By Nancy Ripton
When I look back at photos from the birth of my second son, Beckett, my stomach does a little somersault. These tummy acrobatics aren’t the happy flutters one experiences when recalling a heartwarming experience. Rather they conjure up feelings of fear unlike anything I have ever experienced.
Beckett’s birth didn’t start out traumatic. He was born via a planned C-section to a chorus of congratulations. Nurses commented on his “perfect” colour and hearty wail. His Apgar (a score used to calculate newborn well-being) was one digit shy of perfection. But from the minute he was placed on my chest I knew something was wrong. Unlike the birth of my first son, I did not feel a wave of calmness spread over me when we made contact. I felt anxious and was certain Beckett shared my unsettled emotions. My husband and the nurses told me I was crazy—they assured me everything was perfect.
But when Beckett was still grunting and blowing bubbles in the recovery room the nurses became troubled that he was having some trouble getting the excess fluid out of his lungs. He was taken to the Neonatal Intensive Care Unit (NICU), with my husband Greg in tow, for what I was told would be a 20-minute observation. Half an hour later, Greg returned without Beckett. After a chest X-ray showed white areas on Beckett’s lungs, doctors determined he had transient tachypnea of the newborn, also known as “wet lung.”
In the womb, lungs are filled with a fluid to assist in their growth. During labour, chemicals are released to tell the lungs to stop making and start removing the fluid. In about two percent of full-term births, babies are not able to dispel the fluid on their own and develop a condition referred to as wet lung. Treatment typically involves low-flow oxygen, and in extreme cases Continuous Positive Airway Pressure (CPAP), to help jump-start the transition from fluid-filled to oxygen-breathing lungs. Although extremely alarming to the parents, wet lung is not serious. Beckett was put on the former and I was told he would be in the NICU for another two or three hours.
“Those first few breaths are the most difficult in a lifetime,” says Dr. Paige Church, clinical director of Neonatal Follow-up Clinic with Sunnybrook Health Sciences Centre in Toronto (and the doctor who was on call when Beckett was born). “I use the balloon analogy,” she says. “The first time you blow up a balloon it’s very difficult. If you partially deflate it and blow it up again it’s much easier.” Some babies need more help than others with transitioning — as it turned out, Beckett would need a lot of help. His projected NICU stay was soon increased to 12 hours—I would have to spend the first night in the maternity room without my baby.
The Start of Our NICU Stay
Sleep that night was futile. If I did manage to drift off amidst the coos and cries of other newborns in the ward, I’d soon awake to nightmares that my own baby could no longer breathe, had contracted a hospital superbug, or was simply screaming out in loneliness. I would call for Greg (sleeping on the chair next to me) and ask him to go down one floor to check that Beckett was still breathing. My incision still fresh, catheter and IV both in place, I could not make the short walk myself.
The next morning I was told Beckett’s wet lung was not getting better. He was switched to the CPAP and would remain in the NICU for at least 24 hours. Helpless, all I could do for my baby was continue to attach my breasts to plastic cones every four hours in an attempt to stimulate milk production—hopefully Beckett would need it soon.
Another sleepless night and Beckett’s condition had further deteriorated. He was now on full oxygen ventilation. A machine was doing 100 percent of the breathing for him. He was put into a full paralysis state and was on morphine to deal with the resulting pain of his situation. With my first child I didn’t even take Tylenol while breastfeeding for fear his little body would get some of the drugs; now my newborn was on heavy narcotics. Pain management is a huge priority with all babies in the NICU. “Pain in multiple, rapid succession, with no time to recover in between, can alter the physiological and behavioural state,” says Sharyn Gibbins, head of Interdisciplinary Research at Sunnybrook. “Left untreated, it can give a heightened sense of pain later in life.”
Because of Beckett’s turn for the worse, Dr. Church made a clinical diagnosis that he was surfactant deficient—even though the condition is rare in full-term babies. “When you look at an X-ray where the lung fields that are usually air-filled are not, and appear white, it can be challenging to definitely know the reason,” says Dr. Church. Wet lung improves in time. Surfactant deficiency, which is called respiratory distress syndrome, usually progresses and becomes more severe.
“Surfactant is most critical when we are born,” says Dr. Larry Nogee, a neonatologist with a research interest in pulmonary surfactant at Johns Hopkins University (School of Medicine) in Baltimore. “Surfactant is comprised primarily of lipid or fat. It is like a layer of oil on the surface of the tiny air sacs in the lung and keeps them from collapsing.” Beckett did not have enough surfactant for them to properly inflate.
Once cow surfactant was injected into Beckett’s lungs, he responded immediately. Then the process of weaning him off the oxygen supply and drugs began. His “20-minute” visit to NICU turned into an 11-day ordeal — or almost two weeks of time I lost with my newborn baby.
My appreciation for modern medicine has grown exponentially out of my experience. But the one thing medicine has not been able to find a cure for is the impact an NICU stint has on a mother. “For the most part, infants that are hospitalized in the NICU are totally unaware of the incident, but for the mothers it can be a trauma unlike anything we can ever understand,” says Dr. Church. “It can cloud the whole birth story.” In worst-case scenarios with prolonged or severe hospitalizations, parents may become overly concerned with their child’s safety and develop vulnerable child syndrome, in which parents worry excessively that their child is more susceptible to behavioural, physical and developmental illnesses, despite being healthy.
While I can’t see myself being overly protective of Beckett, I can’t quite shake the feeling that he may be affected by his NICU stay. I’ve been told there is no long-term physiological impact on NICU babies. In fact, a new study from the University of Montreal found that babies who were in incubator care were two to three times less likely to be depressed later in life. Still, when Beckett won’t go to sleep without me by his side I worry that it’s because he felt abandoned by me at birth. At 14 months, Beckett has had more than his fair share of colds. The doctor says it’s because he has an older brother who brings these treats home to him from preschool, but I can’t help but wonder if it has something to do with his surfactant deficiency. Like the unsettling flips in my tummy whenever I think of Beckett’s birth, I wonder if these worries will ever fully go away.
Nancy Ripton is a freelance writer and co-founder of justthefactsbaby.com. Her son Beckett is thriving and is fascinated by doctors.
By Jennifer MacLean