by Oneida Diaz-Cadavid
When I learned I was pregnant, I was overcome with anxiety as memories of my first pregnancy came to mind. My first pregnancy came with its challenges, but in the end, I delivered a healthy baby boy at 36 weeks.
As a nurse anesthetist my assignments vary in stress level. Determined not to repeat history, on Monday morning I went directly to my supervisor’s office to inform him of the news. I began doing my part, eating healthy, drinking plenty of water and trying to take it easy. It wasn’t long before history began to repeat itself. By week 7, I began bleeding profusely so we rushed to the emergency room and were told the baby’s heartbeat was great and the bleeding came from a subchorionic hemorrhage. I spent the rest of my week at home off of my feet, taking it easy. At week 14, we decided to go to a private facility to have a gender reveal ultrasound. As soon as I got a glimpse, I screamed with joy, “it’s a boy, it’s a boy”. As the days went on, I started to become overly exhausted as if I were in my 3rd trimester. I knew something just didn’t feel quite right and went and spoke to my manager. I requested to change my schedule to shorter hours and he approved it effective immediately. Monday of my 16th week, only 3 days after speaking to my manager, I was sitting in the operating room when I felt fluid leak out. I immediately went to see my doctor. He performed an exam and the fluid came back inconclusive for amniotic fluid, which is not unusual so early in a pregnancy. He then performed an ultrasound and the look on his face said it all. My heart sank and I could feel the knot in my throat form. He looked at me and confirmed my fluid levels were low. I was scheduled to see maternal fetal medicine in two days already because of my prior pregnancy, so I was instructed to pass along the information and in the meantime, I was to stay home off of my feet once again.
The next several days were full of emotions, confusion, and frankly, just shock. I was sitting around with my water broken at 16 weeks without any signs of imminent labor. I had never heard of such a thing. Everything became a reality the day we met with maternal fetal medicine. After several exams, we were directed to her office. It felt like a scene from a movie because, honestly, how many times do you actually go sit in the doctor’s personal office and not in an exam room? We spent a good part of the hour discussing all of the possibilities, none of which were positive. The biggest point she elaborated on was the risk of the baby and I both passing away due to me developing a systemic infection. My husband looked at me with desperation waiting for me to say something. I dug deep trying to find words. I looked at her and said, “Have you seen miracles happen because I have. I’ve witnessed things that cannot be explained in a textbook.” She replied, “Yes, but very few times.” I stood up signaling to my husband and as we walked out, and I said, “This is going to be a miracle because this baby is going to be just fine.” The car ride home was difficult. The air was thick to breathe. As a medical professional, my husband depends on me to carry us through these moments. I reached for his hand and said, “Everything is going to be fine”. As scared as I was I truly believed that.
Four days passed, and we once again found ourselves in the emergency room. This time we were sent home with the news all the doctors had been preparing us for. The baby’s heartbeat was low, and the active bleeding indicated I was experiencing a miscarriage. We were sent home. I messaged my physician and was told if the pain became intense to head back to the hospital, but in the meantime plan to see him in his office first thing in the morning. The following morning my parents and my husband all joined me to the doctor’s office. He performed another ultrasound and told us the baby’s heartbeat was normal, but the fluid levels were almost nonexistent. It was that moment that he took the time to be very honest and clear but in the most tender way. He again explained the probability of survival was not on our side. He offered to induce labor and end this emotional rollercoaster, which I immediately refused and stated, “If God wants to take my baby it’s his job to end this pregnancy, not mine.” He continued on to gently introduce things we needed to start thinking about. Do we want to see and hold our child if he passes away? What are our beliefs for funeral arrangements if the baby passes away? He introduced things my husband and I had never discussed. I left his office feeling pretty empty inside. Over several days, my husband and I made some tough decisions if our baby didn’t make it. We went through hundreds of names to find a name that would describe him perfectly, regardless of the outcome. We decided on Dominic- belonging to God. It was perfect.
