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Josiah’s due date was yesterday – he’s finally 40 weeks! He had a check-up yesterday and is growing really well. He weighed 6# 8oz (2950gm) which is a normal size for a newborn. He’s gained 2# already, and it shows!

I finally finished writing down the experience I had in the hospital. Maybe now I can stop thinking about it so much.

It’s a long story . . . Samuel encouraged me to get it down to 2 or 3 pages, but I could only get it down to 10. So if you’re up for it, click and read away!

Josiah’s story

June 3rd 2005 was the beginning of one of the most difficult, heartbreaking, surreal weeks of my life.
It’s hard to know exactly when “it” all started. . . between weeks 29 – 32 of my pregnancy my husband and I traveled through Morocco with a group of fellow students from the school we were attending in Madrid, Spain. I had been a little nervous about the trip, but my doctor said it would be fine for me to go. We decided ahead of time to cut the trip a little shorter than what the rest of the students would be doing since the last leg of it would take us on a long, likely uncomfortable bus ride much farther from Spain and adequate health care.

We returned to Spain when I was almost 32 weeks and stayed with friends in the south of the country until we could rejoin the other students and return to Madrid. I had started to notice a lot of ankle and leg swelling while in Morocco, but it was very hot and swelling is normal in pregnancy. The 6-hour bus ride back to Madrid, however, precipitated an incredible amount of swelling that I could feel all the way to my hips. It actually hurt to bend my toes and ankles.

When we arrived back to our apartment in Madrid I decided to check my blood pressure using the automatic cuff that a friend had loaned me. I was alarmed to find that it was high – above 140/90 – normally my BP runs no higher than 110/70. I continued to check it over the next couple days and all but once or twice it was too high. I rested in bed as much as possible, and some of the swelling did go down. My next appointment was only 3 days away. I was worried and disappointed knowing that a diagnosis of hypertension in pregnancy would likely lead to bed rest.

On May 21 we went to the doctor. I brought my readings and the actual machine to check it against the one in the office. First I was weighed and we were all shocked to find that I had gained 7 kilos (15.5 pounds) in the last 6 weeks. I hadn’t even gained that much in the first 28 weeks of my pregnancy. I then told the doctor about my readings and that I had been very swollen. She initially seemed very concerned. Then the nurse aide checked my blood pressure: 120/60 – perfect. Immediately I double-checked it using the machine: 140/110. “Your machine is wrong,” she said. What a relief to be able to put my mind at rest! I felt a little silly for all the worry I had created the past couple of days. But we couldn’t understand the weight gain.

Next we went into the ultrasound room. In Spain, it is routine to do fetal measurements by ultrasound at every visit. She spent more time than usual and seemed concerned. She told us that our son’s growth was not as she had expected it to be. She tried to reassure us that “he may just be a small baby.” But definitely wanted us to come back in a week.

On the way out the door my weight gain came up again and she said “it’s not fluid, it’s not air, you’re doing something wrong. Try walking an hour a day.” I was in the hallway when I had the chance to say, “I’ve already been walking that much, some days up to three hours a day when we were in Morocco . . . ”

She never even looked at the swelling in my feet or ankles. Granted, I knew that I couldn’t be carrying 15 pounds of water, but I also knew that my eating and exercise habits could not have changed so drastically as to cause that kind of weight gain.

I went away with mixed feelings. So the machine was wrong . . . strange, though, that it only measured my pressure as high. Every time I checked Samuel’s pressure it was low. And if my pressure was normal, why so much swelling and why was my baby’s growth slowed?

Once I got home I looked up a fetal growth chart to discover that Josiah had weighed in the 75th% at 28 weeks, but now at 34 weeks had dropped to the 15th%. One of the main causes of growth restriction is high blood pressure in the mother.

Four days later, at about 3 a.m., I awoke with an unusual pain in my right shoulder and neck. It did not respond to heat, ice or massage, in fact they all made it worse. I also felt quite nauseous and a lot of epigastric discomfort, which I attributed to being pregnant, bloated and feeling the baby kick in my ribs. I spent about an hour pacing in the living room before I was finally able to fall asleep on the couch. I eventually went back to bed and woke up a few hours later with the same pain and discomfort. I decided to try acetaminophen, but that if it didn’t work I’d go to the hospital. The medicine seemed to help and the neck pain finally subsided, though I still felt a little nauseous.

