Feb. 26, 2009 - Pondered in Her Heart

**************************Cliffnotes available at page bottom**********************************************

Concerning the birth of Jesus, the Gospel of Luke tells us that "Mary treasured up all these things, and pondered them in her heart." (Lk. 2:19). I've often wondered just what did she treasure. What details, as a mother, did she ponder... did she hold dear. So in the retelling of the birth of our second daughter I thought it only right to let Marla be the one to tell this story. So without any further words from me, I give you the birth of Noelle Nicole, as seen from her mother's eyes.

As all of you know I have been pregnant for the last 9 months. And yes, I'm pretty happy to be able to see my toes again. During the course of the pregnancy it was discovered that this was to be a "high risk" pregnancy. The problem began because my blood type is RH-, which would not have been a problem if Micah's blood type was also RH-. Because he has a positive blood type, Samara also had a positive blood type. Again, this is pretty common, and isn't usually a problem in the United States because here, women with RH- blood are given a shot called rogahm, which works to mask the RH factor. Because most of Samara's pregnancy and her birth was in Brazil, the doctors never gave me rogahm. And somewhere at the end Samara's pregnancy, possibly at birth, my blood became exposed to her + blood type, and my body began to produce antibodies to fight this "foreign invader." This wasn't much of a problem for Samara because she was so far developed, and it took my body a while to start producing these antibodies in large quantities. Then we became pregnant with Noelle. Early in this pregnancy my immune system recognized another "foreign intruder" and began working overtime to produce these antibodies. Fast forward to about 20 weeks into this pregnancy. During the first appointment here in the states my doctor during the routine blood tests finds these abnormally high levels of antibodies. Thus began the weekly trips to the perinatal clinic for ultrasounds and doctor visits, as well as our crash course in why all this matters and what could happen to our baby as a result. There were two possible things that could have happened to Noelle in utero. One being that her system would be overwhelmed by all these antibodies killing off her red blood cells and she would develop anemia, leading to possible blood transfusions in utero. The second, and the one that did happen, was that her little immune system would work in high gear and begin producing huge levels of red blood cells to compensate for the ones my antibodies were killing off.
Fast forward to last Saturday afternoon, my mom was flying in on standby from Alaska and after watching seven flights take off without her, finally caught one that landed her in Portland at PM. We came home and were excited to have few days to spend together before Noelle arrived. But God had other plans. Only twelve hours after my mom's arrival (about 4:30am), I awoke feeling contractions that were becoming more consistent and closer together. I timed them for about an hour and they were a steady 10 minutes apart. I woke up Micah and as he was finishing packing our things for the hospital, I also woke up my Mom and she said something along the lines of "you're kidding!" As we walked in the hospital (about 7:30) the nurses were changing shifts and we saw a friend from our church who I've gotten to know through a womens prayer group. So Jamie got to be my triage nurse. A bit later after I'd walked the halls having contractions and finally got admitted and into a room we found out that my doctor, Dr. Guinn, was the one on call that day! As the hours wore on my contractions got closer and closer together. Finally at 3pm Dr Guinn broke my water and things really progressed after that. It was the most intense and difficult thing I've ever done. Micah was an awesome "coach" as he breathed with me through every contraction and knew just exactly how to help me cope. It was also so special that my Mom got to be there, she would be massaging my back while I was breathing and getting through each contraction. I got to the point where I knew that I couldn't go on for many more hours without something to help with the pain so we decided to do a dose of Fentanol which took the edge off the pain for about 1/2 an hour. I think I had that two times. I don't know how much it really helped physically but I think that mentally I thought it was helping and that made me believe I could keep going. Labor seemed to go on forever...finally I was dilated fully and the Doctor said I could start pushing. This was great as it felt like we were really getting close. I'd pushed for about an hour when the doctor said she needed to use the forceps to help Noelle's head come out. So in went the forceps and with one more big push at 8:36 pm Noelle Nicole was born. Micah cut the cord and Dr. Guinn placed her directly on my chest where the nurses rubbed and wiped at her with a towel. It really was a fabulous moment to finally be holding this little girl we've been praying for and anticipating for so long. Micah's parents, brother Ben and Samara were able to come in and meet Noelle and it was so cute to see how excited Samara was to meet baby Noelle. And compared to our experience in Brazil this was SOOO much better. The nurses were super helpful, and we felt very supported and well taken care of.
Noelle spent that first night in our room where I was able to hold her and feed her and snuggle her. First thing the following morning they did a blood test and we found out that her bilirubin count was high at 9.4 and she needed to be admitted to the Neonatal Intensive Care Unit (NICU). By Monday afternoon she was in the level 2 of the NICU (the higher the number...the higher the danger...3 is the max) under the blue lights that help break down the bilirubin in the skin so it could be passed from her body through her digestive system. It was really hard to not be able to hold her and snuggle her. We could only take her out about every three hours for 1/2 an hour to feed her. They began testing Noelle's blood every 6-12 hours to monitor her bilirubin levels more closely. On Tuesday morning I was discharged from the hospital, but the nurse got permission for us to "board" at the hospital while Noelle was in NICU. That meant that they found a room that wasn't being used across the hall from the NICU and we were able to stay in it. It had a bed, a tv and a bathroom. They let us use it with the understanding that as soon as it was needed for another patient we'd be kicked out. It was so wonderful to be able to be right there and see Noelle whenever we wanted to and to hold her little hands and to pray over her and to be able to nurse her. They tested her again Tuesday morning her count had risen to 10.4. By Wednesday morning it was at 16.4 and by that evening the it had level jumped again to 18.9. What the pediatrician couldn't figure out is that even after having received intense photo therapy for almost 36 hours, her bilirubin count continued to climb. It was at that point that the doctor transferred care to a neonatalogist who had been called in especially to care for Noelle. Our neonatalogist was named Dr Newman. Dr Newman was wonderful as she came into our room and explained everything in great detail. From what we remember, she said that Noelle's bilirubin levels were alarmingly high, even with the photo therapy because her problem was concentrated in the blood. She said that Noelle was born with the number of antibodies (from me) in her little system, but her little body had been attaining equilibrium in utero by producing a high number of red blood cells. The thing is, after she was born, she was no longer receiving more antibodies from me, but her body didn't know this for a while, so her immune system was continuing to crank out a high number of red blood cells. Those red blood cells filled her body and then would die. These cells were being produced and dying so fast, that her liver couldn't process them out as fast as they were dying. So they were building up in her system. As those blood cells died and burst open they released a substance called bilirubin that is yellow in color thus causing the jaundiced yellow skin color. High levels of bilirubin can have very serious and permanent effects of brain damage, deafness, seizures and even mental retardation. These begin to happen with levels near 25. Dr Newman was not wanting to get any closer to those numbers and said we needed to intervene right away. She said that