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Posts tagged ‘Preterm babies’

Adventures of a Preterm Daddy: Part IV – The NICU at Cedars-Sinai

Immediately following the birth of our 25 week-old twins, I was whisked away to the 4th floor of Cedars, while my wife was wheeled to a 3rd floor recovery room following her c-section. In a somewhat numbed state, I entered the Neonatal Intensive Care Unit.

Like Alice, or perhaps more appropriately Alex in Wonderland, I had fallen down a rabbit hole into a very strange world of giraffes, jets, and isolettes. Cedars’ NICU has a capacity for 45 babies spread out over 6 bays and a couple of extra rooms for isolation purposes. Although its NICU is continually unranked in national polls, it is nonetheless an impressive display of the best that technology has to offer. It is equipped with the latest in climate controlled incubators called Giraffes and their smaller cousins, the isolettes. Surrounding each Giraffe, you’ll find monitors, ventilators, screens, and an assortment of tubes and wires leading to each of its inhabitants. Bays 1 through 4 are for more intensive care, while bays 5 and 6 are for those babies preparing to graduate and begin their lives amongst the rest of us. As fate would have it, we wound up in Bay 4, nicknamed “The crazy bay.” Two weeks prior to our arrival, business was so slow that two of the NICU bays had been shut down. The weekend of our arrival must have been High Holy days for preemies and other assorted special needs babies as the house was full. Amidst the flurry of activity and a chorus of various alarm bells and flashing lights, I was given forms to read and sign and instructions on what to do and expect. Through a haze of adrenaline, worry, and concern, I was introduced to Joan, the nurse charged with watching over our little girl. Joan’s presence was calming and reassuring, something gained from 28 years as a NICU nurse.

Cedars-Sinai’s NICU has a battalion of some 130 nurses that rotate on 12 hour shifts. As our midwife had pointed out to us, NICU nurses don’t work in the NICU just because they need a job. These are very special individuals filling a very special need. Some of the nurses, whom we liked to call our Super-nurses, filled that need extremely well. Our super-nurses were Joan, Gilda, Debra, Dalys, Vanji, Tysson, Pam, Kathy, Wendy, Yvonne, Anne, Monica, Macy, Lorna, Adrienne, Judy, Meera, and others. The nurses are the workhorses of patient care in every hospital and no less so at Cedars. Styles vary tremendously and while some embrace the parents in their rightful role as the primary caregivers, others treat them as the enemies. Many of the nurses that I spoke with talked of having dreams about the alarms going off. In this world, babies come and go, and live and die frequently. According to Cedars-Sinai, 27% of the NICU babies don’t make it. Nationwide, the average is much higher at 45% (http://www.csmc.edu/8921.html). For caring hearts, being a NICU nurse can be a very stressful way of life.

My wife’s entrance into the NICU wasn’t until the next day. Following surgery, mothers are first required to have a bowel movement prior to leaving their rooms. By the next day, she had two of them (sorry honey, but its part of the story). This became the hot topic amongst the maternity floor nurses. Nurse after nurse came into her room to inquire how this miracle of God had took place, as most mothers take several days to a week to accomplish this task. Like most medical centers, Cedars has very little knowledge about functional nutrition. Functional nutrients are proven to be more readily absorbed, transported, and utilized than most synthetic and inorganic nutrients. Cedars-Sinai relies heavily on synthetic nutrients to address the real-life needs of their patients. In the case of post-partum mothers, they use ferrous sulfate as an iron supplement to compensate for any blood loss during birth. Ferrous sulfate is a form of iron that causes constipation, bloating, and other symptoms. To compensate for the constipation, patients are given laxatives that work by irritating the bowel wall. Neither product works very well, leaving the mothers feeling miserable and longing to see their newborn babies. We used a natural food and herb-based product called Floradix to address her iron needs and trace minerals to assist with moving the bowels without causing irritation. In less than 24 hours, a mother and her babies were together once again.

