The further removed I get from River's birth experience the more I'm comfortable with actually speaking about it, and the more I actually come to terms with just how FORTUNATE we were with this little miracle. The reality is, his birth is a part of his story. Of OUR story as a family.
So. Now that River is nearly a year old I believe I'm ready to share with you, world. But, I hope you're prepared.
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| 36 weeks pregnant - four days before River was born. |
The night before River's birth was pretty ordinary. Nathan was working a Middle School dance so it was just Finn and me. I stopped by Sheetz on the way home to pick up dinner for us - a salad for me and a Mickey Mouse fruit pack for him. We ate dinner together and played with the Snapchat filters on my phone. We read, I tucked him into bed, watched some tv, and then went to bed myself.
Around 3 am I woke with the uncomfortable sensation that my right ear was clogged. For about a week prior, I had been dealing with fluid in my ear that would get worse during the night when I was laying down. This night, I was particularly frustrated because it was interfering with my sleep and I decided to take to Google to search for possible remedies. In the middle of my search I felt a strange popping sensation in my abdomen. It almost felt like a rubber band snapping. I lay there for a moment wondering if maybe it was the baby. Maybe he was kicking, or repositioning. But a few moments later I was hit with the realization that my water had just broken - at almost 37 weeks pregnant. I woke Nathan and called the on-call doctor to see what he advised. After describing the situation, he said, "Yep, sounds like your water has broken. Why don't you head on in?"
I called my dad ("Hey Dad... listen, either my water just broke or I just peed myself. Either way, can you come stay with Finn?"), finally got around to packing my hospital bag (HA), and took a shower. I wasn't having any contractions at this point and I was really scared I'd get to the hospital and they'd just tell me to go home because I'd only peed. #embarrassing
We finally made it to the hospital around 5 am. Because it was the middle of the night we had to enter the hospital through the emergency room. We walked in and the ER receptionist said, "Not another one! Are they expecting you?' I stood in the waiting room, embarrassed as at this point because there was zero questions as to whether or not my water had broken. The entire waiting room could tell.
I was wheeled back to the Labor and Delivery Unit and given my hospital gown. I apologized eleventy billion times to our awesome L&D nurse, Melissa, because, as it turns out, having your water break is pretty messy and she basically just had to follow me around as my own personal clean up crew. I got settled in my hospital bed, got hooked up to an IV and the monitor that recorded my contractions and the baby's heartbeat, and pulled up my computer to start working on sub plans for the following week. When I was finally checked, I was only about 2 (maybe 3?) cm dilated and 80% effaced. Still a very long way to go.
My contractions were still pretty infrequent, so Nathan and I watched a couple of shows on Netflix and I started updating a few people on what was going on. After a while, Melissa mentioned I could go for a walk to hopefully help my labor progress. Nathan was starving, and I was too, so I told him if he was going to eat he was going to have to do it away from me. Because my contractions were still pretty bearable, he left to eat and I started aimlessly walking the unit in circles. I'd walk by the nurses' station and look at the large TV that showed all of the contractions each woman in the unit was having. I'd take a guess at which one was me based of my last contraction and how painful I thought it was. The longer I walked, the more painful and regular my contractions became. My last few laps took much longer because several times I would stop and hold on to the wall railing and try to breathe through the pain. On one of my last passes, Melissa told me that whenever I was ready for the epidural to let her know. I told her I was ok so far, and began my next lap. By the time I made it back around I was ready. Fortunately, Nathan was just coming back in at this point and he was able to help me get back in bed.
The worst part about the epidural, both times I've gotten one, has been having to remain completely still while you're having contractions. Still, we got it done and after a few moments I had extra heavy sandbags where my legs used to be, and only a little pressure when contractions happened. This allowed me to rest for a couple of hours before it was time to start pushing.
After pushing for roughly an hour and a half, I finally asked in desperation, "Is this going to happen?"
