Monday, June 12, 2017

An Rh Sensitized Pregnancy: Aftermath (Part 5)

At the end of it all, after all my worries about induction and further transfusions, my baby was born normally. Naturally. Spontaneously. (Well, mostly. I did have a membrane sweep.)

And four days prematurely.

After my son's birth, he spent some time with me, then was ultimately taken to the NICU. He was more or less fine at birth--clearly not anemic, no signs of shock, dealing great with the transition to being in the outside world. But because of my Rh sensitization, he would need monitoring for awhile.

Much of the next few days was a blur. I was recovering from birth, but despite my exhaustion, I barely slept that first night. Even without my baby in my arms, I was feeling the birth high! I eventually slept, but roused myself to use the breast pump every three hours or so. (I was determined to breastfeed! And determined that my baby would not drink a single drop of formula.) I visited the NICU frequently to see my little guy, and tried to nurse every time I was there.I slept as I could, and while I was sore, I never really needed pain medication of any kind.

I stayed in the hospital for two days, eating mediocre hospital food (although they get bonus points for having vegan options beyond side dishes!) and pumping and shuffling back and forth from the NICU to my lonely little room.

Coconut Baby, meanwhile, was in the NICU. Initial tests had shown his red blood cell count to be within the normal range, so he was definitely not anemic. His blood sugar was fine, although that'd be monitored for awhile due to my gestational diabetes diagnosis. Baby did, however, have an unknown quantity of my antibodies floating around in his system, and they were breaking down his cells at a faster than normal rate. The result? Jaundice. Baby's bilirubin count was very elevated, and still going up. At some point when I arrived for a visit in the NICU, he had been put on phototherapy, with two big sets of bili lights shining on him from above and a lighted blanket down underneath.

He had blood tests twice a day, to monitor his bilirubin level and RBC, as well as his blood sugar. He had to wear a little mask to protect his eyes from the phototherapy lights. He had an umbilical IV and a feeding tube, although for the first few days they switched him to IV nutrients (as opposed to my milk; instead, I steadily built up a stash of pumped liquid gold in the NICU fridge). He was so tiny, and there were so many wires attached to him, although I recognize that many NICU babies fared far worse. He was very sleepy, from the combination of being newborn, slightly premature, and jaundiced, but aside from that, he was doing well. Breathing fine, no temperature problems, no heart issues. I was barely allowed to hold him; he needed to stay under the lights.

I only got to spend two nights in the hospital, and after that I was forced to spend the better part of every day away from my new little squish. Although I tried to take the opportunity to enjoy being with my older boy, my heart felt torn in half. I continued pumping every three hours, and every day when I visited the NICU I brought all the milk I had made. Baby kept getting blood tests, kept receiving phototherapy. I tried to nurse when I was there, and he received my milk in bottles when I was at home. His bilirubin remained high, and the doctors warned us were were edging toward baby needing a transfusion after all. But instead of just giving him blood--he wasn't anemic, after all--they'd be doing an exchange transfusion. Essentially, the idea would be to swap out most or all of his blood for fresh blood, blood that didn't contain my antibodies.

It was a terrifying prospect.

Instead, we authorized the doctors to give him a dose of IVIg (intravenous immunoglobulin), which would help protect Coconut's red blood cells from my antibodies; this, in essence, would slow the breakdown of the excess cells, hopefully either lowering his bilirubin count or at least leveling it out for awhile so his body could have time to catch up with the load.We were told that IVIg is normally not particularly effective in cases of Rh disease, but that it was certainly worth a try. Anything to try to avoid an exchange transfusion.

Thankfully, it worked. Coconut's bilirubin dropped dramatically after he received the course of IVIg. He still had to stay on phototherapy, but they were able to remove one of the banks of lights. A few days later, we authorized a second dose of IVIg, which further helped his body get on top of things.

Finally, after eleven days in the NICU, Coconut was allowed to come home with us. The monitoring wasn't over just yet, though. He needed a blood test three days later, and then another four days after that. We continued doing weekly blood tests for weeks, monitoring his bilirubin (to ensure it kept dropping), his red blood cell count (to ensure it didn't drop), and his reticulocyte level (which was an indication of how quickly his body was producing new red blood cells). Those days were the worst part of Coconut's week; he hated the heel pricks (who could blame him?), not to mention getting his blood pressure checked and all of his other vitals taken.

Finally, though, when he was approximately six weeks old, the doctors released him. Officially. Bilirubin was nice and low, indicating that his body was able to handle it on its own. Red blood cell count was up, indicating that my antibodies were leaving his system. Reticulocyte count was way up, indicating that his body was finally making plenty of new red blood cells.

Six weeks after birth, my baby was finally free of the effects of my Rh sensitization.

In the end, I feel like I was really quite prepared for the issues I encountered during the pregnancy itself, although the reality of the blood transfusions was far more intense than I had thought they would be. Where I felt unprepared was when it came to the aftermath. No one had really warned me of the issues we'd be dealing with after birth; I had naively believed that once baby was born, he might need a transfusion if he was anemic but that would be that. I hadn't realized that jaundice was a major concern. No one told me my antibodies could linger in his system for up to three or four months. I was unprepared for the frequent, heartwrenching blood tests, or the reality of having a NICU baby.

We got through it, though. It was so much harder than I expected, but it was quite worth it in the end. Of course! Being Rh sensitized made for, quite frankly, a pretty awful pregnancy and birth experience. Thank goodness for the modern medical procedures that enabled this baby to come into the world and into my arms.


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