10.09.2014

Nora's NICU stay

When I wrote out Nora's birth story, I mentioned that we had a longer hospital stay than we had anticipated.  This is the "after birth" story, if you will.

I will start by saying that when Nora was born she took a while to make any sound.  An uncomfortable while.  My boys mostly came out screaming so I was anxious to hear something from her.  No one was freaking out but everyone in the room felt a little bit of urgency.  The doctor placed her on my chest and started rubbing her.  The nurses and Joe and I were all talking to her saying things like "Let me hear you, Nora."  "Give us a cry, little girl".  They suctioned her out and after that little while, she did cry and everything kind of proceeded normally.  We had about an hour of mama/baby bonding, she had a bath, I had a shower, and we moved to a postpartum recovery room, as is the procedure at our hospital. 

All my babies have sounded kind of "snorty" after birth.  I don't know if it's the shape of their noses or what but they all tend to sound like little piglets for a while.  Nora was sounding that way and no one seemed concerned.  I certainly wasn't. 

But after we got to our recovery room at about 3 AM, they took her temp and found it to be a little lower than they wanted.  So, the NICU staff came down, put her on a warmer and got her temp back up.  They bundled her up, brought her back to me, and we all went to sleep. 

We woke up the next morning and had our breakfast, nursed, got checked out by nurses, etc.  The usual.  Except that around 8:30 that morning I started noticing a little bit of wheezing with each breath.  When my nurse came back in, she noticed it also.  We unwrapped her swaddle to take her temperature again, when we noticed that her chest was retracting pretty hard with each breath.  That was when I started to feel worried.  My nurse called the NICU nurses to take a look and they decided to take her up to the NICU for a more thorough exam.

At this point, no one was too worked up.  There wasn't any talk of admitting her to the NICU, they were just going to do an exam.  So, they told me to take a shower, finish eating breakfast and then head up.  So I did.  But I sent Joe with Nora up to the NICU. 

I was taking my time, but when I walked into her room in the NICU, she was under an oxyhood and everyone was a little more somber.


They explained that the oxyhood was actually not providing her with oxygen, it was just humidified air.  But there she was...laying on the warming table with her little chest retracting so hard.  She was just working so hard at breathing.  I cried at the sight of her like this because it was not at all what I expected when I walked into the room.  The nurses said that they weren't sure what was going on; that they were just going to observe her for a while and they would see what the doctor said during rounds.  The on-call doctor came to make rounds about an hour later.  She said the same - that mostly what we needed to do for the moment was observe.  But she also said Nora may have just had some nasal swelling from the suctioning right after birth and maybe it would be something that would kind of turn itself around.  So, that was the verdict.  Wait and observe.  Leave her under the oxyhood, taking her out only when it was time to nurse.

This was hard for us.  We wanted to hold her.  Joe stayed like this for the rest of the day.  I was so thankful that he was committed to touching her and talking to her.  He played her our "Nora" playlist (that we had listened to during labor and delivery).  It takes a lot for Joe to get emotional, but this was a lot for him.

Around lunchtime the nurses suggested that I go back downstairs to eat and rest.  (There is no food allowed in the NICU).  They assured me that they would call my room when she was ready to nurse again.  I cried again when I left her. 

As we were eating lunch the NICU called to say that Nora's blood sugar had dropped and so they had started an IV.  We hurried back upstairs because, although I wanted them to do whatever she needed, it seemed strange that all of that happened so quickly and we weren't there. 



I kept telling myself that there were lots of other babies in the NICU that were in much more serious situations.  But this was still new territory for us.  This was still unexpected.  And no one wants anything to happen to their baby. 

The rest of that day was spent "observing".  While I was taking a nap that afternoon, they decided to put a tube down her nose and make sure there was no extra air in her stomach that might be hindering her lungs from expanding all the way.  Joe hated this.  Hated it.  He couldn't handle watching them place the tube and he was very unsettled about it the whole day.

At some point in the afternoon they switched nurses (not at the normal shift change at 7pm).  The new nurse (Karen) started explaining all the things I needed to know about staying in the NICU.  That was when I knew for sure that they were admitting us.  She told me about all the machines that Nora was hooked up to. We learned about what numbers the doctors wanted to see when monitoring heart rate, respiratory rate, and oxygen saturation.  She told us all kinds of things about long-term NICU stay.  It was overwhelming. 

