Birthday Boy

A year ago today the stars aligned, the universe conspired and God gave his word: I was to have a son! Not another girl as the maternal fetal medicine doctor had written on that piece of paper she gave Jeff. Not another girl as Jeff later told his late grandfather. Not another girl as I later would come to know. Not a sister for JR. Not Josephine Ramez as Jeff and I decided to name her. Not Josie as JR got used to calling her. Not a third female to outnumber Jeff. But a boy. The son I had always wanted. The son I thought I was going to have during my first pregnancy. The son I most probably lost during the second and third pregnancies. The boy who would carry the name onward. A brother to JR. Another man in the house to hold it together, to balance it out, to make it whole. A year ago today we received the news and were left speechless. To this day, still, I often find myself much of the same ~ I wake up and amaze at the boy laying next to me; the son I always wanted never thought I would have.

Happy birthday Yousef. You have been a miracle, a blessing, a gift.

The Story ~ The End, Part 4 ~ going home

It was Saturday morning when we found out why Yousef was not gaining weight. I was to be discharged the next day. We had 24 hours to add some much needed ounces to avoid mother-baby separation. We were fighting for son, and so was the pediatrician.

As a near-term baby, Yousef came with his own set of challenges; he was a great pretender. Earlier in my pregnancy I had gotten in touch with a lactation consultant friend who had prepared me to life with a later-term infant who is like a term baby but does not act like one. He was super sleepy, tired quickly, and tended to have poor sucking skills.  I needed lots of coaching on how to best feed him and had to factor in a fair amount of pumping to compensate for baby.  

And so, with these two constraints alongside Jeff and I tried to pump as much nutrition as possible into that tiny stomach. I breastfed, pumped, bottle fed breast milk and then supplemented with “high-calorie” newborn formula. I had lactation consultants coach me. I had nurses help me. Yousef got weighed at every chance. We recoded, they recorded. He gained an ounce. We had a heart-to-heart with the pediatrician. She agreed to discharge the family.

We were to see her first thing Monday morning and to continue formula feeding him. It was heart-wrenching. I was determined to breastfeed him just as I was determined to have a healthy pregnancy and yet again I was being made to compromise my goals and expectations. I took it all in. What is a mother to do. I tried to fight it but it was stronger than me. I protested. I refused to take part in the formula feeding. I did not help decide what brand to get him. I did not care. What I had was enough, and yet it was not. I breastfed, I pumped, I sustained, or at least I tried. The numbers would tell us all, soon. The plan was to continue this routine for a week and reassess. I kept seeing numbers in my mind’s eye and the day I would let the man-made nutrition for my infant go.

Monday morning came quickly. We put Yousef on the scale. He had put on a few more ounces. “Keep doing what you are doing,” came the instruction, “and come back for a weight check on Thursday.” “When can we stop the formula?” I pleaded. “By the end of the week, if the numbers keep creeping up.” The end of the week brought hope. I did not want to lose my last breastfeeding journey to a bottle. I was not ready to give that part of my motherhood up so soon. I had given it up before I was ready with JR and I was not about to have a repeat with my last child.  

And I did not! Yousef continued to put on weight. By March 6^th, two weeks after he was born, Yousef weighed 7 pounds 5 ounces up from 5 pounds 12 ounces at discharge. Not only that, he had already exceeded his birth weight of 6 pounds 8 ounces. The pediatrician was now fully satisfied with our parenting. We were doing a good job feeding him, so good of a job that six months later, our near-term tiny infant tipped the scale at 18 pounds 10 ounces. If only, however, the journey to get him to that weight had been simple.

The Story ~ The End, Part 3 ~ losing weight

Yousef’s birth was supposed to “correct” everything; my blood pressure was supposed to get lower, the preeclampsia was supposed to resolve itself, the swelling was supposed to be gone, life was supposed to get “back on track.” Needless to say things did not prove to be that simple.

While Yousef checked out with the on-call pediatricians, I lay there getting stitched up and being reassured, again, that “everything will be fine.” As it turned out mostly “everything” was fine, but not all of “everything.”

Although Yousef was a preemie, he was in good health: his lungs were healthy, his temperature stable. He was breathing normally and he passed his initial screening. He did not require any time in the NICU and was free to join us in the recovery room. Then, his weight dropped. It dropped so much it raised flags. We were not worried. The doctors were.

There was only one intervention that could counter the weight loss: supplementing his diet with manufactured nutrition. As dedicated to natural feeding as we both are, we did as we were told. We followed the instructions to the letter. We remember the words clearly: feed him this much and not a drop more. And so we fed him the bottle and measured how much he ate. I nursed, I pumped. He ate. We recorded every feeding on a sheet and handed it to the nurses at every weight check. He was still losing weight. Jeff looked it up. Here is what he found:

"It appears neonates exposed to increased fluid before birth might be born overhydrated, requiring the baby to regulate his or her fluid levels during the first 24 hours after birth." (Read full article here)

While Yousef's primary pediatrician did not seem to be as alarmed over the weight loss, the discharge pediatrician was. She voiced her concern repeatedly and heatedly. She reprimanded us for our parenting approach and all but accused us of "tarving our baby. "I am very concerned about your child," and proceeded to talk about time in the NICU. She informed us that Yousef was not  where he should be in terms of weight and that unless we worked to put some ounces on him, I would be the only one being discharged from the hospital.

