Tag Archives: 29 weeks

A Tale of Two Nicus: Part I

OK, so where was I before I got distracted? Oh yes: in the NICU.

How could I forget? It’s not like I’ve really left there. I can still hear the bings, bongs and high-pitched screams of the monitors when I close my eyes, see the waves of respiratory rate ebb and flow, and most of all, I can smell it, that simultaneously hygienic and nauseating smell of hand soap. I sometimes wonder if I’ll ever leave that place or more accurately those places. For ours is a tale of two NICUs.

Seeing Mr Boo for the first time was amazing. He was small (although at 3lbs 11oz at 29 weeks, not that small), but he was perfect in my eyes. I was elated and couldn’t believe how I’d spent much of the night before worrying I wouldn’t bond with him or that it couldn’t be possible to love him as much as his big sister.

I saw him and I adored him. Then I looked again and the love was polluted by a fear so intense it hurt. Both the love and the fear have only deepened since.

I honestly don’t think I saw the CPAP tube, the wires (so many wires) and cannulas that were helping to keep him alive when I first looked at him. I initially thought the woolly hat he was wearing was cute (it kind of was) until I saw it wasn’t designed to be aesthetically pleasing. The hat was keeping the breathing apparatus attached; there was a flap so they could scan his head. Little did I know how those scans were going to change our lives. He had no eyelashes and his body was covered in fine hair. And then I saw his skin and with horror realised I could almost see through it, or at least through those bits that weren’t black with bruising.

The lovely unit sister who I’d first met in the delivery suite the day before talked me through the various monitors and told me not to panic when the alarms went off. I couldn’t believe how something so unnatural and terrifying could be so normal to anyone, why alarms didn’t cause people to start determinedly running like in ER. (I later realised they sometimes did.) Then a consultant came over and explained that Mr Boo could participate in a trial treatment for preventing NEC. It was the first of many acronyms (CLD, PVL, IVH …) that I would have to get up to speed with during the crash course in neonatal physiology every NICU parent is put on. Crash course is right. Reality hit and my air bag wasn’t going off.

Everyone had told me Mr Boo was a marvel. He had no obvious health problems and despite arriving too quickly for steroids he’d got off the ventilator within 24 hours and was breathing with CPAP. He’d even managed several hours in air. And he was an unfeasible size for a 29-weeker. He was strong. But I now realised that he was also terribly vulnerable. He could succumb to NEC or any number of problems I was now googling between this day and that as-yet-unknown day, hopefully some time in the next 11 weeks, when he could come home.

I was shown around the NICU and tried to take it all in: the layout of the unit (milk kitchen, expressing room, family room), the rules on hand washing and visiting. I didn’t remember a thing. I went back to my private room and felt liked I’d been beaten up. (Why couldn’t I cry? Surely I was supposed to be crying.) Then a nurse came in with an expressing machine and I found out what I really needed to be doing. I was amazed that any colostrum emerged and was pitifully embarrassed by the 10mls produced after 20 minutes of pumping. But I’d read the Bliss leaflet and understood the benefits for Mr Boo and it made me feel good. There was something I could do for him after all. But it made me think about and miss Sissyboo too. The last time I’d used an expressing machine I was pumping in the vain hope of trying to get through the excruciating pain of thrush and breastfeed her beyond six weeks of age. I failed. I still felt guilty about putting her onto formula so young (why?) and even more guilty that I’d let her down again now by not carrying Mr Boo to term. By giving birth 65 miles from home.

And then she arrived with The Grumposaur and I was happy, wonderfully happy for the few minutes before I realised I needed to be in two places at once. I couldn’t be the mum I wanted to be to both of them. Not now. Not with Mr Boo in hospital in one county and Sissyboo at home in another. As I write this, they are asleep in the same house, just yards from one another, but I still feel the same sense of disappointment and suffocating regret that I can’t be there for both of them all the time in the way I’d like to be. I never (and I mean NEVER) feel like I do enough for Mr Boo to help his development no matter how many hours I spend in appointments or doing physio with him. So why do I feel I let Sissyboo down every (and I mean EVERY) day by not paying more attention to her needs and wants? By putting Mr Boo’s health first too often.