The on-call doctor came in and decided to check. "You know," she said, "I don't usually tell people they can't have vaginal deliveries, But that's not how you'll be delivering this baby." After that, they started prepping me for a c-section. I texted my friends and family to let them know what was happening and we were left waiting for an available operating room.
Once I was rolled into the operating room and prepped for surgery, Nathan was allowed to come back. The anesthesiologist took a couple of pictures of Nathan and me as we waited to meet our newest little love. Before long, the c-section was underway. Though I didn't feel pain, I could definitely feel lots of tugging. It was a lot different than how I remembered my first c-section. The doctor said that things weren't right and she needed an additional doctor to come and assist with removing the baby. Finally, another doctor came in. I could hear them talking about how difficult it was and how it wasn't going as planned. There was lots of desperation in their voices, but I tried to be strong and brave and pretend I didn't hear any of it.
I knew something was extraordinarily wrong when I heard the nurses shouting, "Get the NICU. We need help NOW." I didn't even know that River had been pulled out. I started asking anyone that would listen if he was ok. Why wasn't he crying? My anesthesiologist stepped away to see if there was anything he could do to help. When he came back I asked him if River was okay. Was he even alive? I'll never forget him telling me, "You're my priority right now." What did that even mean? I burst into tears as Nathan kept telling me that it would be alright. Finally, after what seemed like forever, the NICU team arrived to take River away. They quickly held him up for us to see, and then just like that, he was gone.
The next couple of hours were so hard. We didn't have any answers about River. We didn't know his birth stats. And to be completely honest, we didn't even know if he was alive. People were calling and texting and we had nothing to tell them.
Finally, the doctor came in to talk to us. She said, "that was the scariest and most difficult c-section of my career." As it turns out, my uterus had a lot of scar tissue from when it healed from my section with Finn. Because of that, it had also contorted on itself, and basically folded over, which made getting River out extremely difficult. Also, due to my trial of labor and pushing, River had descended somewhat into the birth canal, and the only way to get him out was to go back up the birth canal and push him up and out. He was pulled out feet first. He was blue, and he was not breathing, which is why the nurses were so desperate for the NICU team to arrive.
River's first APGAR score was a 0. He was blue, no pulse, no heartbeat, and no reflex response. Five minutes later, he was a 4, with a heart rate of less than 100, irregular breathing, blue extremities, and no reflexive responses. Because he was born not breathing, they had his cord gases analyzed to determine how long he was without oxygen. This would give them an idea of the chances of River having any brain damage or other effects like Cerebral Palsy due to oxygen deprivation. Incredibly, River's cord gasses showed that though he was born not breathing, he wasn't deprived of oxygen during the delivery. Not exactly sure how that makes sense, but we'll take it. The doctor said that it meant River was born 'stunned.' Basically, she said, it's like jumping into an ice cold lake. You jump, and then it takes your breath away until your body tells you you need to get to the surface. She said that the traumatic nature of his entrance into the world caused him to need a few moments to figure it out.
The doctor also explained that because she had to go back up the birth canal to get River out, that the sterile field had been broken. She immediately started me on a triple antibiotic to hopefully curb any bacteria growth that could occur because of that. Finally, she wanted us to know that it was entirely possible that Nathan and I could develop Post Traumatic Stress Disorder from such a traumatic delivery, so she gave us some signs and symptoms to look out for.
Meeting River
Hours later when we were finally able to go to the NICU to see him for the first time, we were informed he was just coming back from an MRI.
"An MRI? For what?" I asked the nurse who was wheeling me over to see my sweet boy.
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| River - Born March 12, 2017, 7 pounds 5 ounces, 20.5 inches |
The next day, I was finally allowed to hold River for the first time. The feeding tube had been
rerouted down his nose and the nurse disconnected the tiny wires and placed him in the crook of my arm. I caressed his tiny face and tried as hard as I could to burn his little details into my brain. It wasn't until the transport team from MCV arrived that I started to understand that something was seriously wrong. No less than six people showed up to take one tiny baby. My tiny baby. "Why are there so many of them?" I remember asking Nathan as we, and the rest of the NICU ward, watched them load River into the mobile isolette. We were given some information regarding how to find him at MCV, and just like that, River was gone and I was left without my baby.
