Joshua Graham - 1/17/2012

Our sweet son, Joshua Graham, was born via scheduled c-section on January 17, 2012. His gestational age was 37 weeks and 1 day, and we had no idea what his first week held in store for him. This is the (very long) story of his birth and first weeks, complete with an abundance of pictures. The amazingly good photos are courtesy of Jeni Dwyer Creative (http://www.jenidwyercreative.com/); the rest are from our camera.

Starting in December, my obstetrician began frequent monitoring of Josh and me. This was mostly a precaution and for peace of mind, but after we lost Elliott, it was also to detect any potential distress that our sweet baby may have been in during the last trimester of pregnancy. Twice a week, we went as a family to the clinic for non-stress testing (NSTs). These tests consisted of strapping two monitors to my stomach - one to measure contractions and baby movements, and one that tracked Baby's heart rate continuously. To "pass," the test had to show at least two heart rate accelerations of at least 15 beats per minute for at least 15 seconds each, within a 10 minute window. I can only remember two of these NSTs going perfectly without intervention, and the rest took some help from cold apple juice to get the results we wanted. As we got closer to the 37-week mark, it was harder and harder to leave the testing room and the comfort of the monitors. Every day inside is worth three outside, developmentally, so we kept waiting. In the final 10 days, we added NSTs on Sundays too, not wanting to wait 4 days between sessions, and had an extra biophysical ultrasound done to measure amniotic fluid levels and assess Baby's development. Everything looked good, so the wait continued.

Saturday, January 14, the talented and amazing Jeni Dwyer flew to Seattle from Durham, NC to be here for family and newborn photo sessions. She held a contest on Facebook last year, and I won! So out she came, with probably 100 pounds of photo equipment and props, and the final weekend before Baby started. It was unusually cold that weekend, and light snow fell that Saturday, but nothing stuck. All of us went down to Golden Gardens to get some pictures of Owen in action, and Jeni got some great shots of him and our family of three. Look for those photos in an upcoming post! Here's one Jeni got of me, two days before delivery:



And one on the couch:



The next day we went to the Seattle Art Museum's Olympic Sculpture Park for another session, but it was bitterly cold above Elliott Bay, so we came back home to the warm house, and Jeni and I went out later for pedicures. It was a quick day, despite the nerves and anticipation of what the following day would bring. Grandpa Louie came over to spend the night (we had an early morning scheduled), and we went to bed.

January 17

We woke up a few minutes before our 5:30AM alarm went off, and adrenaline hit for the first time that day. It was baby day! We were hours away from meeting our sweet son or daughter, but had several hurdles to clear first.

1) The amniocentesis. Since we were planning a c-section for 37 weeks, there was a question of lung maturity. While technically full-term, there is a margin of error when estimating due dates, and we didn't want to take Baby out if he wasn't ready. We checked in to radiology at 6:45AM and our appointment started at 7:00. Though not as scary as it could have been, the procedure is hardly comfortable. The only pain was the initial needle poke, but the feeling of the needle entering the uterus was very weird. It was, thankfully, a short procedure, and then we had to wait for results. The fluid sample was rushed to UW for processing, and I was wheeled to Labor & Delivery to begin preparations for the surgery. It was around 8:00AM at this point, and the target was 10:00AM for the OR.

2) Placing the IV. I hate needles. Like, really hate them. I had more anxiety over the IV than I did the actual c-section. Just how I am. Our nurse, Angela, was fantastic though, and the IV was started with very little discomfort, and I began a treatment of saline fluids and antibiotics (a preventive measure against surgical infection). The anesthesiologist came in to talk to me about the spinal block she was going to place for surgery, and let us know that she was making a special exception for us - Jeni could join us in the OR to take pictures of the birth. Wow! At 9:45 AM, Dr. Kurachi came bursting into our room. Baby's lungs were ready! We needed the test to come back below 260, and Baby was a 226. It was time! Dan and Jeni suited up in scrubs from head to toe, and I got my special hat too. Angela led us down the hall to the OR, the same one we delivered Elliott in, and we got started.









3) The spinal. One more needle to go. I could feel the sting of my previous epidurals, and was least excited about the spinal. Leaning over my giant baby bump, rounding my back, and taking deep breaths, the anesthesiologist worked her magic. The spinal was SO much less painful than an epidural, and as my legs got warm and numb, it was time to lay down and be prepped for Baby's birth.



Dan and Jeni came in, and Dr. Kurachi got started. It's such a strange feeling to be on that table. Hope and anticipation and love and sadness for what is lost. After months and months of wondering and dreaming, it all comes to this point, the birth of our baby. Only 10 or 15 minutes after the surgery begins, Joshua Graham is born at 10:36AM! He comes out with a timid cry, but he's here and he's alive. What a moment in a parent's life! At 9 pounds 4 ounces and 20 inches tall, size wasn't an issue our early-term son was facing.



















Jeni captured the emotion and elation of that moment, and we will treasure these photos forever.

But then the next chapter started abruptly. Josh's oxygen saturation levels were low, as was his blood sugar. His nurse wanted to take him to the special care nursery (SCN) to give him some food and check his oxygen saturation for a while longer. My heart dropped - what was wrong? Was this temporary? Did we take him out too soon? When would I get to hold and nurse him? Dan went with him to the SCN and stayed there with him for hours. I was wheeled back to my room for recovery, wondering and worrying about the son I had yet to meet. I was anxious and stir-crazy and mildly panicked, and then it hit me -- it was all too familiar. To have the surgery, deliver the baby, and then lay in a quiet room, empty-handed...It was too much. I did a lot of crying, and a lot of willing the spinal to wear off so I could go visit sweet Josh. Dan came to our room to let me know how Josh was doing. His white blood count was high, suggesting infection, and his red blood count was low - anemia. With every exhale, he made a (super cute) squeaky noise, but that could mean his lungs weren't ready after all. It was a lot to take in, especially with so many theories and not too much in the way of confirmation.

