Noah's Arrival

As you might know, Noah's due date was December 29th with a scheduled c-section on December 21st. However, it turns out that God had other things planned.

Missy had been having painful contractions for about three weeks, but those were attributed by her physicians as Braxton Hicks' contractions. We both had a sense that Noah would come early, but we did not anticipate that it would be this early.

At about 19:00 on Thursday, November 1st, Missy began having significant cramping while we were at church for Praise Team practice. She decided to go home and lie down in the hopes that things would resolve. Within minutes of getting home her pain became so severe that she couldn't bend to put her shoes on. She was able to walk across the street to Paul and Nancy Browne's house and asked Nancy to drive her to the hospital.

They roared into the church parking lot long enough to inform me that they were off to Lankenau hospital because Miss was in labor. I could tell from the look on her face that this was it. I rushed home and got a few items for Missy and then headed off to Lankenau. When I arrived, three people in the Emergency Department informed me that they "were expecting" me and I was escorted up to Labor & Delivery by a security guard. Missy was already in the operating room having an emergent c-section.

It turns out that Missy hobbled through the door of the emergency room and was immediately whisked upstairs to the Labor & Delivery unit. The OB/GYN on-call physician examined her and found she was fully dilated. They checked her with a quick ultrasound and found that Noah was in a breech position. They took her straight to the operating room and placed Miss under general anesthesia. Sixteen minutes after Miss hobbled through the door, Noah was delivered. This is a feat that I still marvel over. Those chaps at Lankenau have an amazing system in place.

According to the chief of OB/GYN who happened to be on-call and doing the operation, Missy had placental abruption. When that occurs, there are frequently severe complications that can include the deaths of both the baby and the mother. Essentially, the vessels between the placenta and the uterus are sheared and there is a large amount of blood loss. The baby can basically bleed to death in the womb. However, the abruption must have happened at or near the time that she arrived at the hospital because Noah's had no evidence of significant blood loss when he was delivered. His arterial blood gas, which is used as an indicator for the baby having had distress during or before the delivery, was perfect.

Noah was intubated in the delivery room and received surfactant. He was taken up to the neonatal intensive care unit and ultimately was extubated to nasal CPAP about three hours later. He weighed 3 lbs and 7 oz (1556 grams) at birth and was 16 1/2 inches long. The neonatologist told me I was the first person to ever ask him how many grams their baby weighed.

Missy was a bit euphoric from the anesthesia when she came back to her room in the L&D unit. We didn't get to her actual room on the post-partum floor until well after midnight. She had a significant amount of "oozing" from her incision site during the remainder of the night and underwent at least 3 dressing changes. I expressed some concern over her pallor and repeated dressing changes without anyone acknowledging that there could be an issue.

In the morning, her hemoglobin (red blood cell level) was 8.8 at 05:00 (down from 12.5 at admission) and the repeat around 09:00 was 7.1. This indicated a large amount of blood was going somewhere. She stopped making urine (very bad sign) and a transfusion was ordered.

A bit later in the morning, her OB/GYN evaluated her and was worried with the appearance of the surgical site and emergently took her to the OR for an exploratory laparotomy. There were three attending OB/GYNs in on the case and a general surgeon; they obviously were concerned with her status. They evacuated at least 2 liters of blood from her peritoneal cavity and found a bleeder that was ligated. That equates to more than 40% of her total blood volume. She was irrigated with 9 L of saline and then closed. Afterward, laparoscopy was performed to evaluate the liver and spleen to rule out the involvement of either. The OB/GYN with whom I spoke after the surgery said that her hemoglobin during the case was "likely in the low 6s to high 5s." She ultimately received four units of blood during the case.

During the surgery, I sat in the waiting area gripped with the fear of the very real possibility that I might lose the love of my life that day. I was thankful to share visits from my friends Anitha John and Nancy Browne, as well as our pastor during the time. As well, Jay talked at length with me via cell phone.

That day, Friday, November 2, 2007 was the hardest day of my life. I knew in my heart that true faith in that situation was to pray that God would do whatever He felt best. I had to admit that I didn't have that faith at that time. I couldn't fathom not having Miss with me. I didn't know what to pray and was reminded of Romans 8:26; "In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit Himself intercedes for us with groans that words cannot express." I didn't want to pray some non-Biblical, Joel Olstein "believe and you will receive" kind of garbage. Instead, I had to simply trust the Lord. He knew the desire of my heart. Thankfully, God's faithfulness, as well as His plans, have nothing to do with my lack of faith.

Isaiah 25:1
O Lord, you are my God; I will exalt you and praise your name, for in perfect faithfulness you have done marvelous things, things planned long ago.

In the recovery area, Missy was feeling much better. It's amazing how good you feel when your blood is staying in your vessels and delivering oxygen like it is supposed to instead of running into your abdominal space! She went upstairs to her room and we visited. We rejoiced in God's goodness and the excitement of Noah's birth, albeit quite early. Miss tried some clear liquids later in the evening and was doing quite well.

Noah did well throughout the day. His respiratory status began to improve, though he was started on caffeine due to apnea. He also began urinating a lot more and his swelling began to decrease. He was started on small volume feedings through an oral-gastric tube and seemed to tolerate that well.

At the end of the day, I could say that it was one of the very best days of my life. God is so good and has been so good to our family.