To its credit, Cedars-Sinai has a unique philosophy toward the parent’s involvement in the NICU. Their philosophy states that the parent is the most essential and constant member of the infant’s health care team and promotes parents as active and equal participants in order to instill confidence and empower them in their role as the primary caregivers. Well, at least that’s what it says on the plaque on the wall outside the NICU. Inside the doors of the NICU however, it’s doctor’s egos, nurse’s preferences, hospital policies, standards of care, and defensive medicine that take precedence over the care, comfort, and individual needs of each child. If there’s room left over, then the parents might have a voice. This “voice” was something that my wife likened to hostage negotiations. Although they may be willing to listen to what you have to say, they proceed with their own agenda.

As the week began to creep along, my wife was discharged from the hospital and we began our daily treks back and forth between home and the hospital. Everyone told us that our lives would change once we had our babies, but this wasn’t the change we had been expecting. Both doctors and nurses told us to plan on bringing our babies home around their original delivery date, August 16th, some 100+ days later. With cell phones permanently on in case the hospital needed to call us for an emergency, our previous lives faded away and we waited nervously for what was yet to come.

The Adventures of a Preterm Daddy: Part II

There’s an old spiritual saying that goes something like, “God will never give you more than you can handle,” to which Mother Teresa was quoted responding, “I just wish that he didn’t trust me so much.” These statements will soon become a core part of our life during this pregnancy.  

As the last week of April approached, all of our plans for a long pregnancy seemed to be in place. I left town for a neurology seminar and my wife attended a birthday party for another set of twins while I was gone. An April heat wave left her feeling faint, dehydrated, and thirsty at the party. After cooling off a bit she left the party early and went home to rest and relax. By the time that I returned home that Sunday night she was experiencing some cramping which gradually increased over the next 2 days. We made a quick trip to her OB doctor to check things out. Yet another ultrasound (http://www.huffingtonpost.com/dr-jeffrey-mccombs/the-adventures-of-a-prete_b_215874.html) revealed the possibility of a slight detachment of the placental sac that keeps the babies safe and nourished in the womb during pregnancy. She recommended rest and no exercise and informed us that she’d be out of town that coming weekend but there would be another doctor covering for her while she’s gone, if needed. She also recommended going to the Sonogram Doctor for a more detailed ultrasound if things didn’t improve, and noted that he would also be out of town with another doctor covering for him. That weekend also happened to be the weekend that our midwife was going to be out of town. Somewhere in the back of my mind, I remember an old marine saying about rats leaving a sinking ship, so as the last weekend of April approached, we had the setting for a perfect storm. 

Friday morning came with more cramping and spotting. We quickly made our way to the sonogram doctor’s office where we were greeted by an admittedly neurotic doctor. As can be expected, neurotic doctors and worried expectant mothers don’t make a good combination. Another more detailed ultrasound revealed the same results of a possible slight placenta detachment. The sonogram also indicated that the length of the cervix was long. The length of the cervix is one of the deciding factors as to when the delivery process will commence. A long cervix indicates that there is a ways to go before it’s time to deliver, and in our case this was a very good sign. Fetal heart monitors showed that the twins were doing fine, seemingly oblivious to the events shaping the world around them. We were given a reprieve and sent home with instructions for complete bed rest and if the symptoms didn’t stop, we were to go to the hospital. 

That Friday night, the symptoms continued to worsen and by Saturday morning we had called the substitute OB doctor (Dr. M) and we were on our way to Cedars-Sinai Medical Center in Los Angeles. Cedars-Sinai was founded at its current location in 1976. With some 10,000 employees and over 75,000+ patients being served each year, Cedars ranks as one of the top hospitals in the country. Its proximity to Beverly Hills is underscored by the names of celebrities found adorning the many rooms, centers, and buildings, as well as the streets surrounding the hospital. We were quickly ushered to one of the Labor-Delivery rooms on the 3rd floor, where yet two more ultrasounds and some IV fluids later, my wife was stabilized. The ultrasounds revealed that the cervix had shortened overnight, so we were wheeled down the hall and admitted to the Maternal-Fetal Care Unit. The nurses and doctors told us that our stay there would last until the cervix had stabilized and the other symptoms had diminished or disappeared. As a side note, one of the nurses mentioned that the previous occupant of the room had been there 7 weeks under similar circumstances, but had gone home stabilized and pregnant. We kept our hopes high and our fingers crossed, as I became familiar with the art of shallow breathing 