I was awoken by the same discomforts every 2 days for the next 6 days for a total of 4 times.

The afternoon of the third episode I had a scheduled appointment. This time my blood pressure was high in the office. I wasn’t swelling as much and was happy to see that I had lost 2 kilos. Baby was still small, but measurements indicated that he had gained 250 grams. We told the doctor that we would be switching doctors at this time, and in fact had an appointment scheduled in five days. She wrote a short summary of the pregnancy up to that point and in her summary wrote that the baby had IUGR (Intrauterine Growth Restriction) – something I was very familiar with, but she had never told us or explained it. She told me to “lead a quiet life” and “rest as much as possible” because of the blood pressure. She also encouraged me to check it daily somewhere.

I hadn’t told her about my three episodes of feeling sick because I figured they were normal symptoms of pregnancy, and she didn’t ask. In fact, I don’t recall that she ever asked me any specific questions other than the rote “how are you?”

Two days later on Friday, June 3, I was sick again. As I was up, pacing, feeling the pain in my neck and the familiar nausea and epigastric discomfort I thought about how odd it was that this kept happening every 48 hours. I kept praying that the symptoms would go away. When I was finally able to sit down again I sat on the couch and rested my hands on my belly. While sitting there I noticed that I was contracting frequently. I started timing them: about every 8 – 10 minutes. They didn’t hurt and were only uncomfortable because it felt like the baby was being pushed up into my ribs with each contraction. Around 6 a.m. I was able to go back to bed, but I had decided that if the contractions continued when I woke up in a couple hours I would go to the hospital. I was only 35 weeks gestation, and knowing that he was small, he needed to stay inside me as long as possible, so if I was starting to go into labor, it needed to be stopped.

I awoke again at 8 a.m. still feeling nausea and contractions; but also had the sensation that something “wasn’t right”. I woke up Samuel and told him what was going on.

A friend from our school drove us to Hospital La Zarzuela on the other side of Madrid. I started feeling better and wondered if this would be a wasted trip, but the contractions continued.

We checked into the emergency room and after a short wait I was taken to a room. I told the woman there what I had been feeling and experiencing and she made notes. She checked my cervix and told me it was closed. She then handed me a cup for a urine sample and told me I’d be monitored for a while.

I moved to a shared room divided by a curtain where I was hooked up to a fetal monitor. It picked up mild contractions about every 8 – 10 minutes. I was also given IV fluids for hydration.

I had probably been there almost two hours and hadn’t yet had my BP checked. I finally asked a nurse to check it. I think it was 130/90. This seemed to alarm him a bit and a short time later labs were ordered. By this time I was feeling better, but very hungry. I asked if I could eat and was told no because they were going to draw labs. Initially I thought they wanted fasting labs – though this didn’t make sense in light of the fact that they were giving me glucose through the IV and that would be the only worthwhile lab to check fasting.

I was never told why labs were being drawn, though from my experience working as a nurse in an OB office I figured they were checking my liver and kidney function. I was also finally told that my urinalysis showed protein (a sign of problems with the kidneys).

I was moved to a private observation room to be monitored. I was there for about 4 hours having my blood pressure checked frequently. It was always high, and medications did not seem to affect it. The contractions, however, had dissipated.

I asked at least twice about the results of the labs drawn earlier in the ER and no one had any answers.
I was eventually moved to the OB floor and told that labs would be drawn again at 8 p.m. What and why was never explained to me and the nurses were in and out so quickly that we weren’t able to inquire further.

Labs were drawn at 8 p.m. and I had the impression that I wouldn’t be leaving that night. I was quite hungry but was told a couple of times that I couldn’t eat or drink anything.

None of this was making sense to me. I knew my blood pressure was high, but not high enough to warrant hospitalization. I knew that the baby was smaller than normal for dates, but he had grown well in the last week and his heart rate was excellent on the fetal monitor, so he was fine. I also knew that “fasting” labs would not be drawn while receiving glucose by IV. I remember saying to Samuel at some point that the only reason they wouldn’t allow me to eat or drink anything was if they were planning to do surgery – but they had no reason to do surgery. I just figured they were being overly controlling and restrictive – as I had read the Spanish medical system tends to be. I was thirsty, so I drank.

