February 13, 2009

Going into having a NICU baby, we were told it was going to be a rollercoaster ride with many ups and downs. Cohen had an amazing birth day and following two days, and we were really hopeful he would continue on that path and come home early. And then there was today. Cohen officially made some dips on the rollercoaster.

I usually schedule my visits for his care time so I can help do some of the tasks, see his little face and touch him. This morning’s visit with him was brief. His nurse said he had a few episodes of Apnea, but that was to be expected. I was hoping he would have gone the entire stay without a single episode but I guess that was just wishful thinking. He was really fussy and uncomfortable at about 8am, so she did his care an hour early and told me to come back at noon for his next care time.

Right at noon my mom and I went to see him. We entered his room to the sight of his nurse trying to get the oxygen prongs into his nose. (He switches between the CPAP and another machine every 4 hours so he doesn’t get blisters from the CPAP mask) After about 20 minutes of the nurse trying and another 15 of the respiratory therapist trying, the nurse decided to put him on the nasal cannula (which is what people usually get when they need oxygen at the hospital). The nasal cannula makes him work harder than the other two machines, but his nose was just too small and he was really expending a lot of energy and calories fighting with the nurse to keep the big prongs in his nose. The nurse said that if his O2 sats stayed in the mid 90’s, he’d probably be allowed to stay on the cannula and not go back to the CPAP. Great news considering we would be able to see his face all the time and he wouldn’t have to wear the uncomfortable mask! My mom and I left to meet John and Carter who came up from Moscow.

At 4ish, John and I went into see Cohen. He was still doing really well on the nasal cannula, only having a few drops in O2, but she did say he had a few apnea episodes. He was sleeping really well so the nurse had us return at 6pm to do kangaroo care.

At 6pm John got to do kangaroo care with Cohen. John holding Cohen made him look really really REALLY small. Cohen was pretty fussy and uncomfortable and kept pulling the nasal cannula out of his nose, which would then cause his stats to drop. After a good 15 minutes of fussing, Cohen had a brady while John was holding him. His whole little body went limp, and it took the nurses a few rough taps before he started breathing again. Needless to say, his kangaroo time was over. It was really a scary experience, and I can only imagine what John was feeling. It was a good thing John was the one holding him because I would have just freaked out (more than I already did).

The nurse put Cohen back in the incubator where he had two more Bradys before we left. She kept telling him it wasn’t nice to misbehave when daddy hasn’t seen him in a few days! I would have to agree! The nurse told us that Cohen has not been digesting his feeds at all today, and even having more residual than what was given to him. This means he has reflux and is not digesting his food. On top of that, he had not pooped in 24 hours. All systems are connected so the nurse was hoping that by giving him an enema, which would help get his little system back on track. In the meantime, his feeds were reduced back to 1cc. I don’t like moving backwards!!

We did have some good news today. Cohen’s cranial ultrasound came back negative for bleeds whatsoever, and the final diagnosis was a “normal cranial ultrasound”. We were SOOOO relieved. Bleeding in the brain is one of the more difficult complications from premature birth and can lead to developmental and mental retardation. Only a few more tests before John and I can rest easy (as easy as one can in this situation…)

We left the hospital a little discouraged with the backtrack of progress, but we know he is in good hands and hopefully we will have many more good days as compared to bad days!

Visitor Information

We know everyone is very excited to meet Cohen, and we feel very blessed to have such wonderful friends and family who want to see him. However, he is in a very fragile state right now and the NICU has guidelines regarding who can visit and such to help protect the tiny babies from getting sick. Cohen is considered a Micro-Preemie (less than 3lbs), so he is in the most protected group of babies. If you fall into one of the categories below, we ask that you please wait until you are no longer in the category before asking to see him. We really are not wanting to be mean or prevent anyone from seeing him, we just can't risk someone bringing Cohen a virus...and this includes us as well! Once he starts to get bigger, his restrictions will change and he will be able to have more and more visitors.

Sick/Illness Guidelines:

• During the cold and flu season, children under 18 are not allowed, unless they are the parents. However, across the hall is a room for kids to play and they have TV, games, and lots of fun stuff to do if you have kids and want to visit. On Wednesday nights there is a free dinner and a movie :)
• Anyone who has a cold, or cold symptoms or any illnesses cannot come into the NICU (parents included), cough, sniffles, runny nose, etc.
• If you have been around someone who has the flu, you have to wait 48 hours to see if you get the flu before being allowed in the NICU
• If you have been around someone with the Chickenpox or any other contagious disease, you must wait the entire incubation period before being allowed to visit.

Other general guidelines:

• The most important thing to do to keep Cohen safe and healthy is to wash your hands when you FIRST come in the door. Even though you may not hold him it is important to wash your hands when you come in the room so you don't leave any germs behind on something you may have touched. At Sacred Heart, instead of using soap and water, there are two dispensers of an antibacterial mixture that works better than soap and water. It is on the right hand side when you first walk into the NICU
• Flowers are not allowed in the nursery. If you bring some, they will hold them up front for me until we can take them home.
• Only two visitors are allowed with Cohen at one time. And at least one of the visitors must be a parent. If you come in a group, please realize that it will be a one at a time process!
• There are no visitors allowed (unless its a breastfeeding mother) during shift change. Shift change occurs twice a day 6:30am-7:30am and 6:30pm and 7:30pm.
• Cohen can have blankets and stuffed animals in and around his station! The more it feels like home and not a hosptial, the better babies do. (Babies R Us, here I come :) )
• Cohen is located in the "Far East" Bed 46B (I think...)

