First, the good news!
Katherine Bodhi Gray (tentative name)
born 3/31/08 5:09pm
21.5 inches long
9 lbs 13 ozs
I'm afraid I don't really have any great close up photos. We've been pretty busy round these parts and only have what our doula snapped directly after the birth. Hence the baby you see in these photos is still pretty gooey. You'll have to just trust us that she's beautiful for now. Tonight I hope to get the chance to hold her again, and I'll see what I can snap without disturbing her too much.
Labor was AWESOME! My water broke at around 2:30 Monday afternoon. I called Josh home and we didn't exactly run to the van, but we didn't piddle around much either. By the time we left, contractions were about a minute long but only a minute apart. But the time we hit Blackhawk (about 20 minutes outside of Rapid City where our hospital was) my contractions had turned into pushing. I just tried to chill and let my body do the work to prolong things as much as possible. I began active pushing as soon as we were in our room, and she was born 15 minutes later at 5:09. Lets hear it for SHORT labors! Whew! I figure that mom, dad and baby made a pretty outstanding team!
The bad news!
Katie developed some trouble breathing a few hours after birth. At first it presented itself as "singing" or grunting as she drew in each breath. From there it progressed to a lot of retractions and even some desats. Retraction is fairly obvious-you can see the baby's chest and stomach sucking in deeply for each breath. Desats are short for desaturation of the blood. Normally, practitioners like to see oxygen saturation levels in the 90's and there were times when her O2 levels would go down into the low 70's, and she would grey out before coming back up to higher levels. Her breathing wasn't consistent-she had some hitches and pauses. They transfered her to the Neonatal Intensive Care Unit at about 7pm for observation, and by 1:30am they hadn't seen any improvement in her, so they decided to put her on oxygen and start a round of antibiotics as they were concerned about the possibility of Group B Strep (GBS) infection. The round of antibiotics has earned her a three day minimum stay in ICU. They also ordered a battery of blood tests, cultures and x-rays.
Here is what we know now. Three different rounds of testing for white blood cell production show that her levels are elevated, but seem to be tapering off. We tentatively think this indicates that the production is due to stress, not infection. An additional test looking for inflamation in the body (also a sign of stress) seems to back this conclusion up. It takes 3 days for the GBS cultures to come back with preliminary results of infection, however, so we won't be sure until then.
An initial chest x-ray indicated some fluid in the lungs and a repeat x-ray this afternoon showed an enlarged heart. An electrocardiogram revealed that the enlargement was due to pulmonary hypertension, and NOT some dreaded defect in the heart itself. There is one area of the heart that hasn't closed as it should have, but they are expecting this to resolve on it's own in the next few days.
The heart itself is enlarged due to interuterine stress that has probably been going on in the last few weeks of gestation. Exactly what may have caused this is hard to say, but is apparently "commonly" seen in larger babies. The pulmonary hypertension is what is most likely causing Katie's breathing problems. It's been dumbed down for us and explained like this: The tiny aveoli in her lungs lie next to veins and capillaries. As she breathes in, O2 transfers from the aveoli into these veins and capillaries. The most efficient way for this to happen is if the veins are loose and open, lying closely against the aveoli so that a good transfer can take place. In Katie's body, however, the veins are constricted and lying further away from the aveoli, the body isn't making efficient use of the O2 coming into her lungs and she is forced to work much harder to saturate her blood stream.
We were hoping to see a bit more improvement in her this afternoon so that they might be able to wean her down a bit more from her O2. She had been doing well enough that they were only giving her a mixture of 26% O2 (room air is 21%) but she had some further setbacks early this evening. So, I beleive they are bumping her back up to 30% and have decided to begin actively treating the pulmonary hypertension with a drug. What drug you may ask? Brace yourself! Viagra. Yup! That's right! Viagra works to open up blood vessels, capillaries, and veins to allow the area to fill with blood more easily. What works for old men also works for little girls!
What is most discouraging about this is that while we got a wonderful nursing session in last night before these problems started, we haven't gotten to hold our girl since then. Essentially, we haven't had more than about two hours to get to know her. Stroking your sleeping baby's head around an IV in her hand, an OG tube down her stomach, three different sensors on her chest and abdomen, and another sensor measuring skin temp is a lot different than cuddling her and gazing into her eyes. In fact, they don't even really recommend that we touch her at the moment, as it just disturbs her into a more shallow sleep that prevents a deeper healing. We aren't hurting her when we do, but they don't really feel we are helping either.
I'm struggling to find a balance between what I see as an honest and basic need for her to have human contact and touch and a chance for her to rest and get her poop in a group. How much time should I spend in there with her? Am I a bad mother for staying away or am I doing the right thing? Fortunately, the NICU nurses have been pretty understanding. Guilt... the unavoidable baggage of parenthood. I've struck a balance so far by trying to be with her at the scheduled times when they will be checking her stats and changing diapers anyway. That way, I can sneak in some cuddle time, but it will be during points when she is already being disturbed-that way she's getting the maxium amount of rest in, and I still feel like she (and I!) are getting at least a bit of basic bonding time.
I'm extremely grateful to have gotten in some good nursing last night just after labor. She was a very hungry little girl, and latched on both sides for a good 20 minutes each followed by an additional short session later. Hopefully, that established a foundation for nursing later, and gave her a chance to snatch up some colostrum. She's recieving fluids, nutrients and fats through an IV. They really don't want to jeapordize her breathing by trying to have her suck at this point. For now, I'm pumping and saving every single drop of colostrum I get for when she CAN have it.
Shift change is almost over, and I get to go hold my little girl now. Our intentions are to post updates here, so check back over the course of the next few days to learn more.