Around 10 pm I was in the bathroom when the doctors finally came in. As I walked out I heard one of the doctors say “Caesarean.” I was confused, thinking she was talking of where she had been before coming to see me. I said “What?” She repeated herself saying “Caesarean ahora!” with a sense of urgency in her voice. Samuel’s immediate response was “no,” because he had heard me repeatedly say how over-medicalized Spanish doctors are, they do way too many C-sections (30% of all births) and there was no reason for a C-section given what I knew.

I think they were shocked by his response. I heard them say something about my blood pressure and the baby being small and I think they also mentioned HELLP Syndrome. The next several minutes were a blur of confusion, panic, fear, disbelief and struggling to understand. I told them I was an OB nurse and I knew that by ACOG (American College of Obstetrics and Gynecology) standards I did not meet criteria for C-Section based on blood pressure and baby’s size.

They showed me the lab results, but flipped through them so quickly that they weren’t registering. They seemed very frustrated with us and said we could sign ourselves out AMA. In the frenzy of everyone speaking I started crying and said I needed to hear this in English and asked if there was anyone who spoke English. Samuel and I thought about our friends who lived nearby who spoke English and Spanish well and asked for some time to call a friend to come translate.

Our friends arrived, we told them the situation, and then an anesthesiologist came in who spoke English. He explained to me that the problem was HELLP Syndrome. He was the first one to speak to me calmly and thoroughly. He explained that they were concerned about my low platelets which, if they got too low – around 35,000 – would prevent my blood from clotting (normally platelets are about 150,000; at 2 pm mine were at 73,000 and at 8 pm at 65,000). He told me that it wasn’t the baby who was in trouble – he was doing fine, but it was my life they needed to save.

I noticed then that I was contracting at least every 5 minutes. I pointed this out and asked if I could be induced. He explained that because induction could take 24 hours or more we didn’t have time, if the platelets continued to fall at a certain point they wouldn’t even be able to do surgery because of the risk of bleeding. It was then that it finally hit me that I would have to consent to the C-Section.

As I signed the consent I was still skeptical that I was doing the right thing and that there was no other option.

At midnight I was transferred to a stretcher and taken down to surgery. Samuel was not allowed to come with me. The anesthesiologist asked me if I’d like to watch the baby come out, I said yes.

I felt the incredible pressure of them pushing on my uterus and pulling on the muscles to get the baby out. I was given my glasses, the gown that had been blocking my view was lowered and I saw my tiny, purple baby being pulled out and was happy to hear him cry right away. My glimpse of him lasted 3-4 seconds. I said, “He’s so small” and started sobbing. The doctor told me then he would give me a tranquilizer, and the rest was a blur.

While in recovery I was told that Josiah had been taken to the NICU, I had hoped he would b e well enough to be with me, or at least be in the normal nursery, so I was surprised and sad to hear that he was in NICU.

Samuel said he had seen Josiah for a few minutes in the NICU. He was in an incubator with an IV and oxygen and Samuel told me that parents were only allowed to visit twice a day for 30 minutes at a prescribed time. He was also told that Josiah might be there for a week. My heart broke again. Pictures were also not allowed – so I couldn’t even see a picture of him.

Later that morning a doctor came in to check on me. He had studied in Colorado and spoke English. I asked if I could see Josiah that day, he told me no, I wasn’t ready to get out of bed yet. He also told me I couldn’t eat or drink because my blood pressure was still too high. After he left, I thought of more questions, like how does my blood pressure relate to eating, and when would I be able to see Josiah?

Samuel went to look for him and brought him back in the room to ask more questions. I asked about the eating and drinking and explained that the hunger pains I was having were making my incision hurt worse, which in turn was probably causing my blood pressure to be high. He just shrugged me off and said if I needed to have more surgery I’d need to have an empty stomach. While he didn’t explain it further, I knew that he meant if my platelets remained low and my uterus started to bleed, they would have to do a hysterectomy. Of course, he didn’t say anything about the odds of that, or even if I was in danger of that.

