Sunday, March 30, 2008

Kangaroo Care

Today they are upping Jacob's calorie count from 90 to 104!!! Baby steps!!! He seems to be responding well to his breastmilk feedings and it appears his digestive system is having no issues so they have decided to up his calories and continue with the 1cc a day feedings 7 times a day.

I was able to hold Jacob for the first time yesterday and for once felt like there was something I could do for my child. I have felt so helpless since last Sunday when I went into pre-term labor and have spent many days crying because I haven't been able to do anything to help him.

These sessions, called Kangaroo Care, are designed to keep him warm while I am holding him against my bare chest and help regulate his breathing and heart rate. They lie him on me covered with a fleece blanket, a heat pack and another blanket on top of that. They also shined a heat lamp on me, but he was actually a little too warm so they shut the light off for the last half of the session. He seemed very comfortable.

When they took him out of the isolette, his heart rate was around 170 which is abnormal for him. When I was pregnant and even after he was born his normal heart rate was somewhere around 140. His heart rate tends to go up when he gets stressed out and having his diaper changed is one of those moments! When they took him out of the isolette and put him on my chest he immediately settled down to a heart rate between 138-145, more in his normal range.

You can tell that these sessions really help and I feel like he is calmer when he lies with me. He lounges in his isolette and always appears comfortable, but is continuously readjusting himself, especially his legs. When he is on me, he doesn't move for the entire hour and a half and even periodically opens his eyes and looks up at me. I know he can't see anything, but I know he feels better lying with me!

Ian was able to have his turn holding him today so now we have both been able to hold him!

Friday, March 28, 2008

Feisty Guy!

Tonight Jacob will start receiving breastmilk!

I have been pumping and freezing my milk until they were ready to start him on it and tonight he will be receiving 1cc which is 1/5th of a teaspoon!

He has also been receiving an Electrolyte/Vitamin mix and Lipids via IV. They are hoping this will help him gain weight because he has been fluctuating between 1 lb 4 oz and 1 lb 7 oz since birth. I will feel much better one he starts to gain weight because he is incredibly tiny right now! The pictures do not do his size justice, he appears so much bigger and longer in the pictures than he does in real life.

You will notice in most of the pictures that I will be posting that he is wearing a "Zorro" mask and has his ventilator taped to his face. The mask is to block out the phototherapy lights that they have on him to help with his high bilirubin levels called Jaundice. In the isolette, with his mask on, he looks like he is tanning!

The ventilator is taped to his face so he doesn't accidentally knock it out which he has done multiple times already. Our little guy is a feisty one and hates to have his diaper changed! He has ripped off his heart monitors multiple times and was grabbing and whipping his wires around so much that they had to move them from his wrist to his ankle so he can't reach them! His ventilator has also fallen out a few times and he was doing so well breathing on his own that the alarms never sounded and the nurse didn't realize it was out until she went to weigh him. This is actually a good sign, but due to his size they will not take him off the ventilator and put him on the CPAP for a few more weeks.

Wednesday, March 26, 2008

Head Ultrasound and Echo

Today Jacob had a head ultrasound to check for brain bleeding called an IVH (Intraventricular Hemorrhage). Nearly all IVH's occur within the first three days of a preemie's life and this is one of the most serious conditions that a preemie can develop. The report came back good and Jacob does not have any bleeding going on. The fact that he arrived via c-section was probably a huge blessing and helped him avoid this. They will probably do a head ultrasound again within 7-10 days of birth to make sure that there is still nothing going on, but this was a huge hurdle.

Jacob also had an Echo today to look for a PDA. This occurs in 40-50% of all preemies born between 23 and 25 weeks. This condition occurs when the ductus arteriosus, a blood vessel near the heart which is supposed to close within the first few days after birth, remains open. This is treated first with medicine, which usually works, and then with surgery if necessary. The doctor does hear a murmur when he listens to Jacob's heart, but right now it is so small it does not warrant the medication. They will continue to monitor it until it (hopefully) closes on its own. If it appears to get louder they will discuss putting him on the meds.

Sunday, March 23, 2008

Jacob's Story

I figure this blog is pointless if I don't tell you the story of how we ended up here, so here it goes! WARNING: THIS IS LONG AND GRAPHIC

I was ecstatic in October of 2007 to discover that I was 4 weeks pregnant! It was my first cycle of Clomid (due to a mild case of PCOS) and I was sure it would take a few cycles to work. My due date was determined to be July 7th, 2008 and since most women deliver their first child late I was preparing for a long Summer of being huge and pregnant. My pregnancy was pretty uneventful for the first few months, but I was mildly concerned about the fact that I had
previously had a LEEP procedure back in 2001 and mentioned this in passing to my doctor (this type of procedure can lead to an incompetent cervix). She wasn't concerned in the least bit so I let that take a back seat and tried to enjoy my pregnancy.

