By Mike Brhel

**Originally published in the Summer 2007 Secondary Attachments issue of The Journal of API

My wife and I had always wanted a family. We had tried for a child during the first few years of our marriage, but nothing ever happened. We decided to leave it up to God; He would give us a child when the time was right. That time came in December of 2005, confirmed by those two distinct lines.

I was thrilled to become a father and could hardly contain my excitement. This made it extremely difficult to wait to tell friends and family the good news until we were sure that the pregnancy would go to term. After a slight scare in the first trimester, everything was going as expected.

On the morning of June 6, everything changed.

Suddenly in Preterm Labor

Before I really knew what happened, Rita was bleeding and beginning preterm labor at 5:30 A.M. We rushed to the local clinic to meet our family doctor. Fortunately, I had just programmed our doctor’s cell and home number into our phone the night of June 5, not realizing at the time they would be used about 10 hours later. Soon, after the quick visit to the clinic, I was following my still pregnant wife in an ambulance to the hospital at around 8 A.M.

All of the uncertainty about the future of my wife and unborn child created an anxiety like I have never felt. Not knowing why this was happening so suddenly without any apparent warning signs, I was feeling completely helpless as the event unfolded so quickly. It was hard to imagine what Rita was going through herself.

Between the two steroid shots to help the baby’s lungs develop and multiple courses of anti-labor drugs given to Rita, the next three days took their toll on her. It was difficult to see her in that condition, and I was still worrying about the well being of both Rita and our unborn child.

The doctors kept telling us that Rita should be able to hold off the delivery for at least another week or two. Later, we realized, after reading about placental abruptions, how serious the condition really was. The baby could have died from lack of oxygen and Rita could have died from the uncontrollable hemorrhaging. It was a miracle that she didn’t give birth in the ambulance on the way to the hospital. The doctors knew what they were doing, because if we had known what was really going on, both of us would have been a lot more stressed than we already were.

What is a Placental Abruption?

A placental abruption occurs when the placenta prematurely detaches on the womb, causing blood loss for the mother and reduced oxygen and nutrient transfer for the baby. The severity of this dangerous pregnancy complication can range from mild bleeding stopped with bedrest and allowing the pregnancy to continue to sudden, complete detachment of the placenta and death of the baby.

Welcome to the NICU

At the end of four emotionally draining days, our daughter Rachel was born – two and a half months early, weighing only three pounds, seven and a half ounces. Within minutes, a team of doctors and nurses whisked her away to the Level III NICU for evaluation and treatment.

At this point, I had no idea that the term NICU stood for the Neonatal Intensive Care Unit and what treatments and monitoring occurred there. Over the next 45 days in the NICU, my wife and I received our education, one that I don’t wish for any parents.

What is a Level III NICU?

A Level III Neonatal Intensive Care Unit (NICU) is able to care for very premature babies and very ill newborn by providing such interventions as ventilators and surgeries.

Some Level II NICUs are able to do some high-tech inteventions, as well, but typically their role with these very ill babies is to stablize them and transport them to the more specialized Level III NICUs. Some Level III babies may come back to a Level II NICU during their growing/feeding stage when medical conditions are stablized and they’re simply learning how to feed and put on enough weight to go home.

Many hospitals have both a Level III and a Level II NICU within the same facility. This was true for Rachel who spent three weeks in a Level III NICU before going to the hospital’s Level II for another five weeks.

A few hospitals now classify their NICUs as Level IV because of the addition of an extracorporeal membrane oxygenator (ECMO), basically an infant heart-lung machine. The Level IV classification is very new.

Normal Preemie Problems are Serious Medical Conditions

Rachel had many serious health problems. First, she had severe jaundice which made her look bright red instead of the less intense yellow tint that is usually associated with this condition. She was under the bilirubin lights designed to break down the bilirubin under her skin. A piece of foam protected her eyes from the intense light.

She had several wires attached to her, sending information about her blood oxygen levels, heart rate, respiration rate, and temperature to a monitor designed to alarm when anything moved out of the accepted range. Needless to say that with a total of eight preemies and eight alarms, there was always an alarm sounding to alert the nurses to a potential emergency. It took some time to get used to the alarms going off. We would immediately look to see if Rachel was OK whenever one went off.

