The morning after the worst day of my life is a bit of a blur. The night passed without incident, and so with nothing happening on the delivery front, thankfully, the doctors were cautiously starting to transition us towards “now what do we do to manage this development?”. In the short-term, they moved Andrea from the staging room into a proper room in the maternity ward area. They also started talking about a potentially long stay in the hospital.
So, what do we know?
The first thing they told us was that since there were no signs of contractions, the question was if there was enough fluid for the pregnancy to remain “viable”. I decided I hated that word as soon as they said it. Basically, yes, the membrane had partly ruptured. They call this a PPROM — Pre-term Premature Rupture of Membranes. The amniotic sac had a hole, a small rupture, and the amniotic fluid had leaked out. But it wasn’t all gone, there was enough for the baby to float in, and miracles of miracles, my wife’s body would produce more. There wasn’t enough for the baby to do the backstroke, but there was enough to protect the baby. Except of course there was a hole that would continue to leak.
Ergo, it becomes a math problem: if Water Sack A is leaking at a rate of x ml per day, and the body replaces the fluid at a rate of y ml per day, what variable differential between x and y (where sometimes x > y and sometimes x < y) will produce a stable environment? Oddly enough, your mind goes to fun things like thinking about whether the hole can be patched. With surgical tape. Duct tape. A cork. Whatever. These are not real things that they do, but my mind went there anyway.
The second thing they told us was that we had to know about mortality and morbidity rates. Another math problem. If Mommy A gives birth to Baby B at 26w, 5d, the rate of mortality (i.e. death) is x % and the rate of morbidity (i.e. serious disease) is y %. We knew generally by now that babies as young as 23w had survived birth in the NICU at the Ottawa General but the rate of success was low. We were at 26w, 5d, but that didn’t improve the odds considerably. And most survivors still had long-term health problems.
So, the doctors turned us over to a Fellow in the High Risk Clinic to explain these numbers to us. Time for a third math scenario, whereby if Andrea could hold on for another two weeks, the numbers would change to blah and blah, and if for another four weeks, to blah and blah. The first numbers seemed to make no sense compared with the second and third set of numbers, and it was only in context that we realized the first set had not been the numbers we thought we heard. The Fellow had a very thick accent, and we found it hard to understand her. In future, I’m pretty sure if someone is explaining mortality and morbidity rates to me, I want to understand them better than I did her.
Except, in a way, it didn’t matter — the numbers are meaningless. My child, unborn, had become Schrödinger’s Cat. You’ve heard the horrible premise. Stick a hypothetical cat in a hypothetical box, and put in some poison on a random timer for release. While the cat is in the box, you have no idea if it is alive or dead; only by opening it will you know. So, until that moment, the cat is both alive and dead at the same time. A horrible thought experiment.
Which is what our unborn child had become. A near-thought experiment. He or she was either going to live, or they weren’t. They were going to be sick, or they weren’t. They weren’t going to be 13% or 30% alive. It was a binary world, 0 or 1. That’s it, that’s all. The numbers didn’t change anything nor tell us anything. Even over time, they were only relevant at the point of “opening the box”, so to speak. The Fellow finished, asked if we had any questions after having calmly told us scary numbers about the likely form of our future parenthood, and then disappeared, out of our story. After she left, Andrea and I had a small conversation about what she had said, figured out the numbers, and then shut up about it. It was not a conversation either of us wanted to have, nor in my case, that I even could have.
The third thing we heard about was bed rest. The only thing that would help at this point, the only thing Andrea could do, was bed rest. No other medical interventions, no cork to plug the hole, no duct tape, no glue…just time, and rest. For as long as she could go. At some point, we would need to make a decision — either the fluid would be too low or the baby wouldn’t be active enough or it was approaching 36-40 weeks. Or the decision would be made for us (i.e. spontaneous contractions). Either way, the only thing to do in the meantime was bed rest.
The fourth and final thing we learned should be obvious even from the way I’m writing this post compared to the others. Point 1, bang. Point 2, bang.
Structured, logical, scientific. Clinical.
Our plans for the natural pregnancy were now gone. No holistic mid-wife experience. No delivery at the Montfort. Being followed by the High Risk Clinic was no longer precautionary, it was mandatory. We were now high risk. High risk of early delivery. High risk of infant mortality. High risk of morbidity. High risk of losing our minds with anxiety and worry.