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| Holding River for the first time |
Because I had not yet been discharged from the hospital, I was taken back to my room to wait. Wait for what? Nathan and I decided that he needed to go to MCV to be with River and figure out what was going on. I would be fine. After all, I was just waiting. What could go wrong?
My Recovery
Meanwhile, I was determined to get out and get to my baby. I was told the fastest way to get healing was to get up and start walking. Nathan I would take my IV pole and walk in circles around the postpartum unit. On one walk on Sunday, March 13, I started to feel cold. Like, freezing cold. I told Nathan that I wanted to go back to the room so I could get back into bed and crawl under the covers. I couldn't stop shaking. My nurse came in and took my temperature. It was over 102.5. My heart rate was in the 90s. My blood pressure was low. And my oxygen was in the 80s. I remember watching the nurse as she looked at all of the out of control stats and immediately called my regular OBGYN, Dr. Murray. She came up and examined me. They gave me Motrin to break the fever and heated blankets to help warm me up. Dr. Murray arranged for a consult with an infectious disease doctor, who came and took blood and examined me further. Within a couple of hours, my fever had broken and my stats seemed normal again. It seemed as though the issue had resolved.
The following day, I had another episode. This time, I woke from a nap and knew I was running a fever. I called a nurse in and she took my temperature - 103.2. My oxygen had dropped again, my blood pressure was low, and my heart rate was over 140. This time, I was immediately transferred to the Surgical ICU to be more closely monitored, especially because no one knew what was happening to me. On the transfer, I half-jokingly told my ID doctor, "Please don't let me die." His response made my hair stand up, and still does to this day. He said, "I'm going to do everything I can." Ok, so this must be pretty serious then, I suppose.
Once in the SICU, I had leads placed to monitor my heart activity and given oxygen. I had more blood work completed and was left to wonder what the ever loving F was going on. In the next couple of days, I had two chest X-rays that showed a collapsed lower lobe of my lung, a heart echo that was clear and two ultrasounds of my legs to rule out blood clots. I spent a few days in the SICU just waiting for answers. And it turns out in the SICU, no one wants you to be independent. You have to call to get out of bed. You have to call to go to the bathroom. You have to call to do anything. It was the worst feeling to be so helpless. Also, though I was in the SICU, I was still recovering from a c-section. I was SO lucky to have a nurse for a couple of nights who had previously been a L&D nurse, so she totally understood my needs. She was absolutely amazing and would come in just to chat with me. She saved my sanity more than I think she will ever realize.
Finally, my ID doctor came in and told me good news - my blood was growing bacteria. The bacteria was later identified to be E coli, and I was given a diagnosis. Sepsis due to E coli with atelectasis. Ugh, just typing that out gives me chills. Once the bacteria had been identified, my antibiotics were switched again to Levaquin to target the infection more precisely. I was given an incentive spirometry to help strengthen my lungs and reinflate the lobe that had collapsed. After another day, I was moved back to the postpartum unit to continue monitoring on a less intense unit.
As the days ticked by, mentally I was going crazy. I hadn't seen Finn since Sunday as he got sick and couldn't come visit. I hadn't seen River since Sunday, and couldn't keep up with what he was going through being so far away. I disconnected from everyone except Nathan and my immediate family. I stopped answering calls and texts because I couldn't bring myself to talk about the hell we were going through. People wanted to know about River and I had no idea. People wanted to know about me and I didn't want to talk. I felt as though I would never leave the hospital.
Then, on March 18, I was finally discharged after having all of my stats stabilized and within normal limits for a couple of days in a row. I had to make several follow up appointments for the next week and sent home with a two week course of Levaquin, but I could actually go home. Nathan picked me up and we went straight to MCV to see River.
