January 2013
I’m a crier – and I’m okay with that. Years ago I walked out of a family counseling session and a coworker asked if I had been crying. She said she couldn’t imagine crying in front of a client or their family. I laughed and told her that I had at some point at least welled-up with tears before every client or family. I don’t know how many high-risk fetal medicine physicians cry in front of their patients or families – but if our doctor wasn’t close to it on Saturday, January 5, 2013, he sure looked like it to me.
But the story of our miracle – Nathaniel David Graham – starts long before Saturday, January 5. We felt the Lord leading us over the years to welcome more children into our family. Sometimes the pace of life was slow and the addition of a new baby was fairly easy. For other children, the timing was in the middle of a crazy, stressed-out schedule. We believe that children are a gift from God and that another baby in our family was not to be decided by ease, finances or extra time. Five children – two boys and three girls – arrived in our family every couple of years through uneventful pregnancies in beautiful home-births. We were expecting our sixth baby, in an uneventful pregnancy, due to arrive in May 2012.
Then late one evening in February 2012 we received a note from a friend asking for prayer as she and her husband had just experienced a miscarriage. We committed to pray for them – and we did. Within an hour, Lisa realized that something felt wrong with our little one. We met with our midwife who found no heartbeat and went to the hospital where it was confirmed that Olivia Grace had passed away. We spent that Sunday in the hospital waiting for her arrival. We felt a special peace – as though God was holding us close. For hours we listened to a Steve Green song, “In Brokenness He Shines” and knew that God would be glorified and we would be edified even in sorrow. She arrived stillborn at 30 weeks on February 27, 2012.
The questions and struggles came thick: do we have any more children? Is this a sign that we should be done with our family? Why did this happen? Is God trying to tell us something? We prayed about it and sought counsel from others; in the end we decided that we would allow God to make that decision – after all, He’d proven Himself faithful just as He’d said He would.
Yet it was still with some hesitation that we told our families six months later that we were again expecting – and had been for a few months. They were excited for us – as were our own children. We prayed often that God would continue the healing process by protecting this seventh baby. But we told only the closest family members and friends and asked that they not share our news until later in the pregnancy.
The following Sunday afternoon, Lisa was resting when she believed that her “water broke.” We again went to the hospital where our bad news was again confirmed. Lisa was diagnosed with a P-PROM – “preterm premature rupture of membranes.” She was just 16 weeks pregnant. Internet research showed that p-prom in the second trimester had very low survival rates. Several medical surveys showed that 82% of pregnancies with p-prom ended in miscarriage in the following four weeks. Of the few who did survive longer, there were multiple medical complications, especially involving the lungs.
We were told that there might a chance of survival if there was still a high level of amniotic fluid and if there was only a pin-hole sized leak. When we attempted to have those levels assessed, the hospital sonographer looked up from her machine and said “I’m sorry.” After a week of complete bed-rest in efforts to seal the leak and replenish the fluid, a second ultrasound was done by a different sonographer. The leak had resealed, but the fluid was less than half of the minimum number. We consulted with our midwife, a doctor and a neonatologist. The neonatologist said there was about 90% chance this baby would NOT survive, and if it did, there was 90% chance of lung damage. We were told to expect that labor would spontaneously start within days. We were sent home to wait for our baby to die.
But he didn’t.
After three weeks of waiting and nothing happening, we wondered if we should get on with living. We had a two week trip to Florida planned for the whole family. I was scheduled to speak at Hobe Sound Bible Church in Florida; resigned that our baby couldn’t survive anyway, I instructed our children to stop praying for the life of the baby and to start praying that their mother would be safe while we waited for the baby to die. We thought that another ultrasound would help us decide whether Lisa should make the trip or stay at home. The (third) ultrasound showed the ever-steady heartbeat and a larger accumulation of fluid, but still below the minimum level. After three weeks without the minimum level of fluid, we knew that the baby’s lungs would not fully develop. We prayed and asked God that if the baby was not going to survive, to just take it soon as continuing the pregnancy was proving too difficult.
You’ll remember that we had committed this child over to God. We believed that He had blessed us with this pregnancy so soon after the loss of Olivia Grace as a means of healing. Now we struggled, questioning whether trusting God was a wise idea after all if He wouldn’t keep this depth of pain at bay.
We drove the 800+ miles to Hobe Sound and stayed for two weeks. At one point, we thought that the miscarriage was going to happen while we were there. But it didn’t. When we returned, we had new decisions to make. The baby’s heartbeat was strong, labor never hinted at starting, and now we were at the 24-week mark of viability. We made an appointment with a neonatologist fifty miles away and took the steroid shots to boost the baby’s lungs. But after 8 weeks of slight accumulation, the amniotic fluid began leaking again at 24 weeks. After just beginning to wonder if things might work out after all, we were devastated to realize that any fluid that was regained was now being lost daily.