Over the course of the day, we were subjected to an ongoing parade of doctors, interns, and residents who were pushing for my wife to take the Rhogam vaccine. Rhogam is a human blood-derived vaccine that is typically given to Rh- mothers (my wife) who give birth to Rh+ babies. Since I’m Rh+, this was a possibility, but not necessarily likely. When Rh incompatibility occurs, the mother could become sensitized and in subsequent pregnancies, the baby could develop a serious blood disease. There are approximately 400,000 pregnancies in Rh- women every year. Of these, some 10,000 deaths in babies used to occur due to Rh incompatibility before the vaccine was developed. With the vaccine, these deaths have been averted by giving the vaccine to babies who are Rh incompatible within 72 hours after birth. This allows time for simple blood tests to be performed to determine if there is any incompatibility in the first place. When use of the vaccine is not necessary, it avoids other risks, such as blood-borne diseases, that are minimal but inherent in the vaccine. It has now become a practice in the US to give the vaccine at 28 weeks of pregnancy and then again at birth. The vaccine at 28 weeks is more of a prophylactic choice by physicians, which translates to preventative and usually unnecessary. Through some online research, I was able to find a non-invasive test to determine Rh compatibility that has been done for years on pregnant women in England, but not here in the US. After some email correspondence with the National Blood Bank of England, I was directed to a lab here in the US that has recently started doing this testing – www.lenetix.com. Lenetix Labs also has some other unique genetic tests that can avoid the use of routine invasive diagnostic tests like amniocentesis and CVS sampling that are frequently done during pregnancy and are known to cause miscarriages.  

With the parade over and some carry out food from my new favorite restaurant, Barefoot, to sustain us, we settled into our new Beverly Hills digs. Exhausted from the day’s events, my wife managed to get some sleep and I crawled into a hospital cot which folded up around me like a human taco. And as dreams of going home danced in our heads,…

The Adventures of a Preterm Daddy: Part I

As we sat with my family at Thanksgiving last year, my wife announced that we were going try to get pregnant. This was happy news for my mother who has been waiting for her 50 year old son to contribute to the family line like my two sisters and brother have done previously some 20-30 years earlier. Little did we know that as we sat there, she was already 1-2 weeks along in her pregnancy. Three store-bought, do-it-yourself pregnancy tests later in the first half of December, and we find out that she’s pregnant. This celebrated news was followed up a couple of weeks later with new information that we were having twins, courtesy of a diagnostic ultrasound scan due to some concerns of her doctor at that time. 

A diagnostic ultrasound in our family is not a choice taken lightly. I’m a 3rd generation Doctor of Chiropractic, never vaccinated as a child, grew up on vitamins with each meal and weekly if not daily adjustments. Ultrasound is a type of radiation that can be used therapeutically or diagnostically. My educational and clinical experience with ultrasound has been as a therapy. Ultrasound produces sound waves (a type of radiation) that pass through the tissues. The tissue’s resistance to and absorption of these waves causes heating of the tissues and some other metabolic effects that can be desirable in promoting healing. Therapeutic ultrasound is not recommended during pregnancy, over tissues such as the eyes, heart, spinal column, growing bones, testes, epiphyseal plates, carotid sinuses, cervical stellate ganglion, and vagus nerve. Although you may not be familiar with these anatomical tissues, they are all found in developing babies and everyone else. Given my clinical experience, I naturally questioned its use as a diagnostic tool. This philosophy of questioning comes from a statement found in the Hippocratic Oath that I took upon graduation from school that states, “First do no harm.” It’s the responsibility of a doctor to always assess the methods being used to determine that there is no harm being done to the patient as a result of medications or procedures.  