No midwife. No Montfort. A fully-engaged medical team, at the Ottawa General. Obstetricians, nurses, anesthesiologists standing by. Possible C-sections. The complete opposite of what Andrea had wanted for the delivery. It was still possible, if we made it to term, that she could have a natural delivery, but we would have to wait and see.
It’s rare that my instincts are so diametrically at odds with each other. As a husband, I wanted Andrea to have the “full birthing experience”, whatever that might be. As fully natural as she wanted it to be. But as a father-to-be, I wanted them both safe. Bulletproof even. And if the experts said “You will be here for your birth”, I wasn’t about to push for wiggle room. Oddly enough, my thoughts of “choosing” between my wife and child from the night before, the thoughts that haunted me as I fell asleep, they were all gone. I had realized that at no point in any of this experience had anyone suggested Andrea was in any danger or at any risk. She was young, healthy, and handling the pregnancy well. So the risk was “limited” (if that is the right word) to our unborn child.
Finally, some good news
The rest of that day and the next were a bit of a blur. Doctors came in and out, Some family came by. The extra traffic helped me immensely. It gave me a chance to step out of the room, to go get some food, to take a few breaths away from the scene of the drama. To re-energize my emotional stock for a minute or two. The worry and anxiety were draining, but so was trying to keep it together so as not to stress my wife out anymore than she already was.
As a small digression, when my father died, my mother needed me to “keep it together”. I’m not exaggerating, those are her words. My brother-in-law wisely pointed out though that when you’re in the shower, no one can see you cry. The point is, if you’re trying to be strong, the other person really can’t see you lose your shit. So I would go away to do that. Regroup. Breathe. Come back. Talk about mundane things.
For Andrea, there was likely no escape. The normal reaction of many women in this type of situation is to immediately start thinking it was something they “did” to cause the rupture. Most of the time it isn’t. It’s just something that happens in some pregnancies, often with no apparent cause. Andrea had flown earlier in the week, but women fly during pregnancy up until the 32nd week and beyond with no issues. Could it have contributed? Sure. So too could it have been a genetic weakness or a cold or a virus or just a plain old weak part of the membrane. It happens. We never did find out what the cause might have been.
I don’t know what else was going on in Andrea’s mind during this time other than st ress and worry, worry and stress. As I said, we talked about mundane things mostly. I brought some games to the hospital. There was a possibility that they were going to have her stay the whole time in the hospital, up until her delivery. Six weeks. Ten weeks. Fourteen weeks. All were on the table as possibilities. Schrödinger’s Calendar, perhaps.
And then finally we got some good news. We were due for some, I think. We found out that the Ottawa General had a special “at-home monitoring” program for high-risk pregnancies. Put simply, it meant that Andrea could do her bed rest at home and they would have obstetrics nurses stop by every 2 days to monitor her health and call her on the phone on alternate days. Andrea had to track the baby’s movements, leakage and stuff, etc and report it to them. The program is great for the hospital — it costs a lot less for the mothers to be at home than in a bed. Great for health — less chance of contagion from diseases in the hospital. Great for the mother — not cooped up in a hospital bed. Win-Win-Win.
Of course, the mother has to meet some basic health criteria — lower risk of problems (albeit within a high-risk scale), good health, no need for regular interventions during the day, some basic mobility to get around (bed to washroom, for example). And preferably not going home for supposed bed rest but actually facing 3 other kids at home running around that she’ll take care of during her “rest”. Bed rest meant bed rest, not childcare. She didn’t have to be “in bed”, she could rest on a couch, get up and go to the bathroom, shower, get food from the kitchen, go out in the car, basically anything so long as she mostly sat until she got where she was going and then transitioned to more sitting, including using wheelchairs for short shopping runs or trips to the hospital. The only other challenge was if the program had room for her.
It’s ironic that the success of the program is what constrains it. It has great outcomes, low-cost, and is popular, but it is a totally different type of budget than the hospital uses to provide a space in a room. Different budget, different source of funds, different rules. The type of program that should be rolled out perhaps everywhere, but that’s not the way the funding works. Anyway, Andrea qualified, they put here in the program, and she got to go home after only 5 days in the hospital.
The next ten weeks
It sounds almost anti-climactic to say this, but the next ten weeks were filled with routine and tedium. No huge medical drama. No emergencies. The only real problems were tension, boredom, and scheduling.
Oh, and just for fun, an allergic reaction to antibiotics that covered Andrea’s whole body in an extremely itchy rash — antibiotics that she had taken numerous times before with no issue, now a massive allergic reaction.