Amniotic fluid seems to provide several functions. It serves as protection for the baby. It provides cushion of sorts for the baby. As the baby swallows and expels the fluid, important development takes places – particularly in the lungs. Babies without fluid develop lungs that are congealed. They can have mangled limbs and faces from the trauma of bouncing around inside without the cushion the fluid provides.
At 26 weeks, a new ultrasound was conducted; it confirmed that there was less than two centimeters of fluid – hardly any. Not only was the P-PROM diagnosis confirmed but we were also told that a new complication had arisen. Lisa had developed antibodies against our baby’s blood type (diagnosed as Kidd or Jka – it is a similar scenario to Rh negative, only there is no shot available for this type). These antibodies were now destroying the baby’s red blood cells. So, in addition to the P-PROM, we now had issues with HDN: hemolytic disease of the newborn. This was also the day that we found out that our four-year-old son’s prayers had been answered: we were having a little boy.
We were told by that specialist that our baby would need to be monitored constantly now that we were past the 24 week mark. They advised that Lisa be hospitalized then be induced at 32 weeks. We talked it through and told the doctors that we didn’t feel that Lisa could be hospitalized 50+ miles from home for 2 months. While this might be an option for some families, we had 5 other children at home – 3 of whom Lisa was homeschooling. I asked the specialist if we could come weekly for check-ups and that at some point he would advise us “ok, now is the time for her to be hospitalized for sure” and we could comply. He responded that he believed that we were already at that point. We returned home and Lisa went back onto 24/7 bed-rest.
The specialist consented to weekly check-ups and ultrasounds. The following week we drove the 50 miles. After the ultrasound we met with the specialist; he informed us that the fluid had increased a little, but the HDN was indeed active and that if our baby had any chance he would need an immediate blood transfusion. While he didn’t say it, I got the idea that he expected that we would opt-out and just terminate the pregnancy after-all. Instead, we responded that we wanted to schedule the transfusion ASAP. We noted that if our baby had lived these 10 weeks post P-PROM (when we expected him to die within hours), we certainly couldn’t deprive him of the chance at life if we knew that there was something that we could do to help him. That specialist told us that his hospital system (the third largest Neonatal Intensive Care Unit in the state) was not equipped for an intrauterine transfusion of this nature. We were referred to the largest such facility in the region, 70 miles from home.
The following morning we drove the 70 miles to The University of Virginia Medical Center. The two diagnoses were confirmed and we were told that we needed to wait for a blood match and then the procedure in which basically the umbilical cord would be given a red blood cell-rich transfusion. Finding a match took a few hours as something that matched the baby’s blood was not immediately available. That evening Lisa was admitted. The doctor skillfully performed the procedure and we stayed the night, confirming before we left that the baby’s anemia symptoms were already reduced to normal levels. We were told that our baby would most likely need this same procedure every two weeks and that if he needed a third transfusion, it would be worth considering inducing him early to lower the risks of the transfusion. Under those circumstances, we asked if we could transfer services to this doctor (now the third we’d seen) and he consented. We began to travel the 70 miles each way on a weekly basis for ultrasounds and consultations.
On our second week to make that trip, we were told that the baby still seemed to be fine. We knew that; the baby always seemed to be fine. He was never in any distress. But this time was different. The doctor had thus far always had a very reserved demeanor. This time? He came in with a huge smile on his face. He told that the amniotic fluid level was now at 10cm! He also confirmed that while the anemia levels had increased, we likely would not need a second transfusion the following week.
When we returned the following week, the fluid was still at 10cm. Lisa was now 29 weeks pregnant. I asked the doctor to provide us a guess on percentages again. I told him that I wanted to encourage our children to begin to pray for our little boy but that I didn’t want to destroy their young faith. He looked at me and said that he believed that we could be “cautiously optimistic” that our baby would survive. He told us that we could safely put off the second transfusion another week, perhaps two.
Each week we made the trip with a suitcase. At any moment we could be advised to have the second transfusion. For that matter, at any moment we could be advised to induce – or even to consider a C-section. We asked a small group of friends and family to pray. Each week the fluid increased or remained stable. Each week the anemia levels remained within the acceptable range.
While we were optimistic, we were still cautious. We still told very few people that we were even expecting – only a handful received weekly updates. We made none of the typical preparations for having a newborn.
We were nearing Christmas and Lisa was secretly hoping that she’d be able to wait until after Christmas to deliver. As we researched baby development, it was clear that the closer we could get to 36 weeks pregnant the better. Our doctor told us that the amniotic fluid levels were continuing to increase despite daily fluid loss (now 11cm!) and that that could only be helping with lung development. He coordinated a tour of the NICU for us.
