I was in the 25th week of my first
pregnancy and everything had been going
fine until one night, after dinner, I
went to stand up and felt a gush of
liquid rush between my legs. I tried to
squeeze my Kegel muscles, thinking I was
peeing, but that did not stop the flow
of liquid. It took me a few seconds to
realize my water had broken. I yelled
for my husband to call the doctor, "MY
WATER BROKE", and I ran to the toilet,
starting to cry as I knew something was
terribly wrong.
It was a twenty minute drive to the
hospital. The only words spoken during
that trip were when I said to my
husband, "You know this means we've
lost the baby". He just said "I
know."
When we got to the hospital, I just
knew my baby was dead. It wasn't until
I was hooked up to a fetal monitor that
I realized the baby was still alive. My
eyes never left that monitor afterwards.
Contractions started and were about 5
minutes apart. My OB arrived and found I
had not dilated, which was a good sign.
After an IV was hooked up, I started to
receive terbutylene, a form of
adrenaline, to stop the contractions.
During one contraction, the baby's
heart rate slowed to 40 bpm (typical
rate was 130 bpm). The nurse immediately
had me lay on my side (a position I
would stay in for the next three and a
half weeks)
I then got my first ambulance ride
to a Level III hospital (Georgetown
University Hosp. in Wash. DC) which
could handle a premature baby. The poor
paramedic, she was extremely worried
that I was going to deliver in the back
of the ambulance, so they were flying
down the road. I was more worried about
falling out of the gurney.
Once at G-town, I felt better
because the perinatologist laid out the
game plan. The terbutylene would
hopefully stop my contractions and then
I would just stay in bed, 15 weeks,
until the baby was born. The
contractions started to slow down, but
my heart was racing and my body was
trembling from the side effects of the
terbutylene. Premature rupture of
membranes (PROM-wow-finally a PROM
queen, 15 years to late) is believed to
be caused by an infection which causes a
weakness in the amniotic sac. There is
no way a situation like this could be
predicted because it was probably an
infection I never knew I had. My bed was
placed in a trendelenburg position so
that my head was about 1/2 foot below
the rest of my body (the bed was
slanted). This was to keep pressure off
of my cervix and avoid dilation.
After a couple of days, my condition
stabilized enough to move to the
antepartum ward where I would spend the
next three weeks. I was on complete bed
rest, I could not get up for any reason,
had to use a bed pan and everything
(just imagine trying to pee when you're
upside-down let alone into a bed pan).
Luckily I had a private room. Between
the terbutylene and the emotional
strain, I found it hard to concentrate
on anything, and I became a TV talk show
junkie.
I started a diary only because I
began to forget things, like if I took
my pills, when I last went potty (just a
note, when lying upside down, you tend
to lose feeling in many parts of your
body from lack of circulation, so I
never knew when I had to go to the
bathroom, I just forced myself to go
every 3 or 4 hours) I had weekly shots
of betamethasone. This is a steroid that
supposedly helps the fetus to mature in
utero. The shots were given twice a week
in the buttocks and the serum was
thicker than anyone's grandmammys
molasses.
After 3.5 weeks of bedrest, I
started developing bad gas pains which
were really labor pains. Back to Labor
and delivery and terbutylene by IV was
started again. I called my husband (out
on his bowling night) to tell him I'm
in labor again but we are trying to stop
it. I told him he didn't have to come
to the hospital, but luckily he decided
to come anyway. After 3 hours on the
terb, and no slowing of labor, the Dr.
wanted to do an internal exam.
Well Lo and Behold, I was dilated to
8 cm, there was no way we were stopping
this thing now. So off goes the terb and
on goes the pitocin (a drug to induce
labor). My poor body didn't know if it
was coming or going.
On April 16, 1994, after 2.5 hours
of pushing, Alexandra was born at 28
weeks of gestation. I didn't want to
watch her be born, but when she came out
she made a small squeak and I had to
look. She was a big baby (3 pounds, 2
oz.) for only 28 weeks. The neonatal
unit immediately intubated her as she
could not breath on her own. Her 1, 5
and 10 minute Apgars were 4, 6 and 7.