I had to make a decision. Go home to be with Sissyboo and The Grumposaur or stay to be with my baby. The Grumposaur thought it was a no-brainer. They needed me (they did and I needed them); Mr Boo needed doctors. The only thing I could do for him was to express and a quick trip to Tesco would mean I could do that anywhere. The nurses thought I should stay. They said I underestimated the physical and emotional effects of the last 24 hours at my peril. The Grumposaur asked if there was any medical reason why I couldn’t go home. I had nearly had to have a transfusion and I secretly hoped that this would mean that they would say I couldn’t leave, so I wouldn’t have to make the decision. But they said my iron levels were OK so it was up to me. I went home. There was no right or wrong thing to do. There wouldn’t be ever again, I thought.

So instead of commuting to work, I commuted every day for two hours to a hospital to see my son. My sister, who coincidentally had two weeks holiday at the time, moved in and helped us. She came with me to see Mr Boo after dropping Sissyboo at nursery the next day and she was amazed by how well he was doing. I was taught how to do cares (wash, change and touch a baby in an incubator without dusturbing the wires or upsetting them when they were too young to want physical contact). It was just about bearable as far as anything so unnatural could be. I couldn’t remember that I wasn’t still pregnant, though, and turned down offers of cups of coffee and a medicinal Guinness because I didn’t want to harm the baby in my womb. I felt slightly mad. But it was bearable.

And then it wasn’t any more. On day 3 I was looking forward to cuddling Mr Boo for the first time. Instead, everyone had stopped smiling. We were told he had an infection and his infection count was dangerously high. He had to be reintubated. He was unable to accept feeds and was losing weight. A long line to deliver TPN (artificial nutrition) had to be inserted in his leg. He wasn’t responding to antibiotics. They needed to do a lumbar puncture. They wanted another brain scan, although the first had been normal.

He was very ill. You would think there wouldn’t be much difference between a relatively healthy and an unwell prem baby of Mr Boo’s gestation. They just lie there, after all. But it was palpable just how sick he was and for the first time since this nightmare began I truly understood that he could die. I hadn’t allowed myself to think this before. Why hadn’t it occurred to me?

It was Easter weekend and we tried to coordinate hospital visits with fun trips out with Sissyboo. Wherever I was I felt that I should be somewhere else. And then the bottom fell out of our world.

The sensitivity test came back. The sample had been contaminated so they couldn’t be certain, but it was likely he had contracted meningitis. He needed a platelet transfusion and was now being given a high dose of targeted antibiotics. It didn’t necessarily mean anything for Mr Boo’s long-term future, we were told. (How many times have we been told that in different situations since?) As a prem baby he would be followed up carefully anyway, so the problems the meningitis might cause would be picked up. But there was more bad news. He’d had a bilateral brain bleed. Hopefully it would resolve. If not, it could mean brain damage, developmental delay, cognitive and physical disabilites or cerebral palsy. We just had to wait and see. (How many times have we heard that since?)

I cannot describe the agony and desperation I experienced. I felt even more helpless than I had at any point since his birth. He nearly died. I left the NICU each day not knowing if he’d still be alive when I went back the next. But then, as quickly as he succumbed to the infection, he picked up. Within days of having targeted antibiotics his infection count was plummeting. He looked better. He was starting to tolerate minute quantities of milk. The long line in his leg might be coming out soon. He was back on CPAP. They might be able to transfer him to a hospital nearer home.

I got to cuddle him. Finally. The day I never thought would come. The combination of excitement and fear was dizzying. What if I disrupted a wire or tube? What if he didn’t want to be held? What if the alarms went off? They didn’t. He was fine. It felt wonderful. Sissyboo held his hand.

In the relay of the relatives, my sister passed the baton on to my mum who came to stay for a week while The Grumposaur went away with work for 7 days. It was supposed to be the last trip he made before I started maternity leave two months later. I know he didn’t want to go. I know he hadn’t wanted to work and leave me to drive down to the NICU to see Mr Boo on my own as he had so many days since the birth. I know self-employed people don’t get compassionate or parental leave. I know it makes me awful, but I couldn’t help feeling resentful. I still do. Thank God Mr Boo was getting better. I couldn’t have coped at all if he hadn’t been.

I started to forget about the brain bleeds. I focused on Mr Boo’s improvement and having cuddles with my boy. Two weeks after he was born things were looking up. On the day he started a cycle of 6 hours of CPAP and 6 hours in air I got home from the NICU feeling more positive than I had done for what felt like months. And then I got a phone call from the unit. He’d been a good boy, they said. (They always said that.) I wasn’t to worry. In fact he was so good they were going to transfer him to my local hospital 10 minutes away. An incubator was waiting for him in intensive care.

