This blog post will cover only part II of Andrew’s birth, our NICU experience. Other details of our pregnancy, home birth and postpartum journey will be covered in later blog posts. You can find all the topics I’ll be sharing about here.
While we enjoy and frequently reflect on Andrew’s home birth, this next part is not a time we love thinking back on. In fact, it was still difficult to write and relive that time in my mind even though it happened six months ago. It was such an unexpected thing and because of that we were unprepared emotionally and mentally. Thank the Lord, everything turned out okay in the end. We had some incredible doctors and nurses who cared for Andrew while we were there, but a stay in the NICU is an experience I wouldn’t wish on any parent.
The morning after Andrew was born, our midwife and doula came back to the house for his 24-hour check up. We were tired, but in good spirits. Andrew slept a lot that day. I thought he was sleeping a lot because he was a newborn and he was tuckered out from the day before, which was partly true. However, there was more to the story that we would soon discover.
They asked how our night went. I told them we got at least a four hour stretch from about 3:00-7:00 a.m. They asked how breastfeeding was going. We told them Andrew still wasn’t latching well. He would fall asleep at the breast after a few sucks, so we were hand expressing colostrum and feeding it to him with a 1/4 teaspoon so he was at least getting something. I still wasn’t overly concerned at this point because we were making plenty of attempts and I’d heard breastfeeding can take some time to figure out. Plus, I knew that a newborn’s stomach is very small and only needs small amounts of colostrum those first few days, and I knew he was at least getting what we were feeding him in the 1/4 teaspoon. Looking back, I wish I would have listened to that voice in my head several weeks prior to going into labor that said “Maybe you should have some formula on hand just in case.” Unfortunately, I didn’t end up buying any formula to have on hand because I assumed breastfeeding would work out, like a lot of other first-time moms. After all, we took a great breastfeeding class during pregnancy and I felt confident we would figure it out. What I found out, however, is that breastfeeding is incredibly difficult for so many reasons (at least for me)! I know a lot of other moms struggle with it as well and sometimes it doesn’t come as naturally as you’d think. More on that in the next post.
Anyway, we attempted breastfeeding again to show them what he was doing. Again, he’d suck a few times and then got sleepy and acted uninterested in feeding. They moved on to some other check ups, including a hearing test (which he passed), checked his resting heart rate and reassessed his right foot from the day before. After he was born they noticed his right foot looked a little swollen. When they rechecked it that morning it was about the same. They also said his heart rate was on the lower side. In fact, just six days before Andrew was born, we were at our 39 week appointment and our other midwife was listening to his heart rate with the doppler. She listened for a long time and we could tell she was concerned. She said that his heart rate dipped below 100 three times in the matter of a few minutes and that she doesn’t see that happen a lot. If I remember correctly, she suggested we go to hospital triage and have his heart rate monitored within the next day or so. We left that appointment worried and scared, and when we got home we listened to his heart rate again with our own doppler. It still sounded slow. We both had a gut feeling that we needed to go to the hospital right then to have his heart rate monitored. Thankfully, after three hours on the monitor, the doctor said his heart rate was very consistent and there weren’t any concerning decelerations. They felt comfortable sending us home, which was huge since I was full-term and we thought that they might try to induce me that night if his heart rate kept dipping.
Finishing up their assessment, our midwife brought him over to the window and looked him over for jaundice, which is pretty common in breastfed babies. She said he looked like he had a little jaundice, which we knew would clear up once he started eating and pooping more and his liver matured. They suggested we purchase a nipple shield to help with breastfeeding, which Daniel said he would do immediately after they left. They also recommended we move up our first pediatrician appointment so we could get his heart rate and slightly swollen right foot checked out, which we also put on our to-do list.
After they left, Daniel went to a couple stores to look for a nipple shield while I laid in bed next to Andrew wrapped up in his blanket. Like I said, he was sleeping a lot, but I was just enjoying cuddling up next to him and I really didn’t give much thought about how much he was sleeping. After a while Daniel said he was on his way home with the supplies. He gets home and tries to help me figure it out for a few minutes and get Andrew back on the breast. While I wrestled with the nipple shield he said he had to go make a phone call. He said it kind of hurriedly and walked outside to make the call, which I thought was weird. After a few minutes he comes back inside and said that while he was running errands he got a call from our midwife who had been at our house that morning for Andrew’s check up. She said she wanted to talk to him about about a gut feeling she had about his heart rate and slightly swollen right foot. Our midwife knew that Daniel works in healthcare and is familiar with symptoms and what they could mean. He told me when she mentioned those two things specifically that he immediately thought she was insinuating that Andrew might have a heart issue. He went on to tell me that he was just outside talking to our pediatrician who our midwife recommended we get in touch with about his heart rate. Our pediatrician said that if his heart rate was falling below 100 bmp that we should go to the emergency room. My stomach dropped. Daniel went on to tell me that our midwife wanted us to come into the office on our way to the hospital to double check his heart rate.