Joe went home to eat dinner and with the boys and help my mom put them to bed.  I ate dinner down in my room and came back with my Bible.  Karen was getting ready to leave at the 7pm shift change.  But when I walked in she said "reading your Bible?" 
"yes", I responded.
"It's a good thing to read", she said.

After she briefed the new nurse she same back in and whispered "Would you like to pray with me?"
"yes", I said, through a sob.
She smiled.  "Just let me close the door."
So we laid hands on Nora and whispered prayers for healing over her tiny little body, still struggling to breathe.

This is the most amazing thing, you guys.  God is everywhere.  Everywhere.  He shows up in places where you least expect him.  He breaks the rules.  He is relentless.  That nurse was Jesus to me in that hospital room.  She blessed me more than I can say.  Thank God for good nurses.  And thank you, God, for never letting us go.

I continued to pray a lot of verses over Nora the whole time we were there, but these are what I kept coming back to.  God was really speaking to me in Psalm 62:6-9

"My soul be at rest in God alone, from whom comes my hope. 
God alone is my rock and my salvation, my secure height, I shall not fall. 
My safety and glory are with God, my strong rock and refuge. 
Trust God at all times, my people! 
Pour out your hearts to God our refuge!"

 Thursday afternoon, the on-call doctor ordered a chest x-ray and a stomach x-ray.  Both of those looked normal so we could rule out any lung disease.

My dear friend, Kim, came to see us that night which was such a relief to my worried heart.  She is a NICU nurse at a different hospital and it was so helpful to just have her presence and her wisdom.  We got her opinion on what we should be asking doctors and nurses about, and just got to have someone who was used to this kind of environment give us a little encouragement.

That evening we started noticing that Nora actually struggled LESS when Joe and I were holding her.  And that she was breathing fine while nursing.  Both things that were unexpected.  Our nurse was wise and noticed the same things.  She allowed us to hold her for a long time that night, which was good for this mama's heart.

By the end of that night (Thursday), we were feeling really frustrated that we were pretty much in the same place that we were that morning.  We wanted there to be a plan.  She wasn't making any progress and we still had no idea why she was struggling to breathe.

At her 11PM feeding, I accidentally pulled Nora's tube out of her nose.  There were a lot of cords to work around while nursing.  When it came out, Joe told them he did not want them to put it back in unless it was absolutely necessary.  The nurse said she would leave it out unless/until the doctor said something. 

Joe ended up staying the night on the pull out bed in the NICU room and I slept downstairs in my recovery room.  But I came up every three hours to nurse.  When I came up for a feeding at 5 AM, the nurse said "look how much better she is doing!"  And she really was.  She did not look nearly as labored by breathing. 
 Look at this sweet little face.  We were really expecting the doctors to make rounds and be much more optimistic on Friday morning.   But, the thing about the NICU is that different doctors are on call each day and you always have multiple doctors working together.  Which is good - more ideas working together is good.  But it's also kind of hard.  You have some doctors who are very optimistic and some who are not.  The doctor we saw on Friday was not.  She said she was glad to see the breathing getting better, that it probably was just swelling from suctioning, but we still had a blood sugar issue to deal with. 
When babies aren't breathing well, a lot of other issues seem to spiral out of control.  Like the low temperatures and the low blood sugar numbers.  Remember, Nora was on an IV so we had to start weaning her off of that.  So, the on-call doctor told me that, in order to do that, she would need to eat 30mL at each feeding.  I was very overwhelmed with that number because, as a mom who had nursed three newborns, I know that nursing babies are getting drops of colostrum for the first few days.  30mL is a lot to ask, so obviously I would have to supplement with formula.

So, we started this regimen of:  weighing Nora, nursing her, weighing her again to see how much colostrum she was getting, pumping, feeding Nora what I had pumped from the previous feeding, and supplementing with formula.  Oh, and we also had to take her temp at every feeding, weigh her dirty diapers, and she had to have her heel pricked before each feeding to check blood sugar. 

