01/11/05
Some may have noticed that we didn’t actually add this paragraph on the 11th: we’ve been busy over the last couple of weeks as you’ll soon read. By the way, this is Josh, the father, making this post, so you’ll be reading about Malin in the third person (unlike all of the other posts below).

The 11th, one day before his due date, was when Willem decided to show up. He is continuing his papa’s tradition of being born on one of his grandparents’ birthdays – January 11th is my dad’s birthday, and I was born on my mother’s mother’s birthday. It was quite a drama. Unfortunately, my prose is not dramatic, so please bear with me as I recount the tale:

At 5:00am Tuesday morning, Malin woke me up, doubled over in pain with a piece of toilet paper in her hand, crying, “Does this smell like pee?”

Apparently her water had broken, but she wanted me to verify that she hadn’t just urinated on herself. Sure enough, it did not smell like pee. As I got up and got dressed she called the midwife on call at the hospital. They told us to come on in.

Her contractions were pretty strong – much stronger than the faux labor she had experienced before. And they were regularly 3 to 4 minutes apart and about 45 seconds in duration. When we arrived at the hospital, the midwife wasn’t in a hurry to see us because she had only been laboring for about 40 minutes; and first-time mothers typically labor for 12 to 16 hours. The nurse in triage suggested she walk around a little. One lap around the bottom floor (the Labor and Delivery section), and Malin was in too much pain to try another. We went back to triage, and the nurse called the midwife down. The nurse did a litmus-test on the pad Malin was wearing to see if her water had really broken. The test showed negative, but the midwife showed up to examine her shortly thereafter. The cervical exam had the midwife spooked, saying “Wow, you’re dilated to seven centimeters.”

There was a rapid blur of people moving around as she was hurried to a labor and delivery room. While the nurses were preparing the room, one of them opened up an armoire and pulled out a bassinet with a warming lamp. During our previous tour of the facilities (which we did in our birthing classes), they had said that when you see them pulling out the bassinet, you were getting close. Malin brought this to the nurse’s attention, and the nurse mistakenly tried to reassure Malin, “Oh he’s close alright”. At this point Malin was really freaking out. She was terrified that the pain-killing drugs wouldn’t arrive before the baby did. We made several frantic requests for the anesthesiologist, and a nurse informed us, “He’s currently in the OR – one of the other mother’s this morning had to have an emergency C-section.” All the while, they had to take blood and give Malin an IV – something she was madly afraid of, but made it through without too much trouble thanks to her desire to do whatever it took to get the epidural as quickly as possible.

The 7 cm exam occurred at about 7:00am. We didn’t see the same midwife much after that because they changed shifts at 8. The new midwife on duty visited with us, and she was very friendly (we had seen her a couple of times before during the OB office visits). The epidural finally showed up around 10:00am, and Malin was very, very thankful. Once the real pain-killer was running through her veins almost all anxiety left her. The midwife didn’t bother doing any other cervical exams. She seemed confident that Malin was likely already fully dilated. “Let me know when you full a lot of pressure and need to push.”

That happened just before 1:00pm. At about 1:00 the pushing began. At 2:40 the pushing ended. Little Willy had finally escaped his mother’s wicked embrace! (just kidding). At that point, we were told he looked healthy, and we took some pictures. The grandmothers were in the lobby waiting, and they came in to see the new baby boy and get pictures.

And that was the calm part of the day. The real drama began shortly thereafter. A nurse informed us, as they moved the new mother upstairs to the after-delivery rooms, that Will had to stay a bit in the Special Care Nursery (aka the NICU). That really had us worried, and at that time Malin asked everyone to leave – everyone being her mother and mine. I was allowed to stay. She was understandably upset – she’d had a long and eventful day, and was not allowed to see our newborn baby.

A little later the doctor in the NICU spoke to us. This worried Malin further because he spoke with a very strong Puerto Rican accent that she couldn’t understand – she heard only “Doom! Disaster! Terrible Things for you baby!” and was crying considerably in fear. Luckily that is not what he said. He explained, albeit less effectively than perhaps an English-as-first-language doctor may have, that Will had some symptoms that would keep him in the NICU at least overnight:

  1. His breathing was very rapid – 100 to 120 breaths per minute. This is actually common. It is only a problem when it comes to feeding the baby. If he is breathing too quickly, he may have trouble swallowing without choking. They had done a chest X-ray and found that the cause of the rapid breathing was extra fluid in his chest cavity that creating pressure on his lungs. Again, it is not uncommon, but until it resolved itself, Will was to be tube-fed (as you can see in some of the first photos).
  2. The bigger problem was that Will’s blood was not clotting properly. They noticed this because he had petechiae on his chest and back. Petechiae are little red spots on the skin where capillaries under the skin have broken. It is common for newborns to have petechiae on their heads, but its presense on the chest and back indicated a potential problem. The results of a blood test showed that his platelet count was incredibly low. A typical platelet count is around 150 (I don’t know the units – perhaps 1000s of particles per ml?). Willem’s was 32. Because of this, we could not even hold Willem. The doctor said that with a platelet count that low, any contact could result in bruising or spontaneous bleeding.

You can imagine that this last bit of news was very depressing. Not being able to hold him meant a very long, sleepless night for us. The doctor didn’t think it was that serious and that it would probably clear up on its own. But until more test results came in, they didn’t know for sure the cause of the problem, and thus the extent of how bad it would be. They call this condition Thrombocytopenia. They said there were four causes for it (in order of most likely to least likely):

  1. Bacterial infection: They were doing bacteria cultures to determine if this was the cause, but those would take 48 hours before results were available.
  2. Iso-Immunothrombocytopenia: This would be an incompatibility between mother’s blood and baby’s blood. Even though their blood doesn’t mix, some antigens and antibodies do pass from mother to baby through the placenta. This incompatibility causes mother’s antibodies to attack platelets and other cells in baby’s bloodstream. Even though both Will and Malin are type O-neg, there are hundreds of other factors that go into one’s blood type (O/A/B/AB and RH-neg/pos happen to be the two biggest factors).
  3. Viral infection: The doctor said this was very unlikely because Will showed no others signs of the virus that causes this symptom.
  4. Problem with Will’s bone marrow: The doctor mentioned this possibility though he felt it was remote. It would also be the worst case since it could indicate lifelong problems (like hemophilia).

Willem was being given an IV drip of antibiotics (in case the cause was bacteria) and immunoglobulins. This latter item consists of man-made blood particles that any of Malin’s antibodies still in Will’s blood could attack instead of attacking his platelets – in case the cause was the second item above.

01/12/05
Luckily, there was good news the next morning. His platelet count had jumped to 57. That meant that whatever the cause (most likely number 1 or 2 above), it was clearing up and that he would be able to go home soon. It also meant that we could hold him. My dad had flown into town the night of the baby’s birth (also his own birthday) and was able to visit the new guy the next morning.

01/13/05
Unfortunately, the day after that was the last day that Malin could stay in the hospital since she was fine. And Will’s platelet count barely went up – it was 60 on Thursday morning. We visited him frequently and so did his grandparents. But we did eventually have to leave. Another long, sleepless night…

01/14/05
The next day we drove back to the hospital and visited with him much of the day. His platelet count had risen to 80. This was good news and the doctor would have even considered letting him go home, but he wanted to first give Will one more dose of immunoglobulins. But the good news was we were taking our boy home the next morning (Saturday the 15th).

01/15/05
Little Willem was finally released from the hospital and came home with us. And we lived happily ever after…