(Photo courtesy of http://www.information-on-surrogacy.com/how-to-give-an-injection.html)
A 32-year old woman lost three fetuses via miscarriages. She didn’t know then why it happened. This time, she’s pregnant for her fourth. This time she was worked-up and diagnosed that she has anti-phospholipid antibody syndrome (APAS). This is a condition where the mother seems to be reacting against her own self, forming blood clots all over her body, including the placenta. To be able to make the pregnancy viable, mother has to be maintained on anti-coagulants during the course of pregnancy – including aspirin (at a certain period only) or daily injections with heparin. Fetus can have growth restriction, mother can have severe hypertension, among other else.
The mother had been having daily aspirin intake to prevent blood clots. However, in the most recent days, it had to be shifted to heparin injections as aspirin seemed not to be working well. Baby’s status had to be monitored daily. When it was noted that baby’s status was deteriorating, though it was a painful and hard decision, baby had to be delivered even if he was premature (with the risk of the baby dying, AGAIN!). Parents are too aggressive for the survival of the baby. They’ve been spending a lot (my guess, more or less a million pesos) just to make this pregnancy successful. Understandable, this will be their first live born baby, after three pregnancy losses.
Baby came out, wrinkled, tiny, with a shrill cry. On the latest ultrasound, it was estimated that baby is 838 grams (classified as extremely low birth weight — babies weighing less than 1000 grams). In the western countries, what they usually do is, within the 1st 15 minutes from birth, they intubate baby, instill surfactant, then provide nasal continuous positive airway pressure respiratory support. I was tempted to do the same. The surfactant was already available. But then I remembered what was more important was baby’s battle with infection. Thus I prioritized baby to undergo skin-to-skin contact with the mother to acquire the latter’s skin bacterial flora that will populate baby’s intestine and trigger his immune system. I can always administer surfactant a little later and it won’t cause the baby too much harm.
While baby was on his mom’s chest, mother was crying loudly. We understood that as cry (not just tears) for joy. After 4 pregnancies, she was finally able to deliver a live born baby. In between sobs, she was asking me to do all my best to take care of baby. That she had been waiting for her own baby…
Suddenly, the toll was on me, I panicked at the expectations of the mom. She repeatedly asked me if baby can lie beside her at their room. That was how she longed for baby. How could I defy her wish when I realized (1) how long they waited for the baby, (2) how much they want to have their own child, (3) how much expenses they incurred to make this pregnancy successful, among other else. Suddenly a lump formed at my throat, making me swallow hard. (And I was burning in fever due to exudative tonsillitis at that time). I told her I will try my utmost skill to make baby survive, as much as possible, with minimal if not no deficit at all.
At 15 minutes, when the baby started to have nasal flaring, that’s when I took baby off from his mother, brought him to the NICU for further care.