The SCN started an IV with a dextrose drip to help Josh's blood sugar, and a 48-hour antibiotic drip was started too, in case of infection. Dan was amazing and sat with him for all of this, breaking only to check on me, give me updates, and show me pictures.



After 6 long hours, Angela rolled a wheelchair into my room and wanted to let me try to get up. Nothing was going to keep me in that bed, not with the promise of Baby Josh at the end of the hall. I slowly worked to the edge of the bed and hobbled the football field (or 3 feet) to the chair. I was ready! Finally, I got to hold our new son. Study his face...memorize his smell...sing him songs that he must have recognized from his big brother...







That hour felt like seconds, and then I had to go back to my room. Later that night, Josh's bilirubin levels elevated, so he was put in a photo-therapy bed around the clock. Our poor baby. But the lights help break down the bilirubin so Josh's liver didn't have to, so of course we weren't going to argue. The worst part for me was that he had to wear velcroed on sunglasses that would not stay put. He comes from a warm, dark, confined place and gets put into a bright open box, naked...just seems so cruel. His hematocrit level (red blood percentage) was still low -- mid-20s, where normal is 45-50 -- but it was holding steady. Small blessing in a tough time.



By Friday night, his jaundice had diminished, so he got to come out of the light bed and spend more than 15 minutes at a time being held (until this point, he got to come out to nurse for 15 minutes, and then straight back to the box - Torture for Parents 101).





We had a great night of cuddling and nursing, and then it was time for his final lab work at 4:30 AM Saturday morning. He got a bath and his Hepatitis B shot, and we went back to bed.





Then at 7:00AM Saturday, our nurse came in and gave me the bad news -- his bilirubin jumped up overnight and he had to go back into the light box. I was hysterical. How could I do that to him again, after 12 hours of human touch? Why my poor baby?

Dan had spent the night at home with Owen, so I had to deliver the news through sobs over the phone. We weren't going home; we were staying at least through the weekend. We also met with the third neonatologist of the stay thus far, and he had a theory. Sometime in the late pregnancy, some of Josh's blood got into my system and it was incompatible with mine. My body developed antibodies, which went on the attack and started breaking down Josh's red blood cells. This would explain the severe anemia and the high bilirubin, plus helped explain why his lungs were working so hard in the beginning - overcompensating for the low iron levels in his active blood cells. It went farther than ABO typing and Rh factor, which is why it didn't show up anywhere before. Unfortunately, the blood center was closed all weekend so we had to wait until Monday to test his blood. More waiting...more light bed...more worrying.





We finally got the chance to have Owen visit. I forgot to mention to this point that Seattle Snowmageddon 2012 hit while we were in the OR. The city was shut down and snowed in for days! By Saturday, the roads were drivable so Dan could bring big brother for a visit.











By Monday, the doctors were pretty sure of the antibodies theory, and they started talking about a blood transfusion. Josh needed healthy blood cells, and couldn't wait a month or two until his body started doing it for him. They drew blood and sent it to the blood center to make a special batch for Josh's transfusion. They anticipated it to come back by 4:00PM, but due to antibodies (theory confirmed!) it took longer to make the blood solution than expected. At 10:00PM, the blood was delivered and it was time to transfuse. The procedure was to take 4 hours, followed by 4 hours of monitoring and fasting. No food for 8 hours! More tears. Dan went with him to the SCN to start the transfusion, and came back at 10:45 -- it was started. We went to the cafeteria at 11:00PM for some dinner - Chinese New Year menu and my first time out of the L&D floor since getting there a week before - and we talked about our boys, talked about the snow, talked to talk and pass some time. Around midnight, we made our way back upstairs, said good night to a sleeping Josh, and went to bed.

At 3:00AM, 15 minutes after the transfusion ended, the nursery nurse called and asked me to come nurse him. She called the doctor and told him he couldn't wait 4 hours to eat, so he waved the fasting period and I got to take Josh back to our room with me. Josh had labs run again at 6:00AM, and they came back wonderfully! Hematocrit was 39 and bilirubin was 9. He passed both! At 10:00AM, the neonatologist came in and handed us Josh's discharge papers. After 8 days, it was time to take him home!





It's been 5 amazing days since then, and life is good. Big Brother is incredibly loving and excited to have Baby Josh at home with us.







Josh seems pretty happy too:



We had Josh's first follow-up appointment on Thursday, and he's gaining weight and his hematocrit was at 41. It was a great appointment, one of hopefully many to come. We need to test his blood weekly for the next 2 months to make sure his hematocrit doesn't drop low enough to necessitate another transfusion, but we'll take things as they come. Right now, he's healthy and happy, and a great eater. He sleeps decently too, for a newborn at least.

One result of this past week was that we now are pretty sure we know what happened to Elliott last year. It's a mixed blessing to have answers now. There's no way we could have known last time, and it's a good thing we didn't know or we'd never have taken the chance to meet Joshua. Our family is complete - three beautiful sons, two of whom we'll enjoy watching grow for however many years we have ahead of us. Hopefully, Elliott is watching over all of us and we'll see him again in time. Until then life continues, a little more hectically than before, but amazing all over again. We have found our rainbow after the storm, and he's incredible.