We hope the guidelines do not discourage anyone from wanting to visit. We think it is really important that Cohen feel how loved and supported he is. However, the last thing we want is for him to get sick...this could set him back weeks in progress! If you have any questions, or are questioning if you should visit or not, please do not hesitate to call us!

February 12, 2009

Cohen had another excellent night. No reports of Apnea! Today was a big day for him. He had his umbilical line taken out. The Doctor wasn't comfortable with the vein that the line was in, so he switched him to an IV in his ankle. There may come a time in the next week or two where he will need a PICC line, but at this point the IV seems to be working just well. He is doing really well with his feeds and is moving his limbs more and more. Both his Doctors and nurses call him "Fiesty", but I suppose it was only a matter of time before John and I had a child that resembled more of who we were as kids. Cohen's right eye is swollen shut from the CPAP machine, it was so cute watching him try to open his eye and look at me, but also sad that he couldn't open his other eye.

When I went to visit him this morning, I walked in and he was crying in his incubator. It totally broke my heart! It was a cute little cry, but because I don't care for him 24/7 I didn't know what his crying meant. I had to ask the nurse if it was okay that he was crying. She laughed and reassured me that it was okay that he was crying, and that I could offer him the mini pacifier to help calm him. I gave him the pacifier, and he really, really liked it...so much so that he held his breath. This is called Bradycarida. Babies at this gestation have a hard time remembering to do two things at once, and suckling the pacifier and breathing are included. It was a little scary watching the nurse try to get him to start breathing again! The nurse said he loves the pacifier, but he only gets it for a little bit to calm him down when he is upset because he has "bradys" if he is just given pacifier whenever he wants it.

Today was a big day for me as well! Because the umbilical line came out I was able to do skin to skin with Cohen! The term for this is kangaroo care. It was so great to be able to hold him, but "Mr. Fiesty" did not want to be still at all. He kept trying to lift his head up and turn all about...I felt like I had no clue what I was doing! He ended up getting upset, mostly from the busy day he had and because it was 9pm, so our time was very short. Once he starts to get stronger and grow bigger the more occurrences and longer time of holds we can do will increase. I told John I would save tomorrow's kangaroo care for him :)

Also, the doctor is going to start increasing his feeds to 3cc/feed to see how he tolerates that. Soon he will begin the preemie tests that will help aide in the expected prognosis of our little guy. We will keep you updated on what those tests are and how he does.

February 11, 2009

Cohen continues to do really well! He got a bath today and he looks like a whole new baby! The cutest thing is that he has a full head of platinum blonde hair. Quite the difference from Carter's brown skullet! He still has not had any apnea episodes and we are so thankful for that. He is currently under the bilirubin lights to help with jaundice. The doctor has not gotten the results of his heel prick yet, but Cohen looks a little orange so they are treating him with lights because "it's only a matter of time" before he needs them. So, with both the CPAP machine and the sunglasses, his entire little face is covered! It will be nice when he can be done with the lights so that we can see his eyes!

Cohen has "care time" every three hours. This is when the nurses turn the bili light off, give him a rest from the CPAP machine, change his diaper, and do oral care. Oral care is done by taking a swab of my colostrum and putting it in his mouth. It keep his lips and mouth moisturized and allows him to taste the colostrum. Another big event happened today...Cohen got to eat! His doctor thought he was doing so well, that he allowed him to have 1cc of colostrum through the tube in his mouth. After it was determined he did very well with the feed, the Doctor upped his feeds to 1 cc, three times a day. This is huge, as they don't usually consider beginning feeds until the baby is 4 days old!

Cohen was also given new digs today as well. The noises of the open bed were annoying him, so the doctor ordered an incubator for him. I happened to be in the room when they were making the change so I got an "unofficial" holding while the nurses switched out the open bed to an incubator. It was such an amazing feeling holding him, but also terrifying as he is just so little! He was pretty well swaddled, so I felt like I was holding a tiny doll. Pretty soon I am going to blink and this tiny baby will be a 6-5, 18 year old!

More of Cohen's First Day

Cohen had a great first day! As standard procedure for premature babies, he has a umbilical line that goes in through his belly button where the umbilical cord was. The Neonatologist said he is really very good at getting the line into the aortic vein, but Cohen was being difficult so he put it into a smaller vein. If he starts having problems, the Doctor will try again, but for now it is working just fine. All of this vitals have been very good and he has not had any apnea episodes. Apnea is when babies forget how to breathe.