At the end of February, I accidentally fell out of bed (a long, makes-me-sound-stupid story!) and experienced some bleeding. I called into work and Ian drove me to the ER. I am not going to sugarcoat it. I was bleeding A LOT and was convinced that I had lost the baby. I even threw up in the car twice on the way to the hospital (which is only 10 minutes from our house) from the nerves. I was admitted to L&D for monitoring and so the doctor on call, who just happened to be my doctor, could examine me. She did an internal and my cervix was still closed, but something didn't "feel right". She decided the bleeding was most likely a ruptured blood vessel since my cervix was still closed and that everything else appeared fine. We had already scheduled a Level II ultrasound for the following week due to a VSD they had found on my ultrasound at 19w so the doctor added a few orders for the u/s tech and off we went. A week later, I had my Level II u/s and was shocked to find out that my cervix was 2.5 cm. The u/s tech explained that the doctors like them to be 3 cm or longer. They said not to worry, they were going to call my doctor and ask if she wanted me to go straight to the hospital for monitoring (?!?!?!). After waiting for what seemed like an eternity for my doctor to answer the page, she decided to have me go right to L&D to be hooked up to the fetal monitor to see if I was contracting. After an uneventful 2 hours in L&D, I was sent home with orders for another ultrasound in 10 days to follow up and was put on modified bed rest. I had access to work from home so that was the plan and we just waited.

On March 13th, 2008 I called into work since I was feeling under the weather and decided to spend the day at home relaxing with my feet up. After an hour or two, I felt something that didn't "feel right". After a visit to the bathroom, I realized I had lost my mucous plug. In a panic, I called my doctor and spoke with a nurse as I tried to explain to her through sobs what I had just discovered. She explained that women lose mucous plugs all the time and they can regenerate so not to worry too much and she would let the doctor know and have her call me back. I already had another follow-up ultrasound scheduled for that Monday the 17th so my doctor called and said to hold on until then unless I was having any pain (contractions, water leakage, etc.).

On Sunday, the 16th of March, Ian and I celebrated our one year wedding anniversary! It was hard to believe that we had already been married a year and that in 4 short months (or so we thought) we would be parents!

On Monday the 17th, we arrived at the hospital for our second Level II ultrasound. By now, my nerves had calmed a bit since I hadn't had any bleeding, contractions or water leakage at all since I fell out of bed almost 3 weeks prior. I was pretty sure they were going to tell me everything was perfect and that I could return to work. When the ultrasound tech left the room without saying anything my heart started to race with all the possibilities. She returned and told me she had paged my doctor and we were waiting for her to call back. The problem was my cervix was now measuring only 1.8 cm!! They were not able to let me go anywhere until they received orders from my doctor. Since they had paged her at 5 PM and her office closes then they had a hard time tracking her down and it was almost 6:15 by the time they got back to us. My doctor gave me two choices: head down to my hospital back home for monitoring and a possible transfer to a Boston hospital (my hospital only delivers beyond 34 weeks since they don't have a NICU) or continue driving North to Boston and go right to Tufts (which is the hospital affiliated with my hospital that has a Level III NICU). After discussing our options, Ian and I decided to head into Boston. If anything happened we would want to be in the best place possible for the baby. At this point, I was only 23w1d pregnant. They wouldn't even try to save the baby until I made it to 24 weeks so I was anxious and hoping they could do something to turn the situation around. At this point, I still thought everything was going to be fine. I don't know if I was in denial or what, but I was sure there was going to be some quick fix and they would send me home. Little did I know....

I was admitted to Triage in L&D at Tufts Medical Center and told by the doctor on call that "just in case" they were going to administer steroid shots to help mature the baby's lungs. I would receive 2 doses of Celestone over a 48 hour period. The first shot was administered and since it was 11:15 by the time I got it they decided to keep me overnight and plan on keeping me until I was Celestone complete on Wednesday night which means I was there until at least Thursday morning. I just happened to be on vacation that week for work since Ian and I had previously planned on going to Vermont for a couple of days to celebrate our anniversary. Luckily we hadn't planned anything and I just had the week off to vacation in a hospital bed.

I spent a very uneventful week at Tufts watching The Ellen Show and horrible daytime TV waiting for Ian to drop by each day after work. Since everything seemed fine and my cervix had even measured at 3.0 cm at my ultrasound Thursday morning (bed rest really works!!!!) Ian was going home at night and I was left alone with my ultrasound pictures of our little boy to keep me company. I had just found out that day what we were having since we were planning on having it be a surprise. When they said I could possibly deliver early, and girls have better chances than a boy, I decided I wanted to know what I was up against and had the tech tell me. When I told Ian that I knew what we were having he went back and forth for 30 minutes on whether or not he wanted to know. Eventually, he wanted me to tell him and we spent that night dreaming about all of the possiblities for our little guy and throwing around names (the final two were Joshua Caleb or Micah James).