Our minds were reeling. I was shocked that anything could potentially be wrong with Andrew. He looked so peaceful sleeping there on the bed. I also didn’t want to leave the house with our brand new baby. I looked over at the “just in case” hospital bags by the door and felt both grateful that I thought to pack them before we went into labor, but also desperately hoping that we wouldn’t have to use them. We packed everything up in case we needed to go to the hospital after they checked him at the midwives’ office. I slowly got ready because I was tender down there after just having given birth. I fumbled around and gathered my things. I didn’t know what to wear because I didn’t expect to leave the house for at least a few days. We got Andrew in his car seat. He looked so small. It made us sad. We were worried and scared and it was just a horrible feeling thinking about what we might be walking into.
It took us about 20 minutes to get to our midwives’ office. Their office administrator (former NICU nurse) was there and monitored his heart rate and oxygenation. After a few minutes, she said he was oxygenating just fine, but his heart rate was very low for what it should have been. I believe she said it got down into the high 80s at one point. Our midwife recommended we go to the emergency room at the children’s hospital for further examination. Again, we were just beside ourselves. We were experiencing the highest of highs and the lowest of lows in 24 hours. Our midwife kindly let us attempt breastfeeding again in the back room and let us take our time before we headed to the hospital. While we were back there, everything sank in and we just sat there and cried. We were so worried about our little boy and what might be wrong with him. We tried to get him to breastfeed again, but he did the same thing as before. His sleepiness and disinterest in eating was really concerning us now.
After a while, we got in the car and headed to the children’s hospital. We parked in the garage and walked into the main entrance and thankfully they got us back to triage very quickly because he was a newborn. The triage experience was horrible. I know the nurses and doctors were just doing their jobs, but they stripped him down and things were happening so fast and it was heart wrenching seeing our brand new little baby laying there crying and wondering what was going on. After a few minutes of monitoring him they said his glucose was very low, obviously because he hadn’t been eating very much at all since he had been born. They gave him some glucose and his levels increased, but because of low heart rate and lethargy, they said they wanted to monitor him further in the NICU and that a team would be on their way soon to take him there.
While we waited for the transport team to arrive, they asked if I wanted to try to nurse him again. I knew he would do the same thing as before, but we tried anyway. Let me just tell you that attempting to nurse in triage is not the place to get the milk flowing lol.
The transport team arrived and we just couldn’t believe we were seeing our baby being wheeled to the NICU in an incubator. I was pushed in a wheelchair behind him as we made our way to the elevator because I was still very tender down there from just having given birth and everyone was concerned about me walking. Daniel was pulled aside to do some quick paperwork before joining me in the waiting room upstairs which is where we were parted from Andrew so that they could get him set up in a room in the NICU. Having to wait to go back to see him was horrible. We were wrecked emotionally and just sat there for a while and cried. After some time, a doctor came out to talk with us to get some more background on the situation. She asked questions about his birth, my pregnancy, our health, family’s health history, etc. She said she had been monitoring him for a bit and his heart rate was very low (it had even dipped into the 60s!), but that he was oxygenating perfectly and was stable. She said we’d be able to go back and join him in a few minutes.
She left and after a little while we were finally called back to join him. We walked through the halls of the NICU until we came to the room where Andrew was set up. I remember walking in and seeing him laying there with an IV and monitors all over his chest and he just looked so small and pitiful. We looked at each other and cried and still couldn’t believe we were in the NICU.
That first night was a very restless night of sleep. Our room was furnished with a fold out bed and a big recliner, but we couldn’t sleep because of all the beeping machines, frequent pop ins from the night shift nurse to check on Andrew, and our worried minds. I made several slow and painful trips to the bathroom down the hall and I remember thinking that I should not be up walking the halls of the NICU after just having given birth.
The next morning Daniel said that since Andrew was stable and in the best hands he could be in, it would be in our best interest to spend the days with him and then at night go home to sleep since we weren’t likely to get much there. I felt like the worst mother in the world for leaving her baby in the NICU during the nighttime, but Daniel was right. He couldn’t have been in a better place and we (especially me) needed some sleep. We were exhausted since we were both up all night while I labored two nights before, only having gotten about four hours of sleep the night before coming to the NICU, and hardly any sleep at all that first night in the NICU.