He is currently on a CPAP(continuous positive airway pressure) which assists him with his breathing. He is breathing oxygen on his own and this just helps keep his lungs open and makes it so his little body doesn't have to work so hard. My friend Gita described it the best when her twins were on the CPAP...he looks like a scuba diver and the apparatus covers his entire face. It's hard to see him with all the wires and machines. He has a tube down the back of his throat that goes into his tummy. The nurses use this to expel air from his belly, and eventually it will be used for feedings. Right now he is currently getting nutrients and fats from the line in his belly.

We are unable to hold him until his umbilical line comes out due to the high risk of infection. It is hard having him just lay on the open bed and being unable to hold him. We do a good amount of holding his hand and applying pressure to his body. Premature babies do not like to be stroked, they like small amounts of pressure instead.

Cohen Thomas Hawkins

Here are the first photos of our little man. I didn't get to see Cohen until late Tuesday afternoon, because I was still recovering from surgery and my blood pressure would drop too low every time I tried to get into the wheelchair. John took pictures so I could at least see what our new baby looked like. However, the pictures did not really prepare me for how little he really was. When I saw him laying in his bed with all the cords and monitors, I started crying. The pictures made him look much bigger than he is; his head is much smaller than a softball!

February 10, 2009: The BIG day!!

I tossed and turned all night. I was in so much pain; it was making me sick to my stomach. At about 1:30am I called for my nurse and told her I needed more Oxycontin. I had never asked for two at a time, let alone a dosage in the middle of the night. As a precaution, she hooked me up to the monitor and saw that I was contracting 2-3 minutes. She told me before she gave me the drug she was going to call Dr. Watts (he was the hospitalist that night) to let him know what was going on. About 2:00am, Dr. Watts came in. I told him it felt the same as the previous nights, but my contractions were just a little bit more intense. He said he would check my cervix for change just in case. I saw the look on his face as he was checking me. He said in a hurried, serious tone "get the ultrasound machine, stat." I was at an 8-9. (for those unfamiliar with childbirth, you start pushing when you reach a 10.)

Dr. Watts wanted the ultrasound because he couldn't tell which part of the baby was engaged. That made me a little nervous, but his head had been down the entire pregnancy so I wasn't too nervous. It took 4 minutes for the machine to roll into my room, and it took Dr. Watts 2 seconds to determine that the baby was in the transverse position. This means his butt was the engaged part and his head and feet were up high in my belly. He was essentially in the "v" position. Dr. Watts calmly looked at me and said I would be having an emergency c-section. I told my favorite nurse, Logan, to call John. Logan was my nurse on my first night, and she happened to be on the labor and delivery side that night. She is also Dr. Watts' daughter in law! She called John with my phone (I think he answered, Hi babe, haha) and Logan told him that I was dilated to a 8-9, but that the baby was in a difficult position and I was going info an emergency c-section. She told him to drive safe. As the nurses were quickly getting me ready for the surgery, Dr. Watts asked to call John again. He told John to drive safe because I was going into surgery now and there was no way he was going to make it for the birth so he might as well make it here safely. I texted John at 2:25am and told him I loved him and that both baby and I would be fine.

I was wheeled into the OR and was given the best epidural I have ever had. Granted I only had one prior to this, but this one went in smoothly and I was numb quickly and evenly! I was given some oxygen and we were ready to go. The only thing we were waiting on was the Neonatologist to arrive. About 10 minutes later, and after a stern look from Dr. Watts, the Neonatologist arrived and the c-section began.

It was a lot of pulling and tugging. The first thing I heard was Dr. Watts ask the resident who was assisting him what specialty he was going into and the resident responded "Radiology." Wow, talk about reassuring...not!

Then at 2:50am I heard the most beautiful sound in the world..a little cry that sounded like a mix between a bird and a kitten. I couldn't believe he was breathing let alone able to cry. The whole room was very excited that he was crying. But he was whisked away to the Neonatology team (in the same room), before the surgical team could tell what gender he was. I kept hearing, "is it a girl?", "is it a girl?"...I was thinking to myself, no way I have pictures and he is not a girl! Finally one of the neonatology nurses said "No, this is all boy" The nurse by me turned to me and said "sorry to get your hopes up" I just laughed.

As Dr. Watts spent the next 45 minutes putting my organs back inside my body with what felt like a sledge hammer, the neonatology team said the baby's first two APGARs were 8 and 8 and that was very good. He was breathing on his own, and looked very, very good for a 30 weeker. They said he was a good size at 2lbs 15oz and 17 inches. I didn't get to see him, but I saw his little head as they were working on him, and it was soooooo tiny.

I was wheeled into recovery, where Logan came to see how I was doing. I had told her previously that John and I really wanted Dr. Watts to be the delivery doctor and we both wanted Logan to be working the night I had the baby. She laughed and said "looks like you guys got your way...but I would have been on 4 days a week for the next 6 weeks!"

At about 4:30a.m. (it actually felt like only minutes after I was wheeled into recovery), I saw a tall figure dressed in sweats come to my side: it was John! He looked a little nervous, and conflicted. He checked on me to make sure I was fine, but then asked the nurse where he could see the baby. Being the guy that he is, he asked me if it was okay if he went and saw the baby and I said YES!

The next time I saw John was when I was taken to my Postpartum room. We both tried to get some sleep...but we ended up waking up at 5:30-6:00am to start texting everyone our news!