As each day passed, our hope continued to increase that we would make it to “viability”. Viability is defined as 23-24 weeks gestation. At 19 weeks, we met with a second maternal fetal specialist from a different group. Again, multiple exams were done, and it was time for the dreaded face-to-face discussion. This time the conversation went a little different. Despite the lack of fluid, our baby looked developmentally perfect. We learned that the biggest risk other than death was the baby not developing lungs because lung development starts at week 16 and requires amniotic fluid. He ended the conversation saying, “I can’t tell you this is going to be easy, but it’s not impossible. I have seen one other patient rupture this early and make it to 34 weeks and deliver a healthy baby.” That was all I needed to hear. We discussed the plan to be admitted to a high-risk obstetrical hospital in Tampa at week 23 and hope I remained pregnant without complications until week 34, at which time they would schedule to deliver me via C-section, as the risk for infection increases dramatically at that time. I walked out with such a high for the first time in weeks.
In the coming weeks, we started getting things ready for me being an hour away from home. My mother and mother-in-law were now living in our home full-time helping us with our 18-month-old. As things were looking on the up and up, they suddenly came crashing down once again. At week 21, I was rushed to the hospital with suspected placental abruption, a risk of not having amniotic fluid. On complete bed rest, things once again started to subside. The baby remained safe. After several days of being hospitalized and noticing that even a simple walk to the bathroom five feet away caused the bleeding the start up again, it was decided that I would be on complete bed rest and would remain hospitalized until week 23, at which point I would be transferred to the high-risk obstetrical hospital.
Week 23 had finally arrived. VIABILITY. The word I never ever want to hear again. I had felt like my baby meant nothing to many providers because we had not reached that mark until this week. It was a bittersweet trip to the new hospital. I knew my baby now had a chance, but I was now one hour away from home, which meant a lot fewer visits and a lot less time with my 18-month-old. I was given my first shot of steroids in case the baby decided to arrive early in hopes of helping lung health for the baby. Our ultrasound revealed the baby weighed 508 grams, just 8 grams over the “requirement” to resuscitate a baby. This was a huge milestone to us because now our baby truly had a chance at life.
As the weeks went by, so did the milestones. Along with all the good came all the stressors of maintaining a home an hour away from a hospital bed. Financially things started getting more difficult as I had been out of work now for months and some of the initial medical bills started coming in. I had an amazing support system at work that donated vacation time to help with my income loss. Being so far away, the number of visitors also decreased. I remained with a core group of visitors each week, for which I will forever be grateful. I looked forward to the non-hospital meals my visitors brought me. I spent my hours in front of my iPad on Facetime watching my son play at home. My mom would bring my son a couple of times a week for a few hours as he didn’t tolerate much longer than that cooped up in my room. My husband traveled to work 20 minutes from my hospital every morning, another 45 minutes home to spend some time with our son only to turn back around and drive another hour so he could spend the night with me at the hospital. This took its toll on everyone involved. After six weeks of total confinement in my room, I was finally given wheelchair privileges to go outside. My first time outside I was blown away to hear all of the birds chirping and the leaves blowing. My mom pointed out that those birds and leaves are always there we just never pay any attention to them. It was like my senses were heightened. Every several weeks I had a scheduled ultrasound and each time the fluid levels were negligible, and the baby’s growth continued to decline on the charts. I continued leaking fluid throughout the entire pregnancy with intermittent episodes of bleeding.
At week 30, I began having contractions and was transferred to labor and delivery where I received a rescue dose of steroids for baby’s lungs and a large dose of magnesium, which is used to protect baby’s brain in case of imminent delivery. I have never felt so awful in my life. The magnesium takes everything out of you. You feel like you have the worst flu of your life in addition to having your face in a fire pit. My entire body felt like fire and I was immobile in the bed. Things once again settled down and I was transferred back to my room. The next several days seemed to repeat themselves as I had intermittent contractions and bleeding. At the end of week 31, I was once again transferred to labor and delivery and received my last rescue dose of steroids and another round of the miserable magnesium. Despite the contractions’ intensity improving they never stopped this time, but I was told if I was in true labor the magnesium would not have stopped the labor. I wasn’t completely convinced. As they moved me back to my room, I told my husband something wasn’t right.
