This is Mia Kathryn Thuro, born on January 1, 2009, at 8:29 in the evening. She weighed 2 pounds and 14 ounces, at a length of 15.75 inches. And let's just say that, for being just shy of 30 weeks in the womb, she is doing splendidly. Rachel, I'm sure though I have not read it myself, has written a wonderful blog detailing her experience and feelings surrounding the event. But here are mine.
She was born with us being full aware that there was a problem ahead of time. From the very first official ultrasound, no pictures beheld a stomach. At first glance, this simply means waiting for the baby to swallow some fluid and the stomach will appear. However, after many repeated attempts, everyone failed to visualize her little stomach. This could only mean one thing - the connection between her esophagus and her stomach was missing, if not at least defective. It is known as esophageal atresia; and although it isn't terribly rare, not too many babies are born with such an ailment.
What this meant for Rachel from early on was the high possibility of early labor. The baby while in the uterus constantly swallows amniotic fluid, digests it, and re-secretes it through the kidneys. It is also resorbed through the blood and placenta. If a baby can't swallow, the fluid inevitably builds up in excess within the uterus. Too much fluid, in a very thin amniotic sac, leads to only one kind of outcome: premature rupture of membranes, aka POP!
This was of course a scary moment. We had only just finished watching
Ocean's 13 when I decided to take a shower. No longer than I had shut the bathroom door, I hear a small shriek from the living room, thinking Rachel was laughing at something - two sounds which are sometimes surprisingly similar through two closed doors. I came back out to see what was so funny only to see first hand what it meant to have one's water broken - not to mention the fact that there was more than usual to begin with. We quickly dressed and rushed off to the L&D triage center at UAMS. There she was hooked up to a monitor and to our great relief, a baby's heartbeat was present and normal.
We were told at that point that Rachel would be in the hospital until she delivered - be that one day, or one month. It didn't matter. Once one's amniotic sac is ruptured, the risk of infection to the baby and mother is too great to let one go walking around. We were moved into a labor room and awaited greetings by a neonatologist (doctor who specializes in newborns), the obstetrician, and the anesthesiologist. They all got their words in, but the anesthesiologist ended up being of no help. Her water broke at around 2:30 in the afternoon, and she was dilated 1 cm around 3:30. A couple hours and one sedative dose later, she had progressed to 3-4 cm. A few hours later, and in the middle of the anesthesiologist talking to us about epidurals, she was dilated to 10 cm. Buy buy to that doctor, and hello to about three others and a few nurses. Before another 30 minutes passed, Mia was out and whisked away to be stabilized.
An hour passed with great emotion and anticipation. I got to see her briefly in that time, but eventually, when she was safe and sound in her incubator with the Angel One Transport team, she was brought to us. For a few short minutes, we gently touched her hand, and she was then taken to the premier place for sick children in the state - Arkansas Children's Hospital, only twenty minutes from our house.
She was stabilized on the ventilator, and she remains so to this day (1/6/09). The story of her atresia is like this: there's a good part and a less good part. Optimism here. There are five different types. Importantly, the most common is when there is a connection between the lower part of the esophagus and the trachea, or wind pipe. This is not her kind. Mia's is much less common - the kind where no connection exists between the esophagus and the trachea. There are three other even less common variations, but I won't discuss those. With Mia, the lack of a connection to the trachea is a good thing. With a connection, air is drawn into the stomach with each breath. This inflates the stomach, pushing up on the diaphragm, decreasing room for the lungs to expand. This requires higher ventilator pressures to inflated the lungs constantly, which is much more damaging to such premature lungs. So she can now tolerate low vent pressure, and will hopefully wean off of it easily. The unfortunate thing is, when there isn't a connection, the gap between the closed ends of the esophagus is often much bigger, making a repair more complicated or impossible.
So here's what we do. We let her grow for a while. She has had a tube put into her underdeveloped stomach so that she can be fed breast milk, and so that we can get her stomach and lower esophagus to expand. After 4 weeks of waiting, x-ray contrast studies can be done to see how close the ends of her esophagus are to one another. If close enough, the repair will be scheduled. If almost close enough, we wait another four weeks and then schedule the repair. If nowhere near close enough, which is fortunately often not the case, her esophagus is made to drain out the side of the neck and a bigger tube is put in her stomach. Then, at age 6 to 9 months, long after she has come home, they do an esophageal replacement with either stomach parts or intestinal parts. We hope for a repair at 4 or 8 weeks, much more so than a replacement.
Many other things have been checked out on her to ensure that no other accompanying defects had gone unnoticed. To every one's fortune, no other problems have come up yet. There are many times one or several of a list of other problems that can occur with esophageal atresia, but we've been fortunate.
As of now, she remains on the vent, but an attempt to remove the vent will be undertaken tomorrow morning. They will watch her throughout the day to make sure she can hold her own, so to speak. We pray that she can. If she can, then it won't be much longer before we can hold her. Few of you may, but most of you have no idea how hard it is not be able to hold your newborn child for a week or more, no matter how beautiful she is. But we visit her everyday, many hours out of the day, nonetheless. She holds our hands and grips with her toes. She is pretty calm though as she is sedated since she is on the vent and has suction constantly to keep her upper esophagus free from pools of saliva. We don't want her to inhale that stuff and get a pneumonia. But, believe you me, when we get to hold her, you will hear about it.
Other aspects of life have been subsequently inconsequential. I started a work intensive rotation yesterday, but I don't even care. I match into ophthalmology in nine days, but I don't even care. I'd like to find a house we like, but I don't care right now. Some things have just become more important.