The transfer team was already on the way to get him. I couldn’t get back to the hospital in time to see him leave but they’d phone me when he was on his way. I felt sick, especially when they said they’d transfer him in air. I wanted to see him. I wanted to say goodbye to a bunch of people who had shown me more kindness than I knew existed. Mr Boo may have been ready to transfer, but I wasn’t. I phoned The Grumposaur and he was thrilled. This was a good thing. I agreed.

So why couldn’t I stop crying……?

Birth Story Part 2: Labour

I’m not wild about suprises. Don’t get me wrong. If someone wanted to whisk me off to Paris tomorrow or if more than 4 hours sleep in a row were to come my way (pretty please, it’s been a year…) I’d be thrilled. But if I’m honest, I’d be much happier still if I had advance notice to work out my travel itinerary or know I could have a large glass of wine without regretting it. My dislike of surprises is one of many reasons why I find all of this so hard. I couldn’t plan for Mr Boo’s birth. I wasn’t ready. But what really kills me inside now is that I can’t plan for Mr Boo’s future. Will he walk one day? Will he have learning difficulties? Will the spasms come back? When Will we he be diagnosed with cerebral palsy? All I know is that I don’t know anything.

But I’m getting ahead of myself. When I went to work, 65 miles from home, on 2 April last year, I knew I was in for a long day. I was interviewing. I had to be intelligent and on the ball. For a brief 30 minutes or so at the start of the day I felt both of those things. But by mid-morning I wanted to go to sleep and I and was very uncomfortable. At first I thought my discomfort was caused by the chair I was sitting in. (That’s how much I was in denial.) But by the time the lunch break came round I couldn’t sit down at all. The enormous sense of pressure and brief waves of pain welling up inside caused me to curl up in a ball in my office while hoping no one would knock at the door.

I’d hadn’t had normal contractions with Sissyboo, and while the pain I was in fitted the descriptions of what I’d read in the pregnancy manuals all those years earlier, the length of them didn’t. They were 10 seconds of intense pain at most. But they were coming every 2 minutes. I couldn’t be in labour, I told myself, so what could it be? I phoned a friend who’d just had her second baby for advice. And she told me what I knew but desperately didn’t want to hear: ‘You’re in labour. Phone for an ambulance. Don’t worry; they’ll stop it’.

So I made the call and packed my bag with work for the following day and a stack of papers to read overnight in preparation for the next morning. Not only was I coming in to work tomorrow, but I’d be home in time to make dinner for my daughter, who was in nursery in other county.

The paramedics were brilliant and reassuring. They gave me a choice of hospitals local to my work. One was near but I’d heard horror stories from colleagues who’d had their babies there. One was twenty minutes further away and I’d heard lovely things about it. I wanted to say take me to the lovely hospital. I couldn’t be in labour after all and I might as well be sent away with a flea in my ear from a nice hospital than one I’d been told never to be caught dead in. But although I didn’t admit it to myself, I knew things weren’t right and I remembered how wrong they’d nearly gone with Sissyboo. I needed to get anywhere quickly.

I phoned the Grumposaur and in my best cool as a cucumber voice told him that I was having some odd pains and that I was sure I was fine but was going to the hospital to be checked over. It was my calmness that worried him. It’s only when I am really worried that I am ever that collected. He got our daughter out of nursery, deposited her with relatives and got in the car.

When I was wheeled in, on a stretcher and breathing in gas and air, to the maternity day unit, a concerned receptionist took one look at me and said reproachfully to the paramedics that they should take me to the delivery suite asap. I think I frightened at least 5 expectant couples. There I was hooked up to monitors, assigned a fabulous midwife and awaited the arrival of the doctor.

They would stop this. My friend had said so. The paramedics had said so. The doctor said so. And then she examined me and everything changed. It was happening again. I was 10cm dilated and Mr Boo was making his appearance in the world whether I wanted him to at that precise moment or not. Incredulous, I stupidly said, ‘But I’ve just been booked in for a planned c-section in 2 and a half months’. ‘The baby hasn’t read your diary’, said the Aussie doctor. ‘You need to have this baby now and to give him the best chance, you should deliver naturally. There’s no time for steroids. When will your partner be here?’ I said I didn’t know. ‘Try to hold on she said. If it hasn’t happened already, we’ll break your waters as soon as he arrives.’