Tension came from me. With Andrea at home, and on bed rest, my job was to take care of her. Except I wasn’t off work. So I did my best to try to adjust my work schedule, balance things, get home to make dinner, etc. One of the first nights was a bad night. I had missed a couple of days work, things were due, and between work, a doctor’s appointment, and traffic, I was late getting home. We had already decided that we were just having a frozen pizza that night. No biggie, but it takes 25 minutes to cook and Andrea was hungry.
So, she got off the couch, opened the freezer in the kitchen, took out the pizza, put it on a baking sheet, put it in the oven and turned the oven on. No big deal in her mind. I went nuts.
We had never really had a fight before, but we had one that night. I was furious with her. How could she be so stupid? How could she put our baby at risk simply to save 10 minutes before we started eating? She was supposed to be on bed risk, not bending over, getting things out of cupboards, opening doors of ovens, etc. She wasn’t immobilized, obviously, but I felt it was a completely unnecessary risk.
Yet, this was her home, and she had lost control of so much in the last few days, she likely wanted some measure of normalcy back. And she was likely ticked I wasn’t home on time. So, I know she was right. I know she wasn’t being careless. I know I was overwrought, and was experiencing residual tension. There was no harm caused, everything was fine. But I also know that six years later, I’m still a bit pissed about it. I can feel the anger. Let it go, you say? Well, why didn’t I think of that? 🙂
The boredom part is probably obvious. Andrea had to sit on the couch and watch TV, read, or surf on the laptop. We got her set up with a decent layout so that she could use the living room as her “bed rest” site. It also worked well for the regular nurses visits. They could come in, hook up the monitors for 30-45 minutes, ask Andrea all the same questions, chat, take notes, and say, “Great, keep up the good work, see you in two days”. There were three nurses in the program, and they worked staggered days so that they covered weekends too. Best setup ever, and a vastly different experience than if she had been in the hospital for 10 weeks. Plus it gave Andrea someone to talk to during the day. I tried to call most days just to chat, but ten weeks is a long time. By Andrea’s assessment, they were super nice, and great company. Friends and family stopped by too, and helped make the time more enjoyable.
Plus the bed rest gave her time to make new plans. Painting the baby’s room? We were going to do some of it together, instead we had our brother-in-law do most of it. The whackjob actually enjoys that type of thing. Nice guy, but almost as crazy as my family. We also needed to buy a crib still — so we went to Walmart of all places (we didn’t like them anywhere else) and I wheeled Andrea around in a wheelchair. One of the few “outings” we got to do other than going to the hospital. I assembled a crib and change table. We already had a dresser to get us started. A rocking chair we picked up from Sears. We were good to go at home.
But once a week, we went to the High Risk Clinic. Here’s what you do when you go for these visits. You check in at the reception. You wait forever in the waiting room with all the other stressed-out, high-risk, parents-to-be. Then the techs take you in for an ultrasound and calculate how much fluid there is, size of the baby, etc.
Ultrasounds. When we first got pregnant (there’s that “we” again), you know, back before the PPROM, ultrasounds were cool. It was the first time the pregnancy seemed real to me, way back “pre-rupture”. Everything was exciting. Even finding parking was exciting. We were going to see the baby, we were going to see the baby. And we could get pics and a video, just like Disney. Which we did. Exciting. Hopeful. Happy.
Ultrasounds after the rupture were not exciting. They weren’t hopeful. They weren’t even happy. They were stressful. They were anxious. They were worrying. Adjust the monitor here, click the computer mouse there. Measure the brain stem. Calculate how deep the kiddy pool is. Calculate the length of arms, legs, feet, spine. These ultrasounds were clearly medical. Technical. A diagnostic tool to see if the pregnancy could continue.
And then you meet with the doctors. They take the reports from the nurses who make the house calls, and the results of the ultrasound, and use them together to figure out how things are going.
Somewhere in here we started seeing one of the main doctors as our main physician. She was awesome. Late 30s, two kids, had similar issues to Andrea’s experience, and was just plain fantastic. I loved that woman. Dr. Karen Fung Kee Fung. Professional, supportive, warm, funny, and able to have a conversation with us that didn’t make me feel like we were patient 225674 or an experiment that she was running. I hoped that she would be the delivery doctor, but she said it would likely be one of the other two in the ward, just because of planned scheduling for various weekends and where the delivery date would likely fall.
