Nick's Birth Story

 My complications with Nick first began when I was 11 weeks pregnant. Everything started the Friday before Fall Break, which was also the week of parent/teacher conferences (I was a third grade teacher at the time.) I was especially tired this week, and long nights at school meant my diet mostly consisted of snacks I could stash in my desk and fast food between conferences. I was already feeling some nasty side effects of this pregnancy-I had throw-up-in-the-shower-because-I-couldn't-make-it-to-the-toilet morning sickness clear into the third trimester, so severe that I eventually needed an anti-nausea medication for a bit early in the second trimester. That Friday, I was sitting on the couch talking on the phone, when all of a sudden, I began to bleed. I called the emergency hotline of my OB's office, and the triage nurse told us to head to the ER at St. Francis right away.

During the drive to the hospital, I assumed I was having a miscarriage, and began to think of how I would explain this to my five-year-old.  When we got to the ER, a nurse did a quick ultrasound-she was an ER nurse, not a Labor and Delivery nurse, and explained the purpose of the ultrasound was not to identify a specific problem, but basically to determine if the baby was moving and had a stable heartbeat. To our immense surprise, the ultrasound showed a squirmy, active fetus, whose heartbeat was pounding away just like it should. The nurse explained that everything appeared to be normal at the moment, but told us to make an appointment to see my OB on Monday anyways.

 A few days later, at this appointment, a more reliable ultrasound showed that I had what is called a Subchorionic Hematoma (or SH for short.) I know this is not the textbook definition of this condition, but it is essentially when blood gets trapped between the uterus and placenta, which causes otherwise unexplained bleeding. My doctor was not too concerned about this diagnosis-he explained that SH's are relatively common complications, and usually women will have one incident of sudden bleeding in the first trimester, but will have no other issues for the rest of their pregnancy, and the SH will heal itself by the 20 week ultrasound. Usually. SH's do slightly increase the risk of a miscarriage, so I was put on pelvic rest (no working out, no lifting anything heavy) and told to take it easy until my 20 week ultrasound.

For the next month or so, other than dealing with morning sickness that wouldn't let up, my pregnancy was uneventful. On a Sunday morning in mid-November, I woke up at about 1am to discover that I had had a second major bleeding episode. Thankfully, my in-laws happened to be staying with us that weekend, so my husband and I left our two other sleeping children and headed straight to the ER, who promptly sent us to Labor and Delivery. Once again, a quick ultrasound showed a healthy, growing fetus that was in no obvious distress, but it did show that a significant amount of blood was trapped somewhere in my womb. Because of the amount of blood that was evident in the ultrasound, I was admitted to the hospital for observation, and had my first appointment with the maternal-fetal medicine doctor (a high risk pregnancy specialist) the next day. This appointment showed that, at 17 weeks into my pregnancy, instead of healing, my SH had grown bigger and gotten worse. The doctor suspected the SH was to blame for the bleeding, and there was nothing anyone could really do about it. I was prescribed a week of bed rest to help encourage my body to begin healing, but was back in the hospital four days later with the same bleeding. I spent the week of Thanksgiving on bed rest again, but when I headed back to school the Monday after Thanksgiving, it seemed like things had calmed down. 

This brings us to the important week of December 11th. Early that Monday morning, I woke up to discover major bleed #4. We repeated what was becoming a familiar pattern for us: drive to Labor and Delivery in the middle of the night. Get a quick ultrasound to confirm that what we now knew to be baby Nick was not in distress and that I hadn't began to dilate (I never did.) Get admitted to the hospital until the bleeding stopped. See the MFM doctor to try and determine what was going on. I would spend the next five nights and six days in the hospital, which caused several important things to happen. First of all, at this point, Nick and I were officially stumping the doctors. No one could tell us why I was continuing to have this bleeding, but, since I was only 21 weeks pregnant at the time, there was nothing anyone could really do, as the age of viability for a fetus is 23 weeks. The doctors explained that if the bleeding were to cause me to go into labor, at 21 weeks, the baby would be too premature to survive, so there was nothing they could do to help Nick or I at the moment other than to wait and hope for the best. We were given a 50% chance of making it to 32 weeks, were told to plan for long term hospitalization at some point in 2018, and that, in order to help me stay pregnant for as long as I possibly could, I would go on bed rest for the remainder of the pregnancy. Since I was new to the school district I taught at, I did not qualify for FMLA, which meant I would have to leave my job for the rest of the school year. But, the most important thing to come out of this scary week in the hospital, was that, now that the doctors were more or less expecting Nick to be born prematurely, shortly after Christmas, I received my first round of steroid injections to help speed up Nick's lung development. This would show to be a massive blessing during our stay in the NICU, as Nick was able to breathe on his own without the help of oxygen after only a few days.