The next morning, officially 32 weeks, an ultrasound was done, and we were told the baby was now only measuring 3% on the growth charts. I had a record amount of amniotic fluid, still low but enough to catch an image of our baby’s face for the first time ever. It was the best birthday present my husband could have imagined at the time. He went off to work but before leaving I told him, something isn’t right so be on standby as I continued to have contractions. By 8pm, I was being pushed down to the operating room, as it was confirmed I was in labor. As ready as I was for this rollercoaster to come to an end and for me to be able to see my baby, it was the first time that the reality of my baby not surviving really hit me. It was in that moment that I realized I had been in denial for so many months. I had never felt so scared. My husband entered the room and I couldn’t even smile. I knew that in the next few minutes our life would change forever. The room was covered in hospital staff reporting off to each other about my situation. You could hear everyone’s gasps each time someone heard I had been ruptured for 16 weeks. I wasn’t the only one in the room full of fear. You could see the fear on the staff’s faces. The incision was made, and my husband squeezed my hand as we both prepared for the moment of truth. After some pulling and tugging, we suddenly heard Dominic’s screams. I could finally take a breath and the tears poured out. I turned my head to watch all the staff surround Dominic. I caught a glimpse my baby. He was quite discolored which I knew meant his lungs were not working very well just as they had warned us. They brought him over literally for a quick second, allowed me to touch him before rushing off with him to the NICU. I sent my husband with strict instructions to not leave his side and not to worry about me that I would be ok.
As they finished closing me up, I felt so powerless being so far away from my baby and not knowing what was going on. At one point, I received a video of the baby on my phone and I could see that he was pink and doing ok. Before going back to my room, I was wheeled to the NICU to catch another glimpse of Dominic from my stretcher. At this point, he was receiving some respiratory support from a C-Pap mask, but my little guy looked great otherwise. By morning the phone rang, and we were informed that Dominic had to be placed on a ventilator because he was struggling to breathe. We rushed down to his room to see him. It was my first time really being able to see him. He was so tiny, just 3lbs 8oz. He was covered in medical equipment. As a medical professional, it’s hard to shut it off and just be a parent. I looked at all the monitors and interpreted all of the data. I knew even on the ventilator he was struggling. Because Dominic’s lungs were so underdeveloped, he had to have a special ventilator referred to as an oscillator. This machine makes a loud rattling sound as it delivers breaths to the baby, loud enough that the baby had to wear earmuffs to protect his hearing. The next several days were touch and go. One of Dominic’s lungs ruptured, and they had to insert a chest tube. Dominic’s lungs were so weak they had to use a special gas called nitric oxide to help his oxygen levels increase. One of his neonatologists came in to talk to us and explain the situation. I heard all of the medical talk, but what I saw was something different. I had seen that look before. It was the same look the doctor had when he told me I had ruptured at 16 weeks. It was the look of tenderness and sadness. He held my hands ever so gently as he explained the gravity of the situation. As he walked away, my husband looked at me for words of hope. Again, I had to jump into action, “Honey he’s going to be ok. God didn’t let us get this far for nothing.” As the days passed, Dominic started to improve. I was able to hold him for the very first time nine days after he was born with all of his tubes and IVs still attached to him. After 11 days he was finally able to breathe on his own off of the ventilator. The next seven weeks consisted of weaning Dominic off of oxygen slowly, multiple blood transfusions, and getting him to suck from a bottle nipple. At 40 weeks gestational age, Dominic was still having trouble taking milk from a bottle, so we opted to have a feeding tube placed. At the same time, a special cast was placed around Dominic’s hips and legs because he had been diagnosed with hip dysplasia from the lack of fluid during the pregnancy. Finally, at 41 weeks gestational age, nine weeks after he was born, we were able to take Dominic home on low dose oxygen and a feeding tube for meals. Once home, the transition was very difficult, as I was required back to work 2 days after bringing Dominic home. My sister, a registered nurse, and my mother were able to care for him while I was at work.
Dominic is currently six months old, off oxygen, and doing amazing. His feeding tube was out in less than a month and he is already learning to eat purees. His hip cast has been switched to a removable brace, which he is expected to use until age two while he sleeps. This week he has become a pro at rolling over. He is always full of smiles and rarely ever cries. Dominic Andres Cadavid is our miracle baby.