Monday, November 17, 2014

World Prematurity Day: Remember When

I love how the whole month of November seems like it's dedicated to Caleb.  :)

There are a lot of facets of prematurity awareness, but this year I'd like to focus on something positive.  The March of Dimes has a "Hugs Heal" campaign promoting skin-to-skin holding (kangaroo care) for premature babies.  It has been proven to help babies in a lot of ways.  In underdeveloped countries, where proper medical equipment is hard to come by, Kangaroo Care can literally save lives!

Kangaroo Care is "holding your diapered baby on your bare chest...with a blanket over your baby's back to keep him warm"  (Learn more about Kangaroo Care here.)
This is a picture of the first time I held Caleb.  He was 12 days old and had just come off of the ventilator for the last time the day before.  He was still well under 3 pounds at this point (he reached exactly 3 pounds when he was exactly 3 weeks old).

I was so excited when I got the call that Tuesday morning from our favorite nurse, Catherine.  I had previously been told that I couldn't hold him until he had been off of the ventilator and stable for at least 24 hours.  The day before this, he was supposed to have heart surgery.  His lungs had been filling with fluid and collapsing, but he took such a great turn that by that evening he was able to breathe on his own.  Catherine told me, "I know you thought today was going to be a 'recovering from surgery' day, but how would you like to come hold your baby?"  She was always such a great advocate for him!  She told me many times, "I'll always do what's best for your baby.  I'll fight for him and they can fire me if they want!  I only work this job because I love it.  It's worth it to get fired if it means I'm doing what's best for your baby."  And there were many times that I did see her fight for him!  I expect this was one of those times.  I can imagine her that morning, telling the NP and neonatologist, "Look, he's doing great.  He's never been better.  He's 12 days old and his mom has never held him.  Who cares that it hasn't been 24 whole hours since he was extubated?  It's time for Mom to hold him."  This post could quickly turn into "The Many Reasons Why I Love Catherine," but back to Kangaroo Care....

I picked Nate up from work on my way to the hospital.  He wasn't going to miss this!  It took two nurses and one Respiratory Therapist to move Caleb from his isolette to my chest.  Three people for one tiny baby!  They told me that I would probably only hold him for 30 minutes, because by then most babies need to return to the stability of their isolettes.  But Caleb snuggled in and fell asleep almost instantly (well, after trying to pick up his head and turn it around with that big CPAP elephant nose stuck to his face!--he was amazingly strong; and after rooting around to try to find a source of that yummy smell of milk that was so close--AMAZING to see for a baby who hadn't even attempted to eat yet).  His heart rate and oxygen saturation leveled out wonderfully.  Babies this small will often swing between high heart rates and low heart rates, causing the monitors to alarm every minute or so.  They call them "swingers."  But while I was holding Caleb, his swinging was much less than it was before.  He was so stable on my chest that they let him stay there for TWO HOURS!

The best word to describe how it felt to hold him is right.  It just felt so right to have him so close.  Yes, it would have been more right to have him inside of me for another few months, but this was the next best thing.  Mommys and babies aren't supposed to be separated so early and when they are, there is nothing better than being put back together again.  It was truly one of the most incredible moments of my life.

When it was time to put him back (and change his diaper, and start his next feeding, and for me to pump because I was getting pretty uncomfortable) they took his temperature (as they always did every three hours) and it was perfect.  There was no denying that holding him skin-to-skin was good for his health.
Nate's first time holding Caleb.

As the days went on, we were allowed to hold him once a day for those first few weeks.  Nate and I took turns holding him skin-to-skin.  There was one day where I was holding him and he let out a little cry--very unlike him.  Caleb almost never cried.  Then he spit up a little.  I remember thinking, "Oh, he's just like other babies now!  They all spit up, right?"  But Catherine knew something was wrong.  She told the NP that he NEVER cried when Mom is holding him, and that alone was a big red flag.  So they did an abdominal x-ray and found that he was dangerously close to perforating a bowel.  His bowels were so full of air that they were pushed up to the level of his nipples.  It was caused by a combination of starting giving him Human Milk Fortifier to increase the calories and fat content in my breast milk in an attempt to chunk him up (studies have shown that the faster a baby can gain weight, the faster they get out of the NICU) and swallowing air from his CPAP machine.  They immediately stopped feeds, put him on a tube (the Andersen Tube) that essentially pumps everything out of his stomach, measured his girth every three hours, and waited for him to get better.  This was the closest Caleb ever got to dying while in the NICU.  If he had perforated a bowel, it would have required emergency surgery and would have likely caused infection.  Infection is the number one killer of babies in the NICU.  It was a scary few days there, and we weren't allowed to hold him until he was more stable.  About a week later, the NPs wanted to put him back on the Human Milk fortifier.  Again, Catherine pulled out the, "You'll have to fire me before putting him back on that so soon after what he's just been through."  I was there to see this one.  Catherine is one of the most likable people ever, but when she pulls out the big guns you back down!  So they agreed to try a much more gentle fortifier, which we could all be happy with.  My Mommy instinct (which has proven to be extremely trustworthy) tells me that the reason Caleb has such awful GI motility and can't digest food fast enough to consume enough to survive is because of the trauma caused to his GI system from that fortifier.

As you can see, holding my premature baby was an amazing experience for us both.  One that quite literally could have saved his life.  And the emotional experience was unmatched.  It's a moment that will always bring tears to my eyes when recalled.  Hugs truly can heal.  And now I get to hug that big, miraculous 5-year-old all I want!

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