It was my first pregnancy and everything was going very well. I jobshare so I had plenty of time for rest and fresh air. Although I am a trained midwife, I was detached from the midwifery side of things and I was really enjoying my pregnancy.
It was progressing well when - out of the blue - I started getting contractions. That was November 2nd last year and I was exactly 23 weeks pregnant. I rested for a while, thinking that they would settle down. Then, I had a "show" [vaginal discharge]. I knew that this meant that labour was almost inevitable. This was one of my worst moments of the whole experience, as I felt that I was going to lose my baby. I phoned my husband, Peter, and he came home from work. I also phoned my consultant and, within an hour, made my way with Peter to the maternity hospital. I met the consultant in the foetal assessment unit and she did an ultrasound scan. Everything looked fine and we hoped that things would settle down and my pregnancy would continue. I was admitted to the hospital and advised to have total bed rest. I thought, even if I had to stay in hospital for the next 17 weeks and look at a spot on the ceiling, I would be happy if the baby was born healthy and well.
That evening I was given my first dose of steroids. These are given to stimulate the baby's lungs to produce surfactant which makes the lungs more pliable and elastic. Otherwise, if the baby was born, the lungs may be stiff and difficult to ventilate. Soon after this, my membranes ruptured and I knew there was no turning back. Yet, I didn't have many contractions and slept well overnight. On Tuesday evening, I was given my second dose of steroids. I also had another ultrasound scan to check if there was any fluid remaining around the baby. There wasn't. He was lying there like a tiny beached dolphin with an estimated weight of 590 g. On Wednesday morning, I was examined and found not to be in labour. The irregular contractions eased off during the day but by 7 p.m. that evening they were getting stronger again. By 8.30 p.m. my contractions were very strong and I knew I was definitely in labour. The night sister examined me and my cervix was two centimetres dilated. I was transferred to the delivery ward. Within one hour, my cervix had dilated five centimetres and by 10 p.m. it was fully dilated. Kevin was born at 10.09 p.m. The whole experience was very surreal. The neonatal unit team had come down and were waiting outside the door. It must have been very stressful for them as they - my colleagues and friends - were faced with the uncertainty regarding the condition my baby would be in and how much resuscitation he would need.
As it turned out, Kevin was born in a very good condition, weighing 630 g (1 lb 6 oz). He had a very good Apgar score which is a combined score derived from his heart rate, his respiratory effort, his muscle tone, his responsiveness to stimulation and his colour. I just got a glimpse of him on delivery before he was taken away to the resuscitaire. Kevin was incubated and ventilated (i.e. put on life support) in one minute.
He was transferred to the neonatal unit in a transport incubator and I got a look at him as he was going away. Because I work in the neonatal unit, I knew that the sooner they got him there the better, so I was trying to be practical and suppress my maternal instincts. I felt physically well because it hadn't been a long labour. One of my colleagues from the unit brought Peter and I some polaroid photographs of Kevin soon afterwards, which was lovely as we didn't go up to see him until about 3 a.m. It was so strange for me to see him in the neonatal unit where I worked. It was hard to believe he was our baby.
During the whole time Kevin was in hospital, Peter always felt Kevin would survive and be fine. But he didn't know the risks as clearly as I did. Kevin is, in fact, the youngest baby - but not the smallest - who has survived at the National Maternity Hospital.
Because of Kevin's extreme prematurity, all of his organs were immature and the ones which are most at risk are the brain (there is a high risk of brain haemorrhage - especially in the first 72 hours), the lungs, the bowels and the kidneys. Kevin didn't have any brain haemorrhages, which was a huge relief. But once you had put one risk aside, there was another to replace it. Most parents are informed of different risks as they arise, but the difficulty for me was that I knew all the risks that lay ahead.
I can so empathise with parents with premature babies. While your baby is still in the hospital, you dread making the phone call every morning to see how he is, and you fear turning the corner into the neonatal unit in case your little baby is surrounded by doctors and nurses which may mean things aren't so good. The lungs are another major cause for concern but there have been great technological advances in the area of ventilation which makes a huge difference to the survival of premature babies. Kevin required the use of high-frequency oscillatory ventilation (this is a gentle form of ventilation which vibrates the chest wall with up to 600 breaths a minute while minimising lung damage). If this form of ventilation wasn't available, I don't think Kevin would have survived.
The eyes are another problem area and Kevin's eyes were very immature when he was born. He developed a condition called retinopathy of prematurity which can lead to blindness. But Kevin was given laser treatment when he was two months old which solved the problem. He also had a heart murmur but thankfully this responded to medication and he didn't need surgery. He also had 18 blood transfusions. These were necessary partly because of all the blood taken for tests which is usual for premature babies. From the early days, I expressed milk and Kevin started on breast milk when he was 10 days old. He was fed continuously through a nasal tube to his stomach, starting at about 0.5 ml an hour. I remember thinking how one teaspoon of milk did him for 10 hours. He tolerated breastmilk very well, which was great because it helped me feel I was contributing to his care.
At six weeks, he came off the ventilator and began breathing with the help of nasal prongs (these give a continuous flow of oxygen and pressure to his lungs). When he was taken off the ventilator, he went frantic because he had got used to sucking on the ventilator tubes. A tiny little soother had to be ordered and delivered by courier immediately. Once he had that, he relaxed. I went back to work around this time as it meant I could be close to him, although I worked in a less intensive part of the unit. When he was eight weeks old, I breast-fed him.
We brought Kevin home on March 16th when he was four-and-a-half months old. I didn't find this a daunting prospect at all as he was now a well baby. You don't really feel that he belongs to you until you bring him home.
There isn't a day that goes by that I don't look at Kevin and appreciate his existence and his normality. In the early days when we felt so helpless, prayer was a great comfort to us. The support and friendship of all the staff in the neonatal unit also helped us enormously. When it comes to developmental milestones, I use his corrected age [birth age minus the 17 weeks) but he should catch up with other children by the time he is two. He is a very good-humoured little boy, considering what he has been through. He is so strong. I think he was simply meant to be.
In an interview with Sylvia Thompson
