The Before and The Birth

    I thought it would be a good idea to catch everyone up on our story to start, so I'm going to backtrack to the beginning. I want to lay it all out because this entire experience has not been my plan, that has been very apparent. 

    We found out that I was pregnant back in March. At 6 weeks I experienced some heavy bleeding, so I was taken in for an ultrasound. They found a subchorionic hemorrhage (bleeding under one of the membranes that surrounds the embryo inside the uterus), but assured me that it could be normal and should resolve on it's own. Again at 13 weeks I had an episode of bleeding. It was assumed to be the same thing. At 21 weeks, after spotting on and off for the 8 weeks in between, my water broke in the middle of the night. I was at my parents' house and Fredy was with his family up in South Bend. We all made the long drive to Hendricks hospital where my OBGYN is in Danville, IN. I assumed I would lose the baby that day, but thankfully Dr. Boccone had slightly more optimistic news. He told me that it's called Preterm Premature Rupture of Membranes and occurs in about 2-4% of all pregnancies. Their suspicion in my case is that the bleeding irritated the amniotic sac over all that time, eventually rupturing the membrane. About 50% of women go into labor within the first 24 hours, 90% within 7 days. Fifteen years ago we would've been told there was no hope and induction would've been pushed. Instead, they spent the day running tests, and I was sent home on antibiotics and modified bedrest to try to hold off labor with the warning that I was at a very high risk for infection and so was the baby. I was also at very high risk for hemorrhaging from placental abruption. I was to come back in immediately with any change, those conditions could come on very fast and be deadly. 

Thankfully, we beat all of those odds and did not go into labor, get an infection, or abrupt for the next 4 weeks. Our plan after researching outcomes and speaking with Maternal Fetal Medicine (MFM) at Riley and Dr. Boccone was to agree to be admitted to Riley OB at 26 weeks in case I did have any of those changes happen so that he would have the best chance of survival. Up until 26 weeks I would deliver at Hendricks with very minimal intervention if he wasn't able to breathe on his own. Outcomes at 23-25 weeks gestation, while considered viable, appeared to be very poor in both morbidity and mortality, and those statistics were for babies simply born at that gestation, not babies with low amniotic fluid for weeks. He was at great risk for pulmonary hypoplasia due to the lack of fluid; babies use the fluid to practice breathing and develop their lungs. I didn't want to put him through the suffering that it seemed he would need to go through for what could be a very small chance at any kind of normal life. Upon admission I would receive steroids to help his lungs develop. They have a window of time that they work best, and I didn't want to take them too early. MFM wanted me admitted at 23 weeks for my own health risk in case something happened, but I felt like I had a better chance of not going into labor at home, so I accepted the risk of staying home until 26 weeks. I had a couple of scares with bleeding and what I thought was an infection, but was able to stay home until 25 weeks. That's when the plan got thrown out the window. At my 24 week appointment at Hendricks I saw a different OBGYN because Dr. Boccone was on vacation. All was well until I told this different doctor about our plan to come to Hendricks should I go into labor before 26 weeks. She basically told me that was not an option, that not all providers would be on board with that, and there was a chance they would not take my wishes for minimal intervention into consideration upon delivery. They could end up sending him to Riley anyway because he would be considered "viable" at that point. (I've spoken to Dr. Boccone since then. He does not seem to agree with her, but I had no way of knowing if she was correct at the time.) I was shocked and scared. With tons construction going on in Greencastle and the drive time in general, getting to Riley would take too long for my comfort (over an hour vs the 35 minutes to Hendricks). I had to make the decision to pack everything up and be admitted at 25 weeks to Riley in case something were to happen within that next week. 

last day at home

I was admitted July 28th, prepared to sit there for 9 weeks until they would induce me at 34 weeks. The doctors recommended I go ahead and get the first round of steroids in case something happened that week, and if I were to go into labor after that week they could try to slow the labor down long enough to get a second course in before he was born so we could still be within the prime window. It was a 2 shot series, given 24 hours apart. By Sunday night they were in full effect. Monday afternoon I began having pains that the nurses assumed were false contractions. By evening the pains were becoming more regular. By 9pm-10pm I was rating them 8/10 and timing them at every 2-3 minutes. The monitor was picking them up. I was told repeatedly that a doctor would be coming to check me, but she must have been in a surgery or somewhere else. There was also great risk that came with being checked due to our increased risk for infection, so they really wanted to hold off as long as possible. They gave me IV fluids to try to slow down what I think they were finally suspecting to be real contractions. That did not help. They ordered Tylenol but never actually gave it to me, I didn't think it would help much anyway. Around midnight I was in severe pain and the doctor (who still had not come in) had ordered morphine, but for some reason the nurse had to run back out of the room before she gave it. About 12:15AM I had a pain that about threw me out of the bed, and I broke into a sweat all over. I knew he was coming. I called the nurse and told her that I needed to push, and a doctor and resident came running in. They told me his feet were already making their way out, there was no time to do a C-section like we had planned all along due to him being breech. I was terrified that he wouldn't make it coming out feet first. 

Antonio Yanes was born at 12:31AM on August 1st in the antepartum bed that we were supposed to incubate in for the next 9 weeks. We had said back when I was on bedrest that we hoped we could at least make it to August, apparently he heard us. Fredy (who thankfully was there the entire time, smiling and holding my hand, excited to meet him) cut the cord, they put him in a plastic bag to keep him warm and took him away. I was very close to having to have a D&C to remove the placenta, but thankfully at the last minute my body decided it was time for that to come as well around 2:30AM. The neonatologist came in to let us know he was on the ventilator, and that he had let out one little cry right before they had to place the breathing tube. We hated that we had to miss that. He also asked if I was sure about how far along I was, as they had estimated he would be around 500G for his gestation, but he weighed in at 900G (1lb 15.8oz). I told him we were sure. Since then I've heard from multiple nurses that were on that night that they were all so shocked that they had to weigh him multiple times to believe it.

Like I said, none of this was my plan. If my plan had worked out I would've still been at home when those pains started. Who knows if the car drive to the hospital would've sent me into full blown labor, if we would've even made it in time. We would have been going to Hendricks, and if they respected my wishes we probably would have held him and enjoyed him for only a short time before going home without our baby. I definitely would not have been at Riley, let alone for a few days, giving the steroids time to do their work, giving him the best shot he could have at life. I would have chosen to have an epidural if there was time or taken those pain meds, but maybe I wouldn't have been able to feel exactly what I needed to do when the doctors coached me on when to push to keep him from getting stuck. There were so many things that had to fall into place in order for him to even enter this world when he did, let alone stay here. I was just along for the ride. I'll explain more in my next post, but some days I ask God why we're here in this situation, with Antonio suffering day in and day out. If it was all up to my plan he wouldn't be. Other days I am more thankful than I ever have been in my entire life for the lack of control that I had because we love him more than anything and we're so glad he's here. His life has already had so much purpose. He brings joy to every person that walks in our room. We've learned so much in these first four weeks. And more people have sent up prayers than I would have thought possible, that alone is worth so much. His little soul has touched too many to count. So, now that everyone is caught up on how our journey began, I can actually begin to explain his stay in the NICU so far.