By Katrina Hinton-Cooper
Web Exclusive January 22, 2007
When Walter was born I expected to relax, lean back in my bed, and be waited on hand and foot by the caregiver for a couple of weeks. That's how it works here in the Netherlands; why should it have been different for me? I had an excellent team of midwives standing by and all the check-ups and ultrasounds had gone very well indeed. Walter was going to be small, we knew that, but well within the normal range. I had it all planned out—getting started with the breastfeeding, introducing him to our pets and the outdoors, showing him off to visiting friends, getting to know him, indulging him, loving him. But things don't always go as planned.
Walter was born three weeks early. The first contraction came at 2:39 a.m., two hours and thirty-nine minutes after the moment when he would not be considered premature and could be born at home, and 9 minutes after my husband climbed into bed. We'd been joking about that, saying to my belly that day, "You just need to hang on until midnight, you don't want to be born in a hospital." It was all in jest, though; we didn't really think he'd be early. After that first pang, I remember thinking, "Hmm, that was a weird, long cramp..." Several minutes later I thought it again, and by the third one I had my suspicions about what was going on. The contractions quickly got longer and closer together, and after a couple of hours I abandoned the midwives' instruction sheet: it said to wait until the contractions had been five minutes apart for two hours, then call. That was clearly not going to happen: they were coming closer and closer together and I realized time was running out.
When I phoned—far too early according to the instructions, but in my view not a moment too soon—the midwife said cheerily, "What we recommend in such a case is to get into a nice warm shower for a bit, and then wait an hour and see if the contractions are still happening." Grimly, I ground out, "I... did... that!" While the midwife considered this, a contraction came, and then another, and when the third one hit during our five-minute conversation, she said, "I'm on my way." My waters broke as I hung up the phone. While we waited for her, my husband gathered all the things on the list of necessities and jacked the bed up on blocks he'd purpose-built only a day or two before. I amused myself in the meantime by crab-walking back and forth at the foot of the bed. My fingernails punched nice little crescent shapes into the footboard.
The midwife, Thessa, arrived at about 6:30 a.m. The practice had an admirable policy of ensuring that each pregnant woman saw each of the five midwives for at least two appointments. That way a total stranger would not arrive at such a sensitive and significant time as the birth of a child, especially, as in my case, a first child at the tender age of 36. Nonetheless, I had never seen Thessa before—the regular midwife for that shift turned out to be out on maternity leave—but I absolutely did not care. All that mattered to me was that The Professional was here, and she was friendly, and she was going to Tell Me What To Do.
The details of the birth aren't so important. It was neither momentous nor traumatic. He did have the cord around his neck, but it caused no problems and was swiftly and efficiently solved. The whole experience went very quickly indeed—as soon as she arrived, Thessa calmly stated we'd have a look at me now, took one glance inside, and hurtled off down the stairs for her car, shouting behind her, "You're at 10 centimeters; I'm getting my bag!" By the time the assistant arrived, Walter was nearly in the open air. I'm not saying it was EASY—it was unbelievably hard, unbelievably painful. But, in retrospect, it was fast, and uneventful.
My little Walter was born alert, and received excellent Apgar scores: 9, 10, 10. He was, however, a little on the small side (2380 grams, or 5.25 pounds), and his body temperature was just a little lower than the midwife would have preferred. So while I sat against a pile of pillows with my husband, exhausted and beaming at this miracle, my son, feeling very unreal and yet completely natural and right, the midwife phoned a nearby hospital and discussed the case with a pediatrician. It was decided that Walter and I should both be admitted for two days of observation, so they could monitor his glucose levels and make sure everything was OK.
When we arrived at the hospital Walter was checked over and the staff became concerned about a keening sound he was making, which I hadn't known enough to be worried about. They told us that he was having a little trouble breathing strongly enough, and they took him to an incubator to watch over him. This was very hard for me, watching them take him away, but they told me to come downstairs and visit him after about an hour, and then as often as I liked. My husband stayed for a little while, then made his way home to take care of our poor puppy, who had been in her crate since the contractions got strong.
During Walter's first few hours in the incubator, the keening/grumbling sound got worse, so they gave him a chest x-ray and discovered a small hole in one lung. They told me this wasn't unusual, and was due to the difficulty he was having breathing: the effort to expand his lungs had torn a small section of delicate lung tissue. This in itself was due to his lungs being a little less mature than they would have liked to see; why THAT was is still a mystery, but the most likely theory is that I can blame it and his small size on my slightly-smaller-than-normal uterus. Air was found to be collecting in his chest wall, and a drain was inserted. They had to give him a small amount of morphine because of that—ironic, because avoiding any neonatal exposure to painkillers was one of the many reasons I opted to have him naturally, and at home.
When I went down to him, I found my poor little boy strapped down with an oxygen "moustache" tube under his nose. I watched him sleep until they made me go back to my room. They said I was pale, and didn't look well; this didn't surprise me at all. A lactation consultant was waiting for me in my room with a breast pump. She helped me get started trying to establish a milk flow, and that helped me finally feel like I was doing something for poor Walter.
On the day after his birth, early in the morning, I got out of bed and set out to see my son (I was chased down by a nurse with a wheelchair who asked what the heck I thought I was doing. After I told her, she pushed me the rest of the way). I had expected a nurse to usher me into the incubator room, which had been the norm all the previous day. Instead, I was waylaid by the staff pediatrician and taken to a small consulting room. Already frightened, I sat down to hear what she had to say. Walter's lung had collapsed. He was in critical condition. A re-animation team had been called, but thankfully not needed, as his heart hadn't stopped beating. They had him stabilized but barely, tubes everywhere, a second chest drain planned. They sat me down next to my pale, seemingly lifeless little boy, and I worked hard to hold myself together: I wasn't letting anyone send me away.