The NICU attending doctor answered our questions and took us on a comprehensive tour. When I noted to him that we had been told that if our baby even survived delivery (and remember, we were told that there was a 90% chance that he would not), there was a 90% chance that he would have profound enough problems that he would never take his second breath. The NICU doctor told us, “we’re not concentrating on whether this baby lives or not; we’re concentrating on how quickly we can get him home with you.”
When this comment was mentioned to our primary doctor there, he told us that we should expect a “four days to four week” stay in the NICU depending on the severity of his breathing problems. When we visited the week before Christmas we expected to be scheduled for delivery the following week. But things were so good that we were told to come back on December 27 for another ultrasound and check-up and to schedule delivery for later that week. We returned December 27 and things were still so stable that a January 5 delivery date was scheduled. At that point, Lisa would be more than 35 weeks pregnant!
By January 5, both of our mothers (and Lisa’s father) were in town to watch our five older children. We drove the 70 miles for an early morning check-in. Lisa requested that a C-section be avoided if at all possible – and it was. Nathaniel David Graham was born at 10:25pm that evening. He was 5 pounds, 4.5 ounces and 18 inches long.
When delivery seemed imminent, the neonatal teams were called in on stand-by. By the time Nathaniel appeared, there were a total of 14 people in the room. After he took his first breath, it seemed as though the entire room held their breath… waiting to see if he would take a second.
And he did.
They allowed him a few moments with Lisa before beginning an examination as to what level of intervention might be needed. A few minutes later we were told: “he’s fine. He won’t need a NICU stay.” He was returned to Lisa.
Later that evening it was suggested that he spend some time breathing room air through a C-Pap machine. He was only on that for a few hours before he proved that he was just fine with breathing on his own thank-you-very-much. Because of the blood antibody concern and some correlated jaundice, he did spend some time under bili-lights before we were discharged a little more than a week later. The antibodies will take several weeks to cycle out of his system, and until then, he will need to be tested and perhaps given some extra help to prevent anemia.
He’s now safe and sound at home with his brothers and sisters – and two grateful parents who continue to marvel at God’s graciousness to us when, at least for a season, we doubted Him.
There was a point while he was still being monitored at the hospital when we overheard the supervising attending doctor relate information to his students. It was the same doctor who had given us a tour of the NICU weeks earlier. As they discussed Nathaniel’s progress under the bili-lights and the complicating factor of the blood incompatibility, the doctor reminded the others that the most significant concern – the fact that he spent 19 weeks with low or no fluid – seemed to be of no concern at all.
As we waited around the hospital for Nathaniel to be discharged, we told several doctors, nurses and social workers of our journey. Many marveled. Some teared-up. One said “this is why we do what we do.” When we contacted the original doctor back in our hometown, she responded: “Thanks be to God.”
Yes. Indeed.
There was a point back in November when Lisa and I were talking. At that point, the prospect of life was still very grim as there was very little amniotic fluid – and had not been for quite some time. We mentioned how we would give God all the glory if He spared our baby. It was then that I mentioned that it’s easy to give God the glory when something good happens; perhaps the real miracle is not that He grants us our desires and we praise Him in return but that maybe the miracle is that our prayers for life are not answered in the way we desire – but that we receive the grace needed to praise Him anyway.
In the minutes following Nathaniel’s birth, I posted a picture announcing his arrival. Several comments noted that “God is good.” And He is. He has been immeasurably good to our family. But it is important to note that God would have been good even if Nathaniel had died 21 weeks ago as we had expected.
He saw fit to intervene – more than once – in a situation that seemed hopelessly grim. And for that we are eternally grateful. We are excited to see how God will use Nathaniel – for His glory and for our edification.
One final note:
While we told few of our journey, we could not have made it without the help and support of those who were aware – and were willing to walk with us, and shoulder our burdens. My mother was able to drive the 150 miles several weekends in order to help with housework and food preparation while Lisa was on bed-rest. My father was unable to come but regularly sent care-packages and gift-cards for food. Lisa’s parents were able to come up to be with our 5 older children during the initial hospitalization and my mother was able to take over and stay during Nathaniel’s first two weeks of life.
Friends sent well-wishes, notes of encouragement, gift-cards – even preemie clothes. Our Sunday School class helped by watching our children, providing some meals, pledging their prayer support – even helping to fix our bathroom.
Our five older children demonstrated a depth of love and faith that is difficult to conceptualize for you. While Lisa spent more than 4 months off/on bed-rest (mostly on), our children took on the responsibility for much of our household tasks. Our oldest 3 children completed their homeschooling lessons, did most of the meal preparation, most of the cleaning – all while caring for their two preschool-aged siblings. I recently shared with them that without their servant’s-heart attitudes during this time, it’s likely we would not be embracing Nathaniel David right now.
More than one of them “confessed” that they had been secretly praying for him all along.
Andrew
Andrew & Lisa Graham
Josh, Christy, Lauren, Justin, Emily and Nathaniel