Yet there were no issues. Everything was fine. Initially, in weeks 27-30, it was “Can you hold on another week? Every week improves the health prognosis considerably.” And week 30 was a big milestone. When we passed it, the tension in our visits dropped. Not just for us, but the mindset of the doctors seemed to change. A magic number, 30 weeks. When we passed 32 weeks, the conversation started turning towards “So, here’s what things look like if you go to full term”, 38-40 weeks. The Holy Grail when the rupture started at 26 weeks, but Andrea was doing everything she needed to do to keep the pregnancy working, and it was now a real possibility that she could go the distance. It appeared as if we were no longer going to deliver “very early”, and potentially, not even early at all.
At 34 weeks, the fluid levels seemed a little low, and the baby wasn’t as active as it had been before. Mom and baby were doing fine, but the risk discussion was shifting gears. Week 35 was the same. In week 36, we called the audible.
Friday, May 29th would be the day. 36 weeks, 5 days. Ten weeks after the initial rupture.
I left out something big
So the above story is fine. Tension with the worry. Boredom with bed rest. The routine of visiting the high risk clinic. All part of the experience. Admittedly, hard to talk about intelligently because I wasn’t the one on bed rest. It was Andrea. For me, it was just balancing work, getting home, trying to keep her spirits up. Supporting, not stressing.
But I was stressed about something. Our baby didn’t have a name. We had agreed we wanted to be surprised about the sex of the baby, and that view lasted right up until the rupture. After that, I wanted to know. I needed to know. Not because I wanted to know the sex, but I felt our baby needed a name.
Olive wasn’t cutting it anymore. It’s still painful, it’s still hard to write, but I felt like as long as our child didn’t have a name, he or she might die. Somehow naming him or her would give them life. Would make them real. Would make them survive.
I needed to know the sex to give them a name. And I needed them to have a name so they would live.
We joked at one of the ultrasounds that as long as the baby looked human, and not like a turtle, things were good. For Andrea and I, it was an inside joke. When we were in Hawaii, Andrea and I were together the whole time, which meant no chance there could be anyone else who was the father, ha ha. Except once when swimming on Kauai, she went off following a sea turtle and I lost her for a few minutes. About the time the baby was likely conceived. So I joked it was me or a turtle. Ha ha. Sigh.
But the ultrasound technician said, “Oh, did you see a turtle?”, all serious. We both thought the tech might be nuts. However, she was looking for something that looked like a turtle. Because that’s the term they use to describe male genitals when they’re developing. They look like a turtle. Ergo, if you see a turtle, it’s a boy.
We didn’t see a turtle. We didn’t see ANYTHING. Because the baby wasn’t cooperating. Two weeks in a row when we wanted to know, the baby’s legs were hiding the genitals. Completely shy and uncooperative this baby was. Must be a girl, I said, boys usually just let things hang out wherever. Ha ha. Sigh.
Finally, cooperation came, but the technician didn’t tell us. The awesome doctor did. She said, “Okay, it’s never 100% certain”, blah blah blah, but it was a boy. Not Olive. Not Liana, our girl name that we would now not be able to use. Not this round anyway. We were having a boy.
We decided on Jacob. Never Jake, just Jacob. A small play on words in part — if Paul and Andrea were shortened to PandA (i.e. the theme of our wedding), and we called each other pandas already, then what could be more natural than calling our kid a cub? Plus we added a middle name from my wife’s family tradition.
The last name would be my wife’s. For me, it wasn’t even a question. I wanted him to have her name. When we got married, she was asked if she was going to change her name — her response was something along the lines of, “Sure, maybe Elizabeth?”. It made no sense to her (or to me) for her to change her last name when we married. That isn’t a normative thought, more of a “right to choose” thing, but for us, she was a Horton when we met, a Horton when we dated, and a Horton when we married. It had stayed that way.
For Jacob, I thought it would work well with Horton, and on a practical basis, there were already lots of male Sadlers running around. But for Horton, my in-laws had two kids, neither boys, and the other sister had changed her name. Ergo, no more “Hortons” to carry on the family name. Horton it would be. My wife wanted to add my last name as an extra middle name. I have no idea if I would have felt different if my father was still alive. Would he have felt insulted? My mother did, but that’s another story. But we made our choice.
Our baby, our son, had a name. Jacob McKenzie Sadler Horton. Ready to greet the world. Friday of the 36th week. It was time.