We also asked about being allowed to take a picture of Josiah since I wouldn’t be able to see him that day. This is when the conversation got very tense. His response to our questioning their policy about no pictures was, “How would you like to have a camera in your face while you are trying to work? You’ll have the rest of your life to take pictures of him, and you can film him all you want when you go home.”

His abrasive response put me in tears. He then said, “I read your chart, that you had refused surgery and you’ve been a problem and questioning everything since the moment you got here!”

We responded by saying that no one told us anything all day until the doctors walked in and suddenly told me I needed a C-Section. He responded defensively.

There were more harsh words and all I could do was cry. He wouldn’t stop long enough to let us express how we were feeling – not to lash out at him, but just explain what we were experiencing. This is something I don’t think we should have to explain to an obstetrician who should have been aware of the stress we were enduring, but it seemed that his pride and authority were more precious to him than the feelings of his patient.

Samuel finally got him to stop and walked him out into the hallway where he tried to calmly explain that we weren’t trying to cause any problems, that we greatly appreciated their care and intervention, and that it was a very difficult situation for us.

In the midst of my tears after this encounter, the cleaning lady came in. Samuel and I were obviously very upset, but she ignored us and just went about her duties – even to dust the light above the bed I was sitting in. At this point Samuel told her to stop and she finally went away.

Samuel went to see Josiah in the NICU and reported to me after how beautiful and small he was, and he had been able to change his diaper in the incubator. After the second visit he had the good news that he had been taken off of oxygen and the IV had been taken out and he was even able to hold him and feed him.

After 24 hours of extreme stress, hunger and fatigue, Samuel called our friends Jonah and Heather who live in Sevilla. They are also expecting their first baby in August. We’ve been in close contact with one another over the past few months comparing notes on cloth diapers, breast pumps, the Spanish medical system, and pregnancy symptoms. Samuel shared with him what was going on, and even broke down in tears as he shared how stressful this time was. Jonah quickly offered to come to Madrid, and Samuel accepted. They were on the next train and arrived that evening.

We were able to secure housing for them at a friends’ home nearby. Their help and support were such a huge blessing for us. Jonah speaks Spanish very well after living in Spain for 6 years. He took care of all our hospital paperwork and insurance paperwork; he translated for us, took bottles up to the NICU and even fetched pain medication for me. He was also an invaluable support for Samuel who really needed the presence of a friend at that time.

Heather, at 30 weeks pregnant, kept me company and supported and encouraged me, also.

That evening, while Samuel was with Josiah and before Jonah and Heather came, I received a call from our new friend Jesús. He and his wife are good friends of Jonah and Heather. They also live in the south of Spain and had heard about our situation. Jesús called to tell me they were out shopping and planned to get some things for Josiah and wondered what we needed. I hadn’t even thought about the fact that none of his clothes would fit him because he was so small. Jesús said they would get him some clothes, and that Rachel would come up on Monday to see us and bring them.

Wow. Another huge blessing! That these new friends of ours with whom we had only spent a few hours in April were willing to buy us clothes and travel four hours to Madrid to bring them!

On Sunday I was finally allowed to see Josiah. I was taken up to see him in a wheelchair. Outside the NICU the parents waited to be let in to see their babies. There was also a window through which friends and family could see the babies once the blinds were opened. I felt nervous and excited to finally see my baby after 36 hours of being separated. As Samuel pushed me through the doors I could see Josiah lying on his belly in the incubator closest to the door. I knew it was him right away, and I started to cry. After washing my hands I was taken to the other side of the NICU and told that Josiah would be graduating to a regular bed then! I held him and just cried, tears dripping on his little head.

I told him how much I loved him and how sorry I was that that I got sick and that he had to be born so early, and that we had to be separated. I hated to have to leave him, but was encouraged that he had progressed and that I could see him again later that day.

After our visit Jonah showed us that he had snuck some pictures of Josiah through the window using his camera phone! I was thrilled to have even those little pictures, and we decided to sneak the phone in on our next visit that afternoon.

