GUEST POST By: Kristin Lena, preemie mom
I didn’t have a birth plan when I went into labor last July. I hadn’t read that far ahead in my copy of What to Expect When You’re Expecting. I hadn’t attended any childbirth preparation classes. I don’t regret this lack of preparation; nothing could have prepared me for the way my son made his entrance into the world.
As I approached the end of my second trimester, I did have a few thoughts about childbirth. I thought that an epidural might be nice. I worried that I might need a cesarean section because my little soccer player seemed to prefer a footling breech presentation. And I imagined that the birthday of my son would rank among the happiest days of my life, no matter whether I had a vaginal or cesarean delivery.
When I was 27 weeks pregnant, I found some blood in my panties. The on-call obstetrician sent me to labor and delivery. The thought never crossed my mind to bring anything with me like a change of clothes or a book or a camera. I was just going to be reassured that everything was fine and sent home.
In triage, however, it became obvious that I was having contractions every 4 minutes. The doctors and nurses did not seem overly concerned; I was probably just dehydrated.
Unfortunately, a bag of IV fluids did nothing to mitigate my contractions, and after a couple hours in triage, my cervix started dilating. A first round of antenatal corticosteroids was administered, and I was given nifedipine to stop my labor.
The nifedipine seemed to work, and for 20 hours, my cervix held steady at 1-2 cm dilated. I was told to call my nurse if my contractions became stronger. I felt optimistic that provided my water did not break, my son’s delivery could be held off for months – or at least a few weeks.
At 3:00 a.m., almost 24 hours after my initial steroid injection, I had to admit to myself that my contractions were becoming painful. I called for my nurse. She came at about 3:15 and asked me to rate my pain on a scale from 1 to 10. I gave it a 4. My nurse didn’t seem worried, but I was becoming increasingly concerned as the contractions intensified. I was given my second steroid injection, and at 3:35 a.m., a resident finally arrived to check on me.
As he performed the pelvic exam, pain and pressure mounted, and I struggled to lay still. He pulled his hand out and told the nurse quietly, “I feel nothing but membranes.”
This is it, I thought to myself. I gave in to my internal struggle, and my water broke in a huge gush. My baby’s feet slipped out my vagina.
The next 15 minutes passed in a whirlwind. Someone called Code White, the pediatric medical emergency code, and I was quickly surrounded by medical professionals. My bed was broken down, and I was wheeled to an operating room. Babies couldn’t be born in an antepartum room. Especially not premature babies. And especially not footling breech premature babies. On the way to the operating room, a doctor exclaimed, “This is not the way it’s supposed to happen!”
Those words still ring in my ears every time I think of my son’s birth.
A dozen screams and one long push – that’s all it took to deliver my 2 ½-pound baby. At 3:51 a.m., a wave of relief swept over me as the pain vanished. Then a wave of shame consumed me. I was mortified that after giving birth to a tiny, silent baby, my primary response was to feel relieved that the pain was gone. Finally, a wave of uncontrollable shivering overtook me, and my heart went numb.
About an hour after the birth, a neonatologist visited my antepartum room to update me and my husband. Dr. Piccarillo congratulated us and asked whether our son had a name. I panicked, not ready to commit. Thankfully, my husband had a sufficiently level head to christen our son.
“Peter. His name is Peter.”
Dr. Piccarillo told us that Peter was alright. He promised us that we could see our baby in a couple hours after Peter’s umbilical catheters had been placed. After he left, I finally broke down and cried.
Having a baby in the NICU is no picnic. Many mothers of premature babies suffer from postpartum depression (PPD) and post-traumatic stress disorder (PTSD). While 10-15% of all mothers experience PPD, rates of PPD among mothers of premature infants are as high as 40% during the early postpartum period. And the psychological toll that an extended NICU stay takes on parents does not disappear the day that their baby is discharged from the hospital. Studies have shown that even at 2-3 years postpartum, mothers of very low birth weight infants exhibit significantly higher levels of PTSD symptoms than mothers of full-term infants.
During the first months after Peter’s birth, I tried to avoid thinking about the morning that he was born. When the voice of Dr. Piccarillo or an advertisement for cord blood banking made me think of my birth experience, I had to fight back tears. If a nurse mentioned Peter’s precipitous delivery or a neighbor asked about it, my heart would start racing. The sight of pregnant women coming to or going from the hospital made me anxious. I had trouble falling asleep at night, and I woke early in the morning. I was sleep-deprived just like any new mother, but our cradle was empty. (More precisely, the crib was not yet assembled.)