I had to go through it alone. They'd told me, and I'd told my husband by phone, that Walter was to be transferred to a hospital with a dedicated neonatal intensive care unit, but it wasn't certain yet which one. A special neonatal ambulance, called the Babylance, had been called and put on standby. It could arrive, neonatal specialist aboard, at any moment, but, like me, was waiting for an open bed in an intensive care unit to be found. My husband wouldn't know where to meet me, or when. I couldn't call him from the baby room to talk through what was happening, and wasn't going to leave to make the call until I had more that I could tell him. It was agony for him too, waiting alone for any glimmer of news. We don't have any family except each other here on this continent; there was no one to come and be with him. During the wait I held Walter's tiny hand and head, and cried.
Everything entered a state of controlled chaos when that ambulance arrived. The specialist whisked tubes out and tubes in, inserted the second chest drain, spoke to me briefly (explaining that without all the life support equipment he would die, but with it... well, who could say at that point), and then Walter was gone, trotted off down the hallway in a complicated mobile intensive care unit to the ambulance and another hospital. Ten minutes later my own ambulance arrived, and we were off.
They wouldn't let me in to see him for more than two hours—they were "working on him". My new lactation consultant showed up with my new pump, and I had to fill out the meal-preference cards all over again. I met my roommate, a sweet Moroccan girl of about 24 whose baby had been born at 25 weeks (I later learned that nearly three months after that he went home healthy and thriving). We supported each other through the next several days, through all the touch-and-go moments, the glorious day when we both finally had some milk for our babies, the long nights. When they finally let me see my boy, he was equipped with 2 chest drains, three or four different IVs, a tube through the umbilical stub almost right into his heart, a respiration tube, a feeding tube, some miscellaneous other tubes, and dozens of sensors taped all over his minuscule body. A massive bank of machines rose behind his tiny cot. He was slightly drugged, exhausted, and so very, very small. I sat by him, and eventually my husband arrived, and cried. He hadn't seen Walter since he'd been a healthy-looking baby in an incubator at the other hospital, and here he was spread out on the altar of modern medicine, looking so much smaller than he was, dwarfed by all that technology, fragile and impotent. My husband had to go again shortly after that, for the sake of the puppy.
Those were the Bad Days. During the crisis at the first hospital, Walter's blood gases had dropped nearly to zero, so of course along with the terror that he might not live was the omnipresent dread of brain damage. On his second day in this world I was sitting by him, talking, talking—I was telling him over and over again that he only had one job in the whole world and that was to let the good doctors do what they needed to do while he just rested and got stronger. Into this scene came a dapper and painfully shy man with a large, complicated machine covered with screens and dials and what-have-you, trailing a massive bundle of electric cables. It was a portable ultrasound, and for the next half hour I was treated to intricate views of the ebb and flow of blood and gases through Walter's brain. Everything was fine.
When Walter had been stable for 24 hours I let myself believe he probably wouldn't die. The rest of the story is actually rather anti-climactic: he grew stronger, and one by one the tubes and machines were withdrawn. After a week he was still getting supplemental oxygen, and had a feeding tube because he wasn't drinking well on his own, but the rest of the paraphernalia was gone. The day they decided I could no longer take up a bed, he was approved for transfer back to the hospital closer to my home. This hospital ushered us into a week of light therapy, weight gain, breastfeeding tutorials, and the like. I visited Walter twice a day. I would have liked to go more, but it was a long trip with public transport and I was feeling the effects of spending my entire post-partum period standing in fear by incubators. They kept telling me, "He can go home in a few weeks, maybe three, maybe five", but my little man wasn't having that. Walter was a fighter. One memorable morning the doctor watched me with him for a few minutes, then said, "Walter can go home in two days; come stay with him tomorrow night and care for him yourself". The whole thing, every step, had gone much faster than anyone had thought it possibly could. Walter returned home to the place of his birth on the day he was two weeks old.
Getting little Walter entirely off the bottles and onto the breast was difficult at first, because he would always fall asleep within a minute of starting to try to nurse, even during the coaching sessions while he was still hospitalized. My grandmother commented that this must be his way of letting me know that at these moments, everything was right with the world. Gradually, though, he got the hang of it. I always started with the nursing before waking him back up to offer a bottle (of my own milk, of course), and one day he really latched on. After that it was only a matter of a few days before he was getting his full meal straight from me. He has not used a bottle once since the day he turned six weeks old.
Walter was alert and cheerful from the moment we left the hospital. He has never looked back at those days, never frightened us with a health crisis, never been a fussy or unhappy child. He did have nightmares, and the saga to overcome those and get him sleeping through the night is another story. Suffice it to say that he was over the nightmares in just a few weeks—and sleeping peacefully through the night by the time he was 14 months old, which has been his habit ever since.
Walter is our joy and our delight, and is such a happy and charismatic little boy that he makes friends and accumulates fans everywhere he goes. As I write this, it is mid-July and in two months Walter will be two years old. I wouldn't give up a moment of that time, even the long, long nights, even the hospitals and the terrifying days at the beginning. Walter is home to stay, and we are so very glad to know him.
Jennifer Bové is a mother, writer and editor living in Melbourne, Arkansas. Her books include The Back Road to Crazy and A Mile in Her Boots. She's currently working on a new book of family wilderness adventures called Wild with Child. Visit her online at www.bovesboots.blogspot.com.