These pictures were taken a few days after we got home, but you can still see her little owies from the blood sugar checks. 
 
So, Friday that is pretty much all we did.  My mom came up Friday afternoon and cuddled Nora and kept me company.  She would give her a bottle while I pumped.  Nora always took the most formula from Grandma.  :)  It was so nice to have her there.

Friday I was discharged.  So, after my dinner Friday night, I was no longer a patient, but I was not going to leave Nora.  So, I packed up my things and moved up the pull-out couch in the NICU room.  Not so comfy.  Especially when you're still recovering from giving birth. 

Saturday was more of the same - it was exhausting keeping up with the feeding and pumping and supplementing.  It left very little time for rest after washing all the bottles, storing and labeling what I had pumped, and getting everything reset for the next round.  The same doctor from Friday was on-call again.  During morning rounds she kept talking about how a baby on day 4 of life should have no problem taking in 30mL at each feeding.  That is still way more than a nursing baby would usually get, and I kept reminding her that Nora was born at 11:30pm, so what she was referring to as "day 1 of life" was actually only 30 minutes.  She did not appreciate this reminder. 
 
 Saturday was the day that the boys came to see their sister for the first time.  You can see the videos in the previous post.  It was sooo good for me to see them.  I was missing them so much and was worried that they would be worried.   I went to meet them in the lobby on the NICU floor.  When they came out of the elevator they ran to me and hugged me and made a big scene and I loved every minute of it.  More tears.  The woman at the desk commented on how nice it was to see that the kids had missed mom. :)
 
  Nora was still hooked up to all the monitors when they saw her but we just bundled her up so the cords were coming out of the bottom of her swaddle.  They asked a couple of questions but they didn't seem concerned.
 
My mom stayed with us for a while Saturday, also.  Again, so nice to have her company.

When they the boys (and later my mom) left that day, we were still thinking that Nora and I would be there a few days.  The boys really wanted us to come home with them so that was hard to not have a set time we knew we would be discharged. 

However, when Sunday morning rolled around, we got this really awesome new doctor.  :)  Much more optimistic!  We had already gotten the go-ahead to take Nora off the IV since her blood sugar numbers had been increasing during the night. 

When the doctors made rounds one of the residents (who had been there Saturday, also) gave everyone the briefing on all of Nora's stats and said that her opinion was that now, our goal should be allowing Nora to be a "normal" newborn.  Her recommendation was that we stay one more night for observation.  The new doctor responded "why?  I don't think there's any reason we can't talk about sending her home today".

He looked at me and said "what do you think?" 
I told him that I felt like she was acting like a "normal" baby and that I was comfortable with where we were at.  I told him that, especially since my milk was starting to come in, I was sure she would only keep improving on feeding and blood sugar. 

"Yeah", he responded, "30mL is a lot to feed a newborn". 

THANK YOU, doctor!  That's what I said!

So, after a car seat test and a few more hours to get everything unhooked, process paper work, etc.  I put this pretty little girl in a cute outfit and our boys came to pick us up.  We were so relieved to be home! 

Thank you all SO much for your prayers.  We could feel them and we are so grateful that she is doing well. 

Since she had the low blood sugar issue, we had weight checks every few days for the first two weeks.  But when she was above her birth weight at her two week appointment we were back to regular well child visits.

Praise God!!



10.01.2014

Birth Story in Pictures

It probably would have been nicer to put these into my last post (Wouldn't that be fancy?!  Words AND pictures?!)  but I just can't ever quite get my act together enough to do things the "nicer" way.  :)

SO here are some of the photos of our girl's birthday. 


                                                              Ready for induction
Aug 20
11:30 pm

                                                            6 lb 11 oz, 19 in long
so much brown hair!
 
Also, sorry, Nora!  We videotaped all the boys' births (G rated, don't worry) but you came so quickly we didn't get the camera on.  Remember, there were only about 10 minutes between 7cm and ready to push. 
 
BUT, we did get some VERY sweet videos of your brothers meeting you for the first time.  Here are some of our favorite moments:
video
 
video
 
 
...and two videos of Silas because there was just so much cuteness:
 
video
 
video