A lot happened over the next four days while we were in the NICU. Thankfully, they were all good things, but it’s way too long to write all the nitty gritty details, so I’m going to hit the highlights:
- First, the main reasons we wound up in the NICU were Andrew’s low resting heart rate, lethargy, disinterest in eating, and concern about his slightly swollen right foot. After we arrived in the NICU they discovered his bilirubin level (jaundice) was high, likely leading to him being lethargic and not having the energy to eat. While his resting heart rate was very low those first days in the NICU, he was oxygenating perfectly. The doctor showed us that when Andrew’s heal was pinched or pricked or when he moved around, his heart rate rose. Variability with his heart rate was a great sign. They ran all the tests on his heart and we were told that there were no structural issues with his heart. We were so happy to hear this news! Since any heart issues were dismissed, they were also much less concerned about his slightly swollen right foot, which could have been a sign of a heart issue. We’re still not sure why his foot appeared swollen and there was never a clear answer as to why his resting heart rate is on the lower side. The only thing we can think of is that Daniel has a very low resting heart rate as well, so maybe this is a trait that will run in our family.
- Once it was determined there were no issues with his heart, the main goal was to get his bilirubin level down, which would happen once he started eating and pooping more. I remember the first night we were there the nurse caring for Andrew asked if I would like to try to nurse him or if we wanted to use formula or donor breastmilk to feed him. I knew that if I tried to nurse him it would probably be the same old song and dance, so I chose to use donor breastmilk, which I was so grateful to have as an option! We fed him 2-3 ounces at a time and he always chugged his bottle! We were thrilled to see that he was indeed very hungry and interested in eating.
- The four days we were in the NICU Andrew spent most of his time sleeping under the phototherapy light with his little felt sunglasses to protect his eyes. Phototherapy helped lower his bilirubin. He ate a lot and slept a lot. We attempted to nurse several times and even had some help from two lactation consultants who worked in the hospital, but he still wasn’t latching well on his own. Thankfully, we had access to donor milk, so we just kept using that option when it came to feeding him. I was also pumping every 2-3 hours to get my own milk to come in. Whatever I pumped, even if it was just a half ounce of colostrum, we put it in his bottle and fed it to him. I remember being upset when we were told he’d have to be on antibiotics for a couple days because I had been very intentional about what I consumed during pregnancy to help influence a healthy gut for him. I knew that no matter how little I pumped, any amount of breastmilk was the best thing to help build back his gut and overall health.
On the fourth day, the doctor was comfortable discharging Andrew! He said he was very pleased with how far he had come in just a few days. While it felt like we had been in the NICU forever, our nurse told us that a four day stay in the NICU was very short and was happy we were able to go home with him so soon. His bilirubin had decreased, he was eating and pooping like a champ and he was much more alert than he had been that first day at home after he was born. We could tell he felt much better and was ready to get on with it!
An Important Message
While we never thought we’d end up in the NICU those first few days after Andrew was born, we were (and still are) so grateful for the kind, empathetic, and knowledgeable nurses and doctors who cared for him and reassured us during that scary and uncertain time. It was pretty wild to experience home birth (the most natural, lowest intervention birth option) and then to experience the NICU (the most intensive care environment possible) within 24 hours! And I am so grateful for both. I’m grateful for home birth, midwives, doulas and I’m grateful for modern medicine, hospitals, nurses and doctors who gave Andrew the extra help he needed those first fragile days after he was born. And that’s one of my biggest takeaways from this whole experience. I think sometimes those with a firm stance in the natural world feel shameful if they resort to modern medicine for help, and vice versa for those who are wholeheartedly in the modern medicine camp when they choose to take the more natural route. Both worlds are important and they can coexist.
I often tell people we did the opposite of what most people do when their baby is born: we went from home to hospital rather than from hospital to home. However, I believe that no matter where Andrew was born (even if it was in the hospital) he still would have needed some time in the NICU afterward. That’s a message I want to state very clearly for any misconceptions that home birth is dangerous, reckless or unsafe: that he didn’t end up in the NICU because he was born at home. Home birth is a very safe option for low-risk pregnancies. I cannot overstate how knowledgeable our midwives are and that they knew when something was outside their scope of practice and when to refer us to a higher level of care. It was our midwife who acted on her gut feeling to call us back after that 24 hour check up and recommended we get in touch with our pediatrician and to then go to the hospital for Andrew to be further examined.
If you’re able to have a home birth, preparing yourself (as best you can) for the unexpected is key. I’m sure there are some textbook home birth stories out there, but then there are some like ours that took a different turn. Our home birth was the rose and our NICU stay was the thorn. But like I mentioned before, I’m thankful for both the low intervention option of home birth and modern medicine when it’s needed.
The third post in this pregnancy, birth and postpartum blog series: My breastfeeding journey, lactation support and exclusive pumping.