River's Recovery
At MCV Children's Hospital, River was seen by Dr. John Collins, a Pediatric Neurosurgeon. He examined River and told us (well, he told Nathan and my dad, and then they called me and filled me in) that River had a depressed skull fracture that was somehow obtained during my labor and delivery of him. It was the first time they used the words 'skull fracture.' My infant had a SKULL. FRACTURE. River would require a few days of observation to make sure that he didn't have any seizures and to ensure that the fracture didn't impact his brain. He was also jaundiced, so he required time under the bili lights to help his bilirubin levels.
Finally, on March 16, River's brain was deemed clear of any impact from the skull fracture and Dr. Collins was ready to discuss treatment options to fix it. I was still in ICU when Nathan called me with Dr. Collins on speakerphone so I could still be a part of the discussion and decision. Dr. Collins presented us with four different options.
1. We could try a procedure he called the "pop out" where they use a hand-held vaccum to suction the skull back into place. The problem with this was that there wasn't much research out there to support it and he had personally never done it. The upside to this option was that River wouldn't have to be put under, but it had to be completed within the first seven days of life.
2. They could put River under and make a small incision in his skull, then use a tool to "pry" the skull back into place. River would have to be put completely under general anesthesia for this procedure.
3. They could cut the portion of River's skull that contained the fracture and flip it upside down, so that the fracture was now inwards instead of outwards. Obviously, this was the most invasive option presented.
4. We could wait and see what nature did on its own as River grew. Baby skulls are highly malleable and it was possible as River's brain grew it would naturally fix the fracture. The biggest problem with this option, however, is that if it did not naturally fix itself we would have to then go to option three, where his skull was cut and flipped.
It seemed like a no-brainer to Nathan and I to try the least-invasive procedure first, which was the "pop-out" procedure. Dr. Collins made it very clear to us that results were not guaranteed, and that he had never personally done it. Still, we felt it was the best option for our five-day old baby.
The following day, March 17, River had his procedure. With only an anti-anxiety medicine, River's skull was successfully pulled back into place with a hand-held vacuum. River now required 48 hours of observation to ensure the vacuum didn't cause a brain-bleed, but he was well on the way to being discharged.
After my discharge on March 18, I went straight to River. It felt so strange being there at MCV. Nathan had his wristband and chatted with the nurses that he'd gotten to know over the past week. He showed me how to scrub in order to get into the NICU, and helped me get a wristband to show I was River's mother. Finally, he took me back to the room where River was. When we walked in, River was swaddled and sleeping. A nurse came in and looked him over and told us that he would need to eat soon. When he woke, I held him and fed him for the first time. Dr. Collins came in and spoke with us a bit more about the success of the procedure. He told us he had read all of the medical journals he could about using hand-held vacuums for this sort of thing, and had reached out to another doctor that had performed a similar procedure with success. He said that infants born with depressed skull fractures were incredibly rare, so there wasn't much to go off of, but he was happy with the results. As were we. When you looked at River, you could never tell his head had been fractured at all. It was amazing and we can never fully express our gratitude and thankfulness for Dr. Collins and the entire NICU team that took care of River while he was there at MCV Children's Hospital.
River was ready for discharge the following day, on Sunday, March 19. We loaded Finn up and took him to Nathan's parents so we could head downtown to bring our baby home. We scrubbed up, signed in, and went into his NICU room one last time. We fed him, changed him, signed lots of papers, and finally brought our littlest love home to start our lives as a family of four.
One Month Later
A month later we returned to MCV to see Dr. Collins for a neuro follow up. Once we were checked in, we were greeted by a member of his staff who had seen River while he was in the NICU. She was marveling at how well River seemed to be doing and told us that since River's procedure, Dr. Collins had actually used the hand-held vacuum to fix another skull fracture in an infant. Our River was a pioneer! Dr. Collins came in and measured River's head (which he explained would be the best way to ensure all was well with his fracture and brain development) and asked us questions about him. He then pulled up River's MRIs from the night of his birth and compared it to an MRI that he had the day after his pop-out procedure. The images are incredible to see. And even more incredible is knowing our little boy has NO neurological effects because of it. Dr. Collins called him, "a miracle baby." To hear those words from a Pediatric Neurosurgeon was eye-opening, to say the least.