She was fairly stable but on life
support.
I saw her for the first time when
she was about 6 hours old. My first
sight of a NICU. I could not believe the
amount of equipment hooked up to one
little baby. She was lying on the warmer
with the bili-lights on her and the jet
ventilator tube stuck down her throat.
Bert had had the task of signing all the
medical release forms so I was unaware
of her condition and how bad it was.
When I asked her nurse, she just
said that right now things don't look
good but wait for the conference with
the Dr. The conference, about 6 hours
later, left me in tears. I didn't
understand a word the Dr. said. Only
three things stuck out. Something about
a hole in her heart, blood in her brain,
and a bad lung infection. Her lungs were
thought to have stopped developing at
about 25/26 weeks (when my water
broke-hence the betamethasone did not
work for her lungs).
At this point we were told she had a
40 % chance of surviving, and the next
three days would be critical.
Her first and second doses of
surfactant on day 1 were a failure. She
was on the jet ventilator at the highest
pressures and 100 % oxygen. If her
oxygen saturation levels (which were
between 85 and 92 %) continued to
decrease there was no possible way to
pump more oxygen into her. Her body
parts would begin to shut down in order
to conserve oxygen for her brain. Her
third dose of surfactant was luckily met
with more success (alot of praying
helped at this point). Her sats slowly
began to go up to 95 %. The hole in her
heart (actually PDA) closed on day 2 and
her brain bleed (IVH-grade 1) had not
changed in size by day 2. These were all
good signs. By day 3, we were reaching
the end of that critical 3 day period
and beginning to feel some joy in the
fact that our baby may live. The Drs.
gave her up to a 70 % chance of
surviving now.
To us this seemed like excellent
odds. Her oxygen requirements decreased
down to 40% yet pressures still remained
high. The brain bleed was gone by day 3
but had been replaced by tiny holes near
her ventricles (PVL). This was only the
beginning of our roller coaster NICU
ride of three steps forward, two steps
back.
Alexandra remained on the
ventilators for 6.5 weeks (jet 1 week,
conventional the remainder). She
suffered through pneumonia and a few
lung collapses. We thought she would
never breath on her own. She was finally
able to wean from the ventilator when
decadron, a steroid, was started. She
was switched to CPAP for one week, then
blow-by oxygen for a couple of days
until she only needed oxygen during
feeds. Finally, by week 8 we were giving
the prognosis that Alexandra WOULD live
and come home!
During her entire stay she had 3
lumbar punctures for suspected sepsis (2
of which occurred with middle of the
night phone calls), and three blood
transfusions (1 for high biliruben
levels and 2 for anemia problems). There
were also some hypertension problems
that resolved themselves after
investigating the kidneys by ultrasound.
She spent a total of 10 weeks in the
hospital and came home with an apnea
monitor (until she was one 1 year old),
oxygen (until she was 5 months old), and
her meds included aldactazide (a
diuretic), aminophylline (a
bronchodilator), nystatin (for yeast
infections), Zantac (for reflux) and 28
calorie per ounce formula (a limited
fluids diet due to her BPD).
We were unfortunate to be
rehospitalized her first week home, but
that was none of Alex's doing. Her
visiting night nurse overdosed her on
her aminophylline. After that incident,
all future nurses were not aloud to give
her medication without ME! double
checking the dosage.
Today at 2.5 she is a typical
toddler, who is a bundle of joy, all
kisses and hugs one minute then a
screaming maniac in the midst of a
temper tantrum the next. She has some
minor delays in her fine motor skills,
but all her other skills are on par with
her peers. She has been very healthy
with only the occasional minor cold.
Unfortunately though, colds last for
weeks on her and I think this may be
because of her BPD. Her other long
lasting effect from the BPD is a
terrible snoring problem.
Some stats for Alexandra:
reached 10 pound mark at 7 months
old
sat-up unassisted at 9 months
crawled at 12 months
walked at 13 months!!!! (couldn't
believe that one)
and first tooth at 16 months
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