For most parents, their baby’s NICU stay is filled with both highs and lows; it is often described as a roller coaster ride. Unfortunately, we inherently recall negative events more easily and in greater detail than positive ones. Looking back on Peter’s early weeks, I remember all too well the green aspirations that a nurse pulled from his stomach when he was 4 days old, the x-ray that showed just how inflamed his lungs and intestines were, the neonatologist’s decision to treat Peter’s patent ductus arteriosus with NeoProfen, and the numb feeling that overwhelmed me during this first big setback.
I remember how tears blurred my vision and guilt knotted my stomach when I was told that Peter’s second cranial ultrasound revealed an intraventricular hemorrhage. I remember how horrified I was to learn that Peter’s Apgar scores were 1, 4, 6, and 7 and to be told that Peter “gave us a run for our money” in the delivery room. I remember how hopelessly impatient and frustrated I felt when, after making it 4 days without a recordable bradycardia spell, Peter had several spells on the night shift that set back his discharge yet another 5 days.
At the time, I thought I was handling the situation well. I read and learned a lot about the complications that premature infants often face. I maintained a healthy balance between time spent in the NICU and time spent taking care of myself and my household. I did not pester the nurses with the question that weighs on the mind of every mother with a baby in the NICU: When can I take my baby home?
In retrospect, though, I see that I was just putting on a happy face for the doctors and nurses and strangers in the NICU. My son’s birth and first week in the NICU was a traumatic experience for me as a new mother, and suppressing my memories and feelings was only leading to PTSD.
Healing from Preterm Birth
When Peter was four months old and had been home for over a month, I was finally ready to face my birth experience head-on and process the emotions that were tied to those memories. I wrote a detailed account of my birth story. It was not easy to write that 3600-word memoir – I shed many tears while composing it – but after I had edited and reread the story to myself several times, I felt much better.
The next step in my healing process was to talk about Peter’s birth with real, live human beings. I met with a group of local mothers who wanted to share their birth stories with other women. I wasn’t yet at a point where I could sit and discuss Peter’s birth in a casual manner, so I wrote out a script for myself. I trembled and shook as I read the story aloud to the other women, but after I was done, I felt like I had crossed a bridge. My birth experience was no longer a traumatic event that set me apart from other mothers. It was a rite of passage that helped me bond with them.
Peter’s birthday will never be counted among the happiest days of my life. Like many parents of premature infants, I cried tears of sorrow rather than tears of joy the first time laid eyes on my son. However, I believe that it’s important for all mothers to have some positive memories to associate with their child’s first days and weeks even if the neonatal period was blighted by a NICU stay. We deserve that much.
Thankfully, the emotions associated with negative events fade from memory more quickly than the emotions associated with happy events. My camera has helped me to preserve the evanescent details of the sweet moments we had during Peter’s NICU stay: the first time I held Peter, the first day he was allowed to wear clothes, the day his nasal cannula was discarded, the day he moved to an open bassinet, and the day that he was finally unhooked from the vital signs monitors. As Peter’s NICU stay becomes an increasingly distant memory, a nostalgia for those joyous milestones gradually supplants the feelings of sadness, guilt, and fear which at the time made the NICU stay a torturous marathon.
Now, almost a year after Peter’s birth, I feel nostalgic remembering how I used to cup my baby’s fuzzy little peach head with just the palm of my hand. I miss the way Peter used to open his eyes one at a time, wrinkling his entire forehead as if it took a tremendous effort just to lift an eyelid. It gave me such a thrill to watch him peer out at the world upon hearing my voice. I miss reclining after Peter’s feedings with him asleep on my chest. I miss knowing exactly how much he weighs every day. I miss watching Peter’s features develop as he transformed from a wrinkly old elf into a chubby-cheeked cherub. He is still changing on a monthly basis, but it’s not quite as magical as it used to be.
Malie, a mother of twin 26-weekers and a 34-weeker reminsced,
“Honestly, after three years, I have more positive memories of the NICU than negative ones. I was a wreck during our twins’ NICU stay, but I don’t really focus on that when I think back to that time. I miss hearing about every little milestone – every ounce gained, every step lower on the respiratory support, every poopy diaper – and I miss the nurses and doctors who cared for our twins for so long.”
It’s important to preserve and cherish the positive memories of our children’s neonatal period – those “highs” in the NICU or postpartum rollercoaster.