I’d battled all pregnancy to get the birth I’d wanted. To have the best chance of delivering my baby safely with people who could help if it all went wrong. Instead, I was more vulnerable and more frightened than I ever imagined I could be and nothing was within my control.

The Grumposaur arrived, mercifully in one piece, just as a team from the neonatal unit was showing me an incubator and explaining intubation and the challenges Mr Boo would face. I barely remember a word they said. This can’t be happening, I kept thinking. I’m lying here, in a borrowed posh maternity frock, in jewellery and make-up. I’m not ready to have this baby. I have a maternity swimsuit on order from Amazon.

But it was happening. And somehow those 10 second contractions were doing their job. They broke my waters and shortly afterwards Mr Boo arrived. I didn’t see him at first. What I saw was his Dad’s face, amazed, adoring and utterly terrified. Mr Boo cried and it was only when I let out a sigh that I realised I’d been holding my breath. He was big for his gestation as we’d known he would be. At 3 lbs 11 oz (6.75 kg) he was more the size of a 32-weeker, we were told. This had to be a good thing, didn’t it?

I was allowed to cuddle Mr Boo for the briefest of seconds and he was taken away to the incubator we’d been shown minutes earlier. His Dad went to follow him but was told that intubtation was too distressing a procedure for him to watch. We sat and we waited, not knowing whether our son was winning or losing his battle to live or what health problems he had. After 2 minutes, I realised I couldn’t recall what he looked like. And I wondered why it was that I couldn’t force the tears I desperately wanted to cry out of my eyes.

I don’t really remember all that much about the next two hours or the things Mr Boo’s Dad and I tried to talk about to pass the time. I vaguely remember being put on a drip to re-start my contractions as the placenta had not been delivered. My body was in shock. The first thing I remember clearly was a doctor on the next shift coming in and trying to remove it manually. It was excruciatingly painful. And fruitless. I lost a lot of blood and was prepared for theatre for a manual removal with a spinal. All that effort and I ended up in the operating theatre anyway.

As I lay there listening to the theatre staff talking about their dinner and wedding plans it slowly started to sink in. I was not pregnant any more. I had two children. And I had failed them both by giving birth to one too early. When the surgeon started to tell me jokes, I feigned sleepiness and pretended to drift off while my mind raced with the vertiginous possibilities of what life would be like now. I only opened my eyes when the midwife who had held my hand, made me laugh and allayed my fears throughout my labour came into the theatre and kissed my forehead before going off shift.

While I was in theatre, Mr Boo’s Dad got to see our unexpected guest in what he called his goldfish tank. The nurses took a photo to show me. After the epidural I wasn’t going to be going anywhere near Mr Boo for some hours. I was thoughtfully put in a private room so as not to be near mothers who could cuddle their babies and so that I could get some sleep. I was grateful. But sleep? Are you kidding me?

I spent the next 6 hours on my phone reading every website on premature babies my 3G signal would let me look at. My search terms were crude and desperate: “29 weeks”+”survival”; “pre-term birth”+”health problems”; “prematurity”+”disability”. I became obsessed with the statistics websites presented me with. The odds that Mr Boo would survive and grow up without major health complications were good, I found. That was before I lost faith in statistics, however. Before I realised that statistics are actually meaningless. It really doesn’t matter if you only have a 1 per cent chance in life of being run over by a bus if you are one of 1 per cent.

When this got too overwhelming I sent dozens of emails to work colleagues, calmly explaining that I was on maternity leave with immediate effect and cancelling meetings and so forth. Then I kept looking at the clock and  trying to wiggle my toes, desperate to be able to move again and see my baby.

A nurse came round early in the morning and asked if I wanted to see Mr Boo. I said yes. She asked me how I was feeling and explained I had lost a lot of blood and my iron levels were being regularly checked. I said I was fine. She said she’d come back to get me. I went to prepare to see Mr Boo and as I got out of bed, my legs went from under me and blood went everywhere. I called for a nurse who greeted my stupidity with unreserved kindness and offered to take me to see Mr Boo in a wheelchair while my bed was re-made. I insisted on walking. If I could pretend everything was alright, then it just would be, I reasoned.

And it was. As I entered the NICU, overcome by the smell of hand detergent and confused by the carcophony of beeps I can still sometimes hear as I drift off to sleep at night I saw him. My boy. My gorgeous boy. He had ripped his ventilator out overnight and they had let him breathe in air for a few hours before re-intubating him. He was going to be OK. I knew it.

Some surprises, I realised, could be good after all.