Noelle's bilirubin count already warranted a blood transfer and had even ordered the blood from the blood bank before coming to talk to us. A blood exchange in a newborn is taking all of her blood out via a vein in her umbilical cord, while at the same time slowly injecting in somebody else's blood through an artery in her umbilical chord. St Vincent is a huge hospital with the largest NICU in the state. There are about 600 babies born there each month, and even so, this transfusion procedure is very rare. Dr. Newman said they only do "several a year." She said it takes about three hours for the blood to be ready and that in the meantime there was one other treatment (IV IG) they were going to try where they give Noelle a drug through an IV in her umbilical cord that helps to kind of coagulate the bilirubin so her little body can pass it out more efficiently. This was all very emotional for Micah and I, we knew there were so many risks and all we coud do was pray and trust that God was in control. At that point Noelle had already been transferred to the third and highest level of the NICU. As Dr. Newman handed us documents to sign authorizing such a procedure we began to realize how very serious Noelle's condition was or could become. I cried in Micah's arms multiple times and while we were so very thankful to be where Noelle had great care. It was so hard to watch her little body laying there knowing the fight that was going on inside of her. Needless to say we were all for Dr Newman doing whatever she needed to help Noelle.
Surprisingly, IV IG drug treatment helped. After the first treatment was given late Wednesday night (it takes several hours to administer the treatment), her levels had dropped to 17. Dr. Newman was pleased enough to call off the transfusion for the time being and to give Noelle one more dose of the IV IG the next morning. As it turned out, when the doctor tried to put in the IVs in Noelle's umbilical cord, it was already too dried up to access the veins and arteries there so they had to give her an the IV through the soft spot in her head. The second dose of the IV IG, going in again through that IV in her head, brought her bilirubin levels down and it did not look like Noelle would need the transfusion after all. PRAISE GOD!!
During all this time Micah and I were totally supported by so many of you, family and friends who were praying for us and for Noelle and even a few who came to visit. One thing that was so wonderful was that between the two Grammas, Samara was totally being taken care of. She was in her own home, with her toys and bed and normal routine. This made it so much easier on me, not having to worry about Samara. Yes, it broke my heart each time she came to visit and would cry when she had to say goodbye. However I knew without a doubt that she was totally fine, and that as soon as the elevator doors closed she'd stop crying and be having fun with her "maamaw and maamaw laska". And as for my mother, she said that she was in "Gramma heaven," finally getting so spend so much one on one time with Samara.
Thursday Noelle was monitored and her levels had continued to drop, and she was moved back to level 2 in the NICU. They had done the IV IG and now they removed on of the big lights from above her so see what would happen to her bilirubin levels. We could finally see the light at the end of the tunnel. Friday we were just waiting and watching to see what her levels would do and what the Dr would say. They were hovering around 9.5. We knew that she might have to be in the hospital for several more days, and we were so thankful and amazed that we'd been able to board in the hospital all this time. Saturday morning after we went in for her normal morning feeding, the nurses called to say the neonatalogist that was on call was there to talk to us. Dr Kemp told us that Noelle's levels were looking good and that he was going to release her to go home!!! We were totally surprised, in a good way, and so thankful. It took nearly 5 more hours to actually be released. The hospital code of "hurry up and wait." The one condition in bringing her home was that we had to get a Wallaby (portable bili-light blanket) to bring home with us and she had to have it on her 24 hours a day. So we had to wait for it to be delivered from somewhere in the depths of the hospital. There was the normal checklist of things to go over and finally at about 2pm a NICU nurse escorted us to the front doors and helped into the car. It was a great moment to drive away and have Noelle safely strapped into her car seat behind us.
We arrived home to grandparents armed with cameras to document Noelle's arrival. I think they were happy to see Micah and I too =0) It's been great to be home and sleep in our own bed and eat good food and have our little family together again. Samara is pretty enthralled with baby Noelle and loves to help with everything. She is a great big sister and transitioning really well to this new addition to the family.
We still have Noelle on the Wallaby and we have to take her every morning to the hospital for a blood test. The last two days she has been barely under 10 in her bilirubin count, so she is holding steady. We do not know how long this will go on, it could be days or it could be weeks. We are just taking one day at a time and are thankful for all or the support, emails, cards, gifts and prayers that all of you have sent our way. It's been an emotional week, but we've seen and experienced God's faithfulness in such personal ways this week. He's met every need and taken care of every detail. From my Mom arriving in time for the birth and being here to help with Samara, to my Doctor being the one on call, to catching the high levels of bilirubin so early, to a great neonatalogist, to being able to room in at the hospital the whole time, to Noelle eating well. Over and over we've seen God's hand in this situation and we praise Him for his goodness to us.
When I became pregnant with Noelle I spent a lot of time praying about this little one and who she would be and specifically what her name should be. I'd go on long walks and think and pray for both Samara and for this new little life growing inside of me. There was a word that the Lord pressed on my heart for Noelle when I was about 12 weeks pregnant. It was the word victory. I shared this with Micah and of course we got online and looked up all kinds of names that had the word victory or victorious in the meaning. But we just didn't really like any of them. I also had fear in my heart that if this baby's name had the meaning of victory that she would have difficult things in her life to be victorious over. I was afraid of what that might mean. So I just pushed the prompting from the Lord to the back of my mind and we looked at all kinds of other names for this baby. But nothing seemed right. five or six weeks later Micah and I were talking and he said he really liked the name Noelle but it means "day of birth" which didn't seem very cool at the time. Then after we found out about all the possible complications with this pregnancy we came back to the word victory as it seemed that God new what He was talking about after all in that being the word pressed on my heart. In our looking we came upon the name Nicole which means "victory for the people" and we liked the idea of combining the names Noelle and Nicole for the general meaning of "a victorious day of birth." Her birth was indeed wonderful in that she is now here and we can hold her and love on her and be delighted in her. While there were some scary and sketchy times in that first week we are thankful for the victorious day of her birth and we look forward to seeing how she will live out a life of victory as God continue to write His story through her life.
Thank you all for your prayers, and we'll do our best to keep you informed in the coming days. Our plan is still to head to Alaska as soon as Noelle can travel, but we're just not sure when that will be so we'll be in Oregon at least a few more weeks. We are not totally out of the woods yet, Noelle has been home for 4 days and her levels have been slowly going up from 9.5 on Sunday to 10.5 today. If she gets back up to 12 she will be re admitted to the NICU at St Vincents. So please keep praying for her and we will do our best to keep you informed. Please feel free to write or call or if you are in the area to stop by we'd love to hear from you all. Also please continue to pray for little Noelle's levels. They had gone down to 7.4, but have risen back to 10.5 since being home. If they go higher than 12, Noelle will be re-admitted to St. Vincentes.