Diagnostic ultrasound uses a similar frequency range, much like sonar on a submarine, to produce images. It is used to screen for abnormalities of the developing fetus. For more information on the benefits and risks of ultrasound, visit – http://www.ob-ultrasound.net/. Like therapeutic ultrasound, the resistance to and absorption of the sound waves, plays a role in the creation of the images. To me, this indicates some degree of heating of the tissues in a developing baby. Is this enough to create some type of damage to the baby? Currently, the risks are not considered to be relevant but the US National Institute of Health recommends against its use in routine scanning of the fetus and developing embryo and ‘although its use doesn’t appear to be associated with any known hazards, investigators should continue to evaluate risks.’ Hmmm.  

Additionally, some research points to correlations between diagnostic ultrasound and the Autism/Aspergers spectrum of developmental disorders. The bottom line on ultrasound is that it should be used based on a ‘benefit vs. risk’ assessment, a term that I’ll talk more about later. Most doctors and sonogram technicians oppose its use by moms who want to have periodic pictures to show everyone. To me, its use is a big question mark that may or may not have complications years later. 

Okay, well we had one ultrasound that seemed to be necessary, but we decide that we probably won’t elect to have any others unless absolutely necessary. There is a saying that goes something like this, “Man plans, God laughs.” During the course of our journey through this pregnancy, we will seem to keep God amused.

 

My wife’s 1st obstetrics doctor recommended a list of questionable procedures (amniocentesis, CVS, Rhogam vaccine) and handed us a couple of boxes of prenatal vitamins. Medical doctors get about 5 hours of training in nutrition during medical school. This was very apparent by the box of vitamins that we were handed. The prenatal vitamin’s list of nutrients and additional ingredients consisting of synthetic dyes, synthetic nutrients, chemical fillers, and toxic fats were quickly donated to the trash can in his waiting room on our way out of his office. It was time to ask around for references and interview a few OB doctors.  

Obstetrics (OB) is surgical specialty dealing with the care of women and their children during pregnancy. Although our intention is to have a natural home birth attended by a midwife, we will still need an OB doctor and a hospital as a back-up. This is common practice in California for parents who choose homebirths. Unfortunately, twin homebirths in California is against the law and a midwife who attends one can end up in jail. This was interesting since other states allow this practice which dates back to the beginning of man. Concerns about the possible complications associated with mothers carrying multiple babies however, means that this is left to the hospitals and obstetrics doctors in California. I’m not sure if this is a policy based on previous experience or a philosophy of better safe than sorry. 

We consider traveling out of state to Tennessee where the midwife of midwives, Ina May Gaskin, holds court when she’s not teaching midwives and doctors across the country. They inform us that they like to have couples come 6 weeks before the due date and if our babies don’t make it to 34 weeks gestation and decide to come out early, we would end up going to a hospital in Tennessee. Since twins seem to have a habit of coming early, this option doesn’t sound too inviting. Given the logistics and hassles of travel and the possibility of an early delivery, we opt for a natural delivery at an LA hospital attended by an OB doctor, a midwife, and 2 or 3 other people. It’s not home, but we want to make it as intimate as possible. I thought I heard God laughing? 

We selected our OB doctor, Jessica Schneider, MD and our midwife was Elizabeth Bachner. Dr. Schneider wants an ultrasound every month once we hit 20 weeks, but we decide on one detailed anatomical ultrasound at 20 weeks and then one just before birth to determine positioning of the babies. This approach was also recommended by an assistant to Ina May Gaskins and it sounds good to us. The ultrasound comes back normal and we begin to make all of the necessary arrangements. 

We have a doctor and a midwife, and my wife has become a walking encyclopedia on pregnancy, twins, and birth. She’s exercising every day, eating well, taking her vitamins, and spending quiet time with herself and the babies. Her due date is mid-August and so in late April we settle into what we expect to be a nice long pregnancy…and God giggles.

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