Surviving The NICU: A Birth Story
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September is NICU Awareness Month. Surviving the Neonatal Intensive Care Unit (NICU) is no easy task, but it is possible. I’m Briana, the owner of Birth and Beyond and I am here to tell you my NICU survival story. I planned a homebirth in late 2021 for my February 2022 estimated due date. I ate all the good foods, I exercised, I chose a good provider, and I remained stress-free in the middle of a global pandemic.
A Peaceful Pregnancy Gone Wrong
At 34 weeks, I had protein in my urine at a midwifery visit. My homebirth midwife processed this change in events with me gracefully, because I knew that protein in my urine meant preeclampsia, which meant I wouldn’t be able to give birth at home. She transferred my records to Dr. Michael Armstrong at Wake Med Physicians Practices (one of the few obstetricians I wholeheartedly trusted to care for me and my baby).
Dr. Armstrong wanted to do everything to get me to 37 weeks gestation (full term), but with my blood pressure and protein in my urine, it wasn’t looking likely. For 2 complete weeks, I went into maternal fetal medicine every other day for ultrasound monitoring to check on my son. After a few ultrasound visits, we recognized that my baby was no longer growing in utero and I received a diagnosis of intrauterine growth restriction. My baby needed to be born relatively soon, or there was a possibility I wouldn’t be bringing my son home with me.
I called all my midwife friends. I called all my obstetrician friends. I called all my doula friends. I called my doula, Latoisha with Birth Sisters Doula Services. I screamed. I cried. I was terrified of giving birth in the hospital, given how many times I had seen it. I am a planner and I planned a home birth - why wasn’t my birth going according to plan? I didn’t plan for a premature baby.
On February 8th, 2022 I went for a final OBGYN visit at 36 weeks and 1 day, and Dr. Armstrong informed me that I now had “severe preeclampsia” not just “suggested preeclampsia” and that he would like me to have a baby today. He said he was going to call over to the hospital and have me admitted, and to go home, get my bags and head in. I said okay, but instead, I ignored his recommendation and went home and went to sleep.
Induction & Birth
In the wee hours of the morning, I received a call from Labor & Delivery who asked me where I was - that my OBGYN had called over to admit me but that I hadn’t shown up. I packed my bags and told them I’d be over shortly. A few hours later, I went into the hospital and got my induction started. To my surprise, birth was relatively easy in comparison to what I thought it would be, and it was much shorter than I expected.
My son, Trace Ali, was born on February 9, 2022, at 7:27pm weighing 4 pounds 14 ounces and measuring 18 inches long. He was a tiny little baby who did wonderfully with his womb-to-world transition. He didn’t have any respiratory distress and he loved snuggling with his mama. He had some trouble regulating his body temperature, but with skin-to-skin, he was able to stabilize it. I was thrilled that even though he was born early and was small that he was pretty healthy! We moved over to postpartum after a few hours and my son had a blood draw done.
“We Have to Take Your Baby”
At 5am on February 10th, a neonatal nurse practitioner came to see Trace and I and she told me my baby had fatally low platelets and that he needed to go to the NICU for monitoring and a potential blood transfusion. All I heard was “we have to take your baby.” I looked over at Trace, and he was sleeping so peacefully in his bassinet. I immediately started crying. “There’s nothing wrong with my baby, see, look at him”, I yelled hysterically.
My platelets were low during pregnancy and labor (97,000 - normal levels are 150,000 or above), but they weren’t low enough to indicate that my baby would have an issue. I asked her what his platelet count was, and she told me 17,000. “I don’t want him to leave,” I told her, “You can’t take my baby from me.” I was distraught, the thought of someone ripping my baby away from me after I carried him for 36 long weeks and birthed him out of my body was unfathomable.
I told my doula what was going on. My doula had triplets prematurely (much, much earlier than I had Trace) at the same hospital where I gave birth. She was a pivotal piece of my NICU journey, and I am so grateful I chose her as my doula. I formerly worked at a birth center teaching childbirth education, and Krissy Boyd, one of the nurses who worked there was also a former NICU nurse who I called and processed all of this with - so thankful to call her my friend. Aleyda Mercado, an amazing doula and close friend [and owner of Mother Earth Birth & Doula Services], also helped me process what was happening.
I finally let them take my sweet baby after my doula and Krissy talked me off the ledge. I consented to a blood transfusion after talking to the NICU team. I was grateful I had a vaginal birth and that I was feeling pretty good physically - this meant I could go see my baby in the NICU as frequently as I wanted to. Lactation came to see me and reminded me to pump every three hours if I wanted my baby to have my breast milk. So, I did. I pumped every 3 hours and took the long, dreaded walk down the hallway with my milk to give it to my baby. I breastfed him every time I went so that we could have skin-to-skin and snuggle time, and supplemented him with a syringe with my breastmilk.