On Saturday night, the 22nd, Ian came to the hospital and was planning on spending the night with me for the first time all week. The doctors had informed us that I would be discharged Sunday morning at 10 AM and on modified bed rest until further notice. I had called my boss and planned on continuing to work from home until my doctor released me from bed rest. We fell asleep around 10:30 and I woke up around 2:00 AM on Sunday with the worst.cramp.ever. It kind of felt like gas pains, but since I had never experienced a contraction or labor before I didn't know what labor contractions felt like. When it didn't happen again, I decided it must have been nothing and went back to sleep. At 3:30 AM, I woke up again with the same pain and decided that if it happened one more time I needed to call the nurse. I still didn't think anything was wrong since the two contractions were about 90 minutes apart and I knew they had to be closer than that for it to be actual labor. When I had another one at 4 AM I decided it was time to call someone. The last one was extremely painful and I had to concentrate to get through it. I woke Ian up and told him not to panic, but I was having some cramps and I was calling the nurse. By the time she hooked me up to the monitors it was 4:20 AM. Within 20 minutes, I had 2 contractions and she had called the doctor and nurse from L&D to let them know they needed to check me and possibly wheel me down since I had been rooming in the Mother & Infant Unit for the week. Around 5 AM, there was a team of nurses and doctors set up in my room to do an internal. They told me if I was more than a fingertip dilated (which is what I was when I was admitted and had no idea) I would be going downstairs, but if nothing had changed they were just going to keep an eye on me. When the doctor stood up and without expression said, "we're taking you downstairs" I had no idea what was going on. Little did I know that I was 5 cm dilated and my bag of water was poking through!!! I was wheeled downstairs and at the same time they got me on the table the contractions started coming fast and furious. They were so bad I couldn't even talk during them. They were coming so fast and were on top of each other and I had no rest in between. While the nurses hooked me up to IV's and got me prepped for surgery "just in case" they began pumping magnesium sulfate into me to try and stop the labor. Being my naive self, I still assumed that this was something they could stop. I was unaware of how far along I actually was and assumed this would all be over in a matter of hours. All of a sudden, I started to feel like my body was extremely hot and on fire (side effect of the lovely mag) and asked the nurse if it makes you nauseous. She said yes, but we don't like to tell people that because sometimes you can make yourself sick if you know it is a possibility. That is when I vomited in the bed pan she handed me. At this point, I looked at Ian and said, "We're going to have a baby today" and he says he knew right then, when he saw the fear in my eyes, that I knew what I was talking about. A few minutes later, I felt this huge pop and gush of warm fluid. I started screaming at the top of my lungs that I thought my water had broken and they all rushed to the end of the bed and realized we were game on. As they all started running circles around my bed, and Ian looked on horrified clutching my purse to his chest, I started asking the nurses why the water hadn't stopped yet. She asked what I meant and I said I felt something running down my leg. This is when the nurse started yelling orders. It turns out since Jacob was so small I had suffered cord prolapse which means that his umbilical cord had come out before him. Supposedly, when this happens the cord vibrates which is what I was feeling against my leg and thought it was water gushing. When this happens, it cuts off the oxygen supply to the baby and gives the doctor and nurses only a few minutes to get him out. As one nurse literally shoved her fist up inside me with the cord (the only way to try and keep some oxygen flowing) I was wheeled, with that nurse riding on the end of my bed, into the OR. The doors shut behind me as Ian was left in the hallway. They took off my glasses, put a mask over my face and that is the last thing I remember.

When I came to, I was violently shaking from the general anesthesia and didn't know where I was. When I looked up and saw Ian, he wasn't crying, he was still holding my purse and then it all came flooding back to me. All I said was, "Is he okay?". Ian said, "He's pink and breathing." That was all we knew. Ian told me the nurse came out and updated him periodically about what was going on, when they had him out, when they had trouble getting him intubated and when the tube was finally in and he was stable enough to transfer to the NICU. Ian said they wheeled him by and he couldn't believe how tiny he was. He said he was all bundled up, but that his head was the size of a clementine and he was VERY little. Ian also said that he didn't look like a Joshua or a Micah and that instead he looked like a Jacob.

Jacob Andrew was born at 5:53 AM on 3/23/08. He weighed 1 lb 7 oz and was 11.5 inches long. He spent 4 long months in the NICU before coming home with us on July 17, 2008 weighing 7 lb 9 oz and just 10 days after his original due date. If you would like to read more about Jacob's journey in the NICU, please feel free to surf through his Caring Bridge website which we used to update everyone on his condition for the first several months of his life:
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