Christmas and the crucial month of January passed without any episodes. Fast forward to Tuesday, February 6th, approximately 8 days before Nick is born, when this birth story gets really weird. I had a pre-scheduled ultrasound and appointment with my doctor, and the ultrasound showed that the SH was completely gone. Vanished. It seemed as though not teaching and not having to be on my feet all day had allowed my body to finally itself, and the doctor said there was "nothing on my ultrasound that would indicate I wouldn't have a completely normal pregnancy," and that it "wasn't quite in the miracle category, but it was close."

That was on Tuesday-fast forward to early Sunday morning. I woke up in the middle of the night with an intense pain in the lower left side of my back. It felt as though someone was twisting a knife deep in my side. I called Labor and Delivery and spoke to the on call doctor, who told me to take Tylenol, drink a bottle of water, and call back if it didn't stop. I followed her instructions, and was able to go back to sleep for another hour or so, but the pain eventually came back. I headed back to the hospital, where I was strapped to a monitor to check for contractions. The monitor showed that I was having contractions, but they were anywhere from 10 to 4 minutes apart (re: I was not in labor,) and by that point, the pain in my side had dulled to more of an ache than a sharp pain. I was sent home and told to come back if the contractions got more painful. For the rest of the day, I continued to have uncomfortable pain in my lower back. I spent most of the day seated with my heating pad, and I would have occasional sharp contractions, but they were not the same type of pain I remember having when I went into labor before. We went to a family party and came home at around 7pm, and that's when the bleeding began again. Back to the hospital we went. This time, I was having consistent, labor-like contractions, and was admitted again and given a second round of steroids. The next day, we were told that I had finally had too many bleeding episodes, and would need to remain in the hospital for the remainder of my pregnancy.

This brings us to the day before Nick is born. I had an appointment and consolation with my MFM doctor, which changed my situation significantly. The ultrasound revealed that the pain I had Sunday morning was a mild placental abruption, which is when the placenta begins to separate from the uterus. This happens in the final stages of delivery, but, like in our case, when this happens prematurely, it becomes a big deal, because the baby is dependent on the placenta to stay alive. I also had a huge blood clot attached to my umbilical cord, and there was blood in the amniotic fluid. In summary, things were going south very quickly. That night, a nurse practitioner from the NICU came to talk to me about the possible risks of having a baby born at 30 weeks, and explained that the doctors would not induce labor unless either Nick or I was in distress because a crucial part of the baby's lungs do not develop until 32 weeks gestation. The plan was to try our best to hang on for two more weeks.

Throughout the night, my bleeding continued to increase. I called my husband at 4:00 that morning and told him to get ready in case they decided to induce labor. By around 9:00am on Valentine's Day, it was becoming obvious that my body could no longer stay pregnant. I signed papers consenting to a possible c section, and was told not to eat or drink anything in case I needed to be rushed into surgery. Finally, at 10:30 that morning, the doctor told me they decided they needed to get the baby out. Right now. After that, things moved very fast. As I was being prepped for surgery, my bleeding became severe, and I was rushed back to the OR. A very sweet anesthesiologist, who would talk us through each of the steps during the c section, administered the spinal block, and the surgery began at 10:50. Nick joined the world at 11:02, and was immediately handed over to the NICU team that was standing by. The c section lasted for another 30 minutes or so, and all the while, I remember being very tense as we waited to hear how Nick was doing. We were told he was doing great, that he was big for being a 30 weeker (4 pounds and 17 inches), and I was able to see him briefly as he was wheeled past us on his way to his new home in the NICU. After the c section was over, the doctor told us that the abruption had become significant, but that the c section had gone well. I spent the next few hours in recovery before we were taken to see Nick. I was not able to hold him, but I was able to touch his hand through the side of his isolette. 

I will write more about the first few days of Nick's life later, but, as you can tell from all of this, we got lucky that he was born exactly when he was. It's humbling and overwhelming to think about how many times we dodged a bullet in this pregnancy, and if things had gone just a little bit differently, things could have ended so badly for us. We have heard horror stories in the NICU about how some placental abruption cases end, and it's not an exaggeration that Nick is a true miracle baby. As hard as the NICU can be, knowing that we are one of the lucky ones makes the nights more bearable. More to come later!