The thought of going home "empty handed" was terrifying. We tried to explain to her that we were simply "following instructions," but our words were merely met with a nod. From her point of view we were falling short of our parenting duties and she was Yousef's advocate.

Finally, many ounces and conversations later, we discovered the culprit:  the wrong feeding instructions that we were given. The nurse in the recovery room had initially instructed us to feed him no more than 5ml per feeding. "They eat all they can get," I remember her saying, "so do not give him too much. He doesn't know when he has had enough." And with that, and not to our knowledge, we spent the next four days denying our son the nourishment he needed most when he needed it the most.

The Story ~ The End, Part 2 ~ A Boy!

When I left in a rush that morning, I did not hug JR nor did I kiss her goodbye. I was so preoccupied with my condition and so wrapped up in making phone calls and looking online that I gave her little to no attention. I darted out the door as soon as Jeff walked in without looking back. Of course I told her where I was going, and I did say goodbye, but had I known that this would be the last time she saw me for five days, I would have exited differently. I would have sat her down, hugged her tight, and bid farewell to what remained of being an only child. I would have explained to her the reason I was leaving and told her about the day I would come back home. But instead I left her with Teta with nothing more than “Goodbye Jannah-Rae, I am going to the doctor. See you soon habibti.”

The OB gave us one order of business three minutes after we walked into the examination room: check into Labor and Delivery immediately. Do not go home, do not pack, do not take care of unfinished business. Go straight to the hospital and do not leave. I had severe preeclampsia and there was only one way to resolve it: birth my baby.

At 10:00am we took up one of the “mother in labor” parking spots. At 10:05 I was checked in, banded and escorted to a monitoring room. I was strapped down, hooked up and put on show. Decisions were made for me and I was a spectator in what started as another day but turned into the longest 18 hours of my life.

For the next few hours, nurses rotated in and out. My OB dropped by. I was told repeatedly that things were “under control”. But they were far from it. My blood pressure was all but falling, and I was at risk of a seizure. I needed to lay low, stay calm and be patient. I also needed a lot more medical interventions.

I was hence moved to another room and strapped down even further. IV drip, fetal monitor, contractions monitor, catheter. I was a living disaster. I was so bloated that it took the nurse three tries to find a vein for the IV drip. It also took her two tries to properly insert the catheter. The pain of delivering a baby had thus commenced and I was not even in labor. Minutes later, my water broke. I thought the worse. I thought the end was a doomed beginning. But at the time there was nothing we could do to haste the conclusion. We had to wait. I had to be on magnesium, to be monitored, to be pumped up with liquids. I puffed up even further and cried even more. I needed an end in sight and I watched the clock. But the end was still further away.

The minutes clicked away. Five thirty came and went. The OB was ready but the operating room was not. I was getting cranky and nasty. I was miserable. I was sick beyond my, or anyone’s, control. And yet I had to wait. I was hungry, thirsty and anxious. I could not contain myself any longer.

Finally a glimmer of hope walked into the room. It was the anesthesiologist. Not only that, but he was the same doctor who was present at JR’s delivery. What luck! I got wheeled away. A cold room never felt so good. It was my turn and I was finally going to get better. The magic wand had been waved and I was going to be myself again. The nightmare that started with bed rest and ended with severe preeclampsia was soon to be over. Little did I know, though, that these thoughts were merely wishful.

When Jeff and the OB walked in together, it was time to get things moving. A little cut, a little suction, a little blood and the baby was out. “Here is your son!” announced the surgeon. A good set of lungs, but “a son?!” “A boy?!”  Did I hear correctly? Were they talking about my baby? The baby I had been carrying for 36 weeks and 3 days? I was not having a son. I was having a girl. The sonographer told us so. She confirmed it more than once. The maternal fetal medicine doctor wrote it down on that green piece of paper she handed to Jeff. That was the news Jeff has shared with his dying grandfather. We were having another girl. Jeff was going to be outnumbered. We were going to be a family of three ladies and one man.

What happened to Josie? Where is Josephine Ramez? JR’s sister? The little baby girl who was going to wear JR’s clothes again? For whom I had spent hours washing, drying, hanging, folding pinks and reds and whites and purples. The little girl who was going to be little. No. I did not hear correctly. I am drugged and sick. I could not have just birthed a son.

I was crying and laughing at the same time. I asked to see. I had to see for myself. I did not believe. I needed proof. I needed anatomy. But the doctor was right; it was a boy. The boy I had always wanted. The son I had dreamed of. The boy I had wanted to grow up with as a little girl. The male who would carry on the family’s name. Joseph Ramez Mike.  6 pounds 8 ounces and a head full of hair. My son.