in Him for Him,
Marla and Micah

ps. for those interested, we've posted a short video on youtube that shows the umbilical cord being cut, and Samara's first interactions with her sister. Just go to youtube, and search for "Noelle Nicole Routon"
*******************************************Cliff notes below******************************************************************** ***************

-I talk about my pregnancy with Noelle and explain the details of the complications of being RH- and not getting the rhogam shot while in Brazil. Noelle's little body is fighting the antibodies she received from me by very producing high levels of red blood cells. As these red blood cells die off they release bilirubin which causes jaundice in babies. Noelle's levels of bilirubin were very abnormally high and that is why she was in the NICU and monitored so closely. She thankfully did not have to have the blood transfusion, as her body responded to a drug that helped her pass the bilirubin through her system. We are home now and she is on a Wallaby (or bili-light) 24 hours a day and we take her in every morning for a blood test to check her bilirubin levels. The past three days she has hovered between 9.1 and 10. We are not sure how long we'll have to continue this, could be days or it could be weeks.
- The name Noelle Nicole means "victorious day of birth" and we are thankful that she is here and that she will be fine. We look forward to seeing how God will continue to write a story of victory in her life.
-You can continue to pray...we are not totally out of the woods yet. Noelle has been home for 4 days and her levels have been slowly going up from 9.5 on Sunday to 10.5 today. If she gets back up to 12 she will be re admitted to the NICU at St Vincent's and the doctor will reconsider the blood transfusion.