We still aren't 100 percent sure what caused River's skull fracture, or caused me to have an E coli infection in my gut. We have theories and guesses, none of which can be confirmed, but we are so, SO thankful to have a beautiful, healthy, happy nearly ONE year old, and equally thrilled that I'm here to tell the tale. We may have had a rough start to his life, but we're ready to spend the rest of our lives loving our little red-headed miracle baby.
My Recovery
Meanwhile, I was determined to get out and get to my baby. I was told the fastest way to get healing was to get up and start walking. Nathan I would take my IV pole and walk in circles around the postpartum unit. On one walk on Sunday, March 13, I started to feel cold. Like, freezing cold. I told Nathan that I wanted to go back to the room so I could get back into bed and crawl under the covers. I couldn't stop shaking. My nurse came in and took my temperature. It was over 102.5. My heart rate was in the 90s. My blood pressure was low. And my oxygen was in the 80s. I remember watching the nurse as she looked at all of the out of control stats and immediately called my regular OBGYN, Dr. Murray. She came up and examined me. They gave me Motrin to break the fever and heated blankets to help warm me up. Dr. Murray arranged for a consult with an infectious disease doctor, who came and took blood and examined me further. Within a couple of hours, my fever had broken and my stats seemed normal again. It seemed as though the issue had resolved.
The following day, I had another episode. This time, I woke from a nap and knew I was running a fever. I called a nurse in and she took my temperature - 103.2. My oxygen had dropped again, my blood pressure was low, and my heart rate was over 140. This time, I was immediately transferred to the Surgical ICU to be more closely monitored, especially because no one knew what was happening to me. On the transfer, I half-jokingly told my ID doctor, "Please don't let me die." His response made my hair stand up, and still does to this day. He said, "I'm going to do everything I can." Ok, so this must be pretty serious then, I suppose.
Once in the SICU, I had leads placed to monitor my heart activity and given oxygen. I had more blood work completed and was left to wonder what the ever loving F was going on. In the next couple of days, I had two chest X-rays that showed a collapsed lower lobe of my lung, a heart echo that was clear and two ultrasounds of my legs to rule out blood clots. I spent a few days in the SICU just waiting for answers. And it turns out in the SICU, no one wants you to be independent. You have to call to get out of bed. You have to call to go to the bathroom. You have to call to do anything. It was the worst feeling to be so helpless. Also, though I was in the SICU, I was still recovering from a c-section. I was SO lucky to have a nurse for a couple of nights who had previously been a L&D nurse, so she totally understood my needs. She was absolutely amazing and would come in just to chat with me. She saved my sanity more than I think she will ever realize.
Finally, my ID doctor came in and told me good news - my blood was growing bacteria. The bacteria was later identified to be E coli, and I was given a diagnosis. Sepsis due to E coli with atelectasis. Ugh, just typing that out gives me chills. Once the bacteria had been identified, my antibiotics were switched again to Levaquin to target the infection more precisely. I was given an incentive spirometry to help strengthen my lungs and reinflate the lobe that had collapsed. After another day, I was moved back to the postpartum unit to continue monitoring on a less intense unit.
As the days ticked by, mentally I was going crazy. I hadn't seen Finn since Sunday as he got sick and couldn't come visit. I hadn't seen River since Sunday, and couldn't keep up with what he was going through being so far away. I disconnected from everyone except Nathan and my immediate family. I stopped answering calls and texts because I couldn't bring myself to talk about the hell we were going through. People wanted to know about River and I had no idea. People wanted to know about me and I didn't want to talk. I felt as though I would never leave the hospital.
Then, on March 18, I was finally discharged after having all of my stats stabilized and within normal limits for a couple of days in a row. I had to make several follow up appointments for the next week and sent home with a two week course of Levaquin, but I could actually go home. Nathan picked me up and we went straight to MCV to see River.
