room.

Being there the first time, taking pictures. Reaching in to touch her hand. She resembles her sister Annie so much, yet is her own. When we post pictures everyone will comment on how big she is, but in person my 4lb4oz daughter is as small as a baby doll.

We meet the fellow (neonatologist in training) who will be our touch point of the next few months. I immediately trust him and love his energy.

They’ve done chest x-rays. Her lungs look only slightly smaller than normal. Her blood gases are wonderful, her vent setting are going down at a steady rate. He predicts she will be on C-PAP overnight.

The neonatologist is glowing. “We do not anticipate her having more issues than any other 33 weeker.”

I can’t process this. I am making them repeat things, some laugh at me in the way you do when there is such joy.

The pride on my husband’s face. The way he looks at her, the way he talks to her, the way she has taken his heart. The nurses and doctors coming into my room to congratulate us. The palliative care doctor stopping in, and the smile on his face. How grateful he is too witness this incredible outcome. I am in awe of our miracle yet remain vigilant, watching for any threats to my daughter. I don't know when I will ever feel safe.

Steve stays in my room and I feel so grateful to be close. After being apart and carrying our own separate  breaking loads of stress, I had worried where we would find our marriage. Natalie arrives, and we fall right back into place as we have always been.

Waking up at 3 am to pump, and the NICU has just called. She is on C-PAP. The neonatologist tells me “it is just like that dream you had, just as you predicted”

All that April 21^st held for us in 2010 lives in our hearts always. We are grateful for these memories, grateful to have been part of Natalie's journey. It is sacred.