The NICU Experience
I spent 30-45 minutes with Trace every time, feeling joyous every time I saw his face, and feeling distraught every time I left to go back to my room to rest, eat, and pump. By February 12th, I realized I hadn’t showered or brushed my teeth in two days. Krissy brought me a NICU parent care package complete with snacks, chapstick, and good toilet paper! Aleyda came and gave me an abdominal massage, did belly binding, and did a spiritual session with me to help me mentally collect my thoughts about my baby being in the NICU. Thankfully, I was able to stay in the hospital and didn’t have to go home because there was an available room for me to sleep in.
Trace did well with his platelet transfusion, but his platelets weren’t at the desired level of 150,000. They tested him every morning after the transfusion. I kept asking what had to happen for him to go home, what were the expectations? His care team didn’t define anything, which was hard for me. They just wanted to see “a steady increase over several days”. I felt guilty complaining, I felt guilty crying. There were babies in the NICU who weighed 1 pound, babies who had been there for 3 months with no indication of going home. Some were on oxygen because they couldn’t breathe on their own. Some hadn’t seen their parents in days. Some were in incubators and couldn’t be touched. One of the hardest parts about going to the NICU to see my baby wasn’t my actual baby. It was all the other babies. I wanted these babies to be healthy and to go home with their families, just like I wanted my baby to be healthy and go home with me.
Finally on Monday, February 14th 2022 at 7am I refreshed Trace’s My Chart account (like I did 700 times per day) and saw that his platelets had a good increase again. I sprinted (yes, sprinted) down to the NICU with 2 ounces of breastmilk begging the nurse to talk to the doctor. “Briana, they will come and do rounds on your baby between 9am-11am. It’s 7am, no one is even really here to talk to you right now.” I sighed, I was ready for my baby to come home. Thankfully, I was able to take my little valentine home at 7pm that day after he passed a car seat test.
NICU Survival Tips
While my baby wasn’t in the NICU for long, it was one of the most trying times of my life. After talking with some other NICU parents and experiencing this myself, I have a few tips that can help you survive!
Participate in your baby’s care. You have the option to be there as frequently or infrequently as you’d like. Ask your nurses when your baby’s “care time” is. They normally do things on a schedule (feeding, bath, diaper changes). Time your NICU stay according to your baby’s care time so that you can participate. With a baby in the NICU, it often feels like your baby belongs to the hospital. They don’t. Your baby is yours and you have every right to help as much as you want to. I was afraid of how small my baby was. I thought I might break him. Don’t be afraid of your baby! Most NICU staff encourage “kangaroo care,” which essentially means holding your baby for skin-to-skin contact because they know how beneficial this is for your baby’s recovery and your recovery!
Do not live in the NICU. Your baby will appreciate the times you are there with them, but they will also appreciate a parent who is actively taking care of themselves as best they can. This means going home (or back to your room) to shower, sleep, and rest. I was terrified that my baby would forget who I was, that he would want to go home with one of the NICU nurses instead of me. When I had to go back to my room to take care of myself, I looked at the NICU team as my postpartum doulas. They were taking care of my baby while I took care of myself.
Feed. Yo. Self. Easier said than done. Between transporting back and forth to the NICU (and sometimes to the hospital if you’ve gone home), not enjoying hospital food, pumping if you’re feeding your baby human milk, and all of the other tasks that come with being a human and a parent, feeding yourself falls last on the list. Eating is critical for postpartum recovery, and your baby needs a happy, healthy parent. It may sound strange when you have a baby in the NICU, but put yourself first.
Accept help and ask for help. For the first two days, I told everyone not to come, not to call, and that I didn’t need anything. Eventually, Aleyda and Krissy just showed up to help me and drop things off. It was everything I never knew I needed. If friends, church groups, work groups, or anyone else offer to make dinner or set up a meal train, prepare your house for when you come home, buy baby items you didn’t know you needed (preemie clothes, different bottles, etc.) LET. THEM. Accept rides to the hospital if you can’t drive yet (particularly after a cesarean). Many people don’t know how to help a NICU parent. Direct your people to this blog post if they’re unsure how to help. :)
Don’t be afraid to ask questions. Even if you have experience in the medical field, the NICU is a special place. If the language feels foreign, ask them what they mean. Don’t be afraid to advocate for your baby. Always use the BRAIN acronym when the NICU staff makes recommendations. What is the benefit? What is the risk? What is the alternative? What does your intuition tell you? What if you need more time to decide?
September 12-18 is Neonatal Nurse’s Week. Although I had conflicting feelings about others caring for my baby, I couldn’t have asked for a better team. One of my dear friends and superhero, Krissy Boyd, is a neonatal nurse and she just recently received a diagnosis of Hodgkin’s Lymphoma. She never stopped reminding me to eat and take care of myself. To support her family by feeding them, click this link.
Here are some resources for NICU Parents:
NICU Parents Support Group - Virtual with Postpartum Support International (I’m a group leader) We meet on Thursday evenings from 6:30-8pm EST.
Peekaboo ICU: Created by a NICU nurse, this organization strives to empower the NICU parent with an online forum and provide information and resources to parents and family members.