Watching the lines on the monitor bounce for each breath and heartbeat was what we did when we weren’t holding her or changing a dirty diaper. It was supposed to be quiet for the babies, but it rarely was. At times, some of the nurses would wait briefly before answering an alarm to help the babies get stronger. That was hard to get used to until we actually understood the reason behind that strategy.

Rachel was born with respiratory distress syndrome and was prone to apnea spells where she stopped breathing at times. Many times the apnea spell could be ended by stimulating her by rubbing her chest, unless the oxygen levels decreased too far and she turned blue. These situations called for a supplemental oxygen mask to bring her back. She needed this treatment numerous times during her NICU stay. The neonatologists had mentioned that Rachel had the most severe case of apnea they had seen with more than 15 to 20 episodes per hour during the worse days.

What is Respiratory Distress Syndrome?

Respiratory Distress Syndrome (RDS) occurs when babies, commonly premature infants, have difficulty in breathing because the air sacs in their lungs cannot stay open due to a lack of surfactant, a substance produced by the body to keep the sacs lubricated and flexible. Many premature abies are unable to produce adequate amounts of surfactant and must have assistance in breathing.

What is Apnea?

Premature babies can suffer from apnea, the cessation of breathing, because the breathing center in their brains are too immature to regulate the breathing process. Apnea often goes hand-in-hand with RDS in preemies.

The apnea was aggravated by Rachel’s severe acid reflux. During a time when she refluxed, her trachea became blocked, causing an apnea spell. The tube used to release air bubbles from Rachel’s Continuous Positive Airway Pressure (CPAP) didn’t allow the sphincter to close completely, allowing the reflux. The doctors said the sphincter was weak but should tighten up with time.

What is a CPAP?

Continuous Positive Airway Pressure (CPAP) provides a steady stream of air through the baby’s nose into the lungs via a mask that fits onto the face. The air may have extra oxygen or be room air. A CPAP may be used as an intermediate step between a ventilator and a nasal canula, which is a thin tube that provides oxygen to the tip of the nose.

A CPAP helped keep Rachel’s lungs open properly so they wouldn’t get permanently damaged. She eventually graduated to a nasal canula, then, finally, to nothing at all.

Common Preemie Problems

All of Rachel’s medical conditions – jaundice, respiratory distress syndrome, apnea, and acid reflux – are common for premature infants. While serious, they are almost always temporary in infants without birth defects, chromasomal disorders, and other major complications. Two and one-half years later, the only lasting prematurity-related condition that Rachel has is chronic asthma caused by scarring in her lungs from the respiratory distress syndrome.

Kangaroo Care: Our Introduction to AP

Hours after Rachel entered the NICU, we were able to hold her. This simple act helped bring our family together. A few days later, we began Kangaroo Care. By holding Rachel skin-to-skin for a while, she was able to bond with us and to regulate her breathing and body temperature to match ours. The more Kangaroo Care, the better Rachel would do, and before we knew it, she had made the move from the incubator to an open crib.

The early success led us to realize that Attachment Parenting (AP) at home would be even more beneficial. Rachel still makes progress one day only to see it slip away the next, but the regressions come in cycles that are less frequent as Rachel gets older and stronger.

AP is Shaping Our Lives

On July 26, we brought Rachel home. She weighed about six pounds, a dramatic improvement from her birth weight. We practice AP in everything we do. My wife and I changed jobs to be home to take care of Rachel. Sending her to a daycare wasn’t an option with the increased potential for hospitalization from a simple cold. I enjoy interacting with Rachel on a daily basis and watching her development, experiences I would have missed if I worked a typical nine-to-five job.

The Results of AP on Our Daughter

Three of our friends had girls born within four months of Rachel and they all commented on how happy our daughter is – always smiling and laughing. I attribute this to our interactions with her. We do our best to address the reason for crying, to relieve her discomfort rather than to stop her crying. She has learned to trust us and is a happy baby because of it.

The principles of AP can be applied to any parent-child relationship. Everyone’s needs are met productively and positively in a way that is beneficial to both parent and child. The result is an atmosphere where the child is free to learn and develop within a framework of support from her parents.

The Results of AP on Our Marriage

The benefits of AP also enhance our marriage. We communicate better as we strive to provide the best atmosphere for our daughter. We take time to plan things so we know how our time will be spent, whether taking care of Rachel, working, or spending time as a family or with friends.

I wouldn’t change anything about how our miracle baby came into our lives. AP provided a great foundation for us to make it through this challenging time.