River's RecoveryAt MCV Children's Hospital, River was seen by Dr. John Collins, a Pediatric Neurosurgeon. He examined River and told us (well, he told Nathan and my dad, and then they called me and filled me in) that River had a depressed skull fracture that was somehow obtained during my labor and delivery of him. It was the first time they used the words 'skull fracture.' My infant had a SKULL. FRACTURE. River would require a few days of observation to make sure that he didn't have any seizures and to ensure that the fracture didn't impact his brain. He was also jaundiced, so he required time under the bili lights to help his bilirubin levels.
Finally, on March 16, River's brain was deemed clear of any impact from the skull fracture and Dr. Collins was ready to discuss treatment options to fix it. I was still in ICU when Nathan called me with Dr. Collins on speakerphone so I could still be a part of the discussion and decision. Dr. Collins presented us with four different options.
1. We could try a procedure he called the "pop out" where they use a hand-held vaccum to suction the skull back into place. The problem with this was that there wasn't much research out there to support it and he had personally never done it. The upside to this option was that River wouldn't have to be put under, but it had to be completed within the first seven days of life.
2. They could put River under and make a small incision in his skull, then use a tool to "pry" the skull back into place. River would have to be put completely under general anesthesia for this procedure.
3. They could cut the portion of River's skull that contained the fracture and flip it upside down, so that the fracture was now inwards instead of outwards. Obviously, this was the most invasive option presented.
4. We could wait and see what nature did on its own as River grew. Baby skulls are highly malleable and it was possible as River's brain grew it would naturally fix the fracture. The biggest problem with this option, however, is that if it did not naturally fix itself we would have to then go to option three, where his skull was cut and flipped.
It seemed like a no-brainer to Nathan and I to try the least-invasive procedure first, which was the "pop-out" procedure. Dr. Collins made it very clear to us that results were not guaranteed, and that he had never personally done it. Still, we felt it was the best option for our five-day old baby.
The following day, March 17, River had his procedure. With only an anti-anxiety medicine, River's skull was successfully pulled back into place with a hand-held vacuum. River now required 48 hours of observation to ensure the vacuum didn't cause a brain-bleed, but he was well on the way to being discharged.
After my discharge on March 18, I went straight to River. It felt so strange being there at MCV. Nathan had his wristband and chatted with the nurses that he'd gotten to know over the past week. He showed me how to scrub in order to get into the NICU, and helped me get a wristband to show I was River's mother. Finally, he took me back to the room where River was. When we walked in, River was swaddled and sleeping. A nurse came in and looked him over and told us that he would need to eat soon. When he woke, I held him and fed him for the first time. Dr. Collins came in and spoke with us a bit more about the success of the procedure. He told us he had read all of the medical journals he could about using hand-held vacuums for this sort of thing, and had reached out to another doctor that had performed a similar procedure with success. He said that infants born with depressed skull fractures were incredibly rare, so there wasn't much to go off of, but he was happy with the results. As were we. When you looked at River, you could never tell his head had been fractured at all. It was amazing and we can never fully express our gratitude and thankfulness for Dr. Collins and the entire NICU team that took care of River while he was there at MCV Children's Hospital.River was ready for discharge the following day, on Sunday, March 19. We loaded Finn up and took him to Nathan's parents so we could head downtown to bring our baby home. We scrubbed up, signed in, and went into his NICU room one last time. We fed him, changed him, signed lots of papers, and finally brought our littlest love home to start our lives as a family of four.
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| River's MRIs |
We still aren't 100 percent sure what caused River's skull fracture, or caused me to have an E coli infection in my gut. We have theories and guesses, none of which can be confirmed, but we are so, SO thankful to have a beautiful, healthy, happy nearly ONE year old, and equally thrilled that I'm here to tell the tale. We may have had a rough start to his life, but we're ready to spend the rest of our lives loving our little red-headed miracle baby.
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| Photo Credit: Denise Feagans Photography |