Josiah continued to lose weight almost every day that week which, we were told, was normal. But we knew that he wouldn’t be released until he started to gain. He was 2.1 kg at birth and he needed to be “Dos kilos y pico” before he could go home. I tried breast feeding a couple of times before I was told it was too much work for him, he needed to conserve his energy. So I started expressing and pumping and delivering my meager results to the nursery as often as I could.

On Monday, Rachel arrived by train and presented us with a little wooden box full of preemie clothes! At least five different outfits, all very cute, and a little hat on which Rachel had stitched “I love Mom, I love Dad.” They were just what he needed!

Rachel was only able to stay a few hours before she and Heather had to go back to the train station. I was just sorry that I wasn’t in a more social mood; but I greatly appreciated their visit, gifts and encouragement.

Every day we would eagerly and nervously await the report from the doctor about Josiah’s weight and progress. The nurses would also update us on how he was eating. He would take about 30ml (1 ounce) at each feeding. Most of the time he ate slowly. One day when we fed him, he spit up quite a bit. I burst into tears knowing the calories he had just lost.

It was always heartbreaking to leave him, especially after the second visit of the day because it felt so long before I’d get to see him again. We lingered as long as we could before the nurses made it very clear that it was time for us to go. At least they were kind, they understood the anguish the parents were experiencing.

That’s more than I can say for the nurses and staff on the OB floor. Every day I was awakened early, and told to get out of bed so the sheets could be changed. The days when I was already out of bed when they came in to change the sheets, Samuel was still sleeping on the couch bed next to mine. The staff paid no respect to him and turned on the bright lights and talked loudly between one another and woke him up. Toward the end of the week we were finally firm with the staff and asked them to just leave the sheets and come back to clean when we were upstairs.

The nurses – other than Inma and Alba who were with me the first night and a few nights after that – weren’t any better. I was never told anyone’s name, never asked how I was doing, never given more time than it took to do what they had to and leave. I often doubted the competence of the nurses caring for me. They never had any answers to the questions I had – the response was always “You have to ask the doctor.” Of course, I only saw the doctor once a day.

On Wednesday, day 6, I was visited by the doctor and shown the lab results from the tests done on Monday. My platelets were still low, but better. She ordered more labs and told me that if they were normal, I’d be discharged Thursday or Friday.

That night, I still didn’t have the results or know whether or not I’d have to leave the next day. I was not eager to leave without Josiah. We would be staying with friends, and since we don’t have a car, would be dependant on others to give us rides twice a day back and forth to the hospital until Josiah came home.

Thursday morning the doctor came in and asked if we wanted to go home. Samuel responded, “No, not without my son.” And I agreed. She told me my labs were normal, and I told her I thought I had a urine infection. She agreed to do a culture and allow me to stay one more day.

We left Friday after our first visit with Josiah. I cried most of the time we were together because the doctor told us he had lost another 20 grams and hearing that just broke my heart. He had maintained his weight the day before so I had been hoping for more good news. It was awful to leave without him.

Samuel was very sad, too; and we both cried a lot when we got to our friends’ house where we were staying.

The next day, after seven days in the hospital, we were finally given some good news: Josiah had gained weight! The doctor cautiously told us that if he continued to do well that day, he could go home tomorrow. What great news!

That night we got everything ready. We didn’t yet have the bassinet from our friend who would be loaning it to us, so we prepared a drawer for him to sleep in! We padded it with towels and made it very cozy for him.

On Sunday morning I felt excited and nervous as I fought getting my hopes up. I actually put effort into doing my hair and putting on makeup – just in case we’d be taking pictures.

Shortly after walking into the nursery that morning, one of the nurses approached Samuel with a big bag full of formula, diapers and other things and started explaining things to him. This was a sure sign that we would be taking him home today! I cried again, but for the first time, they were tears of utter joy!

Many people say that the day their child was born was the happiest day of their lives. I had hoped and prayed that I would have had such an experience as that; but the day he was born was one of the most difficult and heartbreaking of my life. The day we brought him home, however, would definitely rank high on my list of “happiest days.”

But the challenges continued. The doctor reluctantly told me I could try to breast feed once a day until he gained more weight. I read a lot about breast feeding and realized that everything I was not supposed to do was being done in the hospital and I had no control over it. He was being given bottles and pacifiers and very little touch, and no real “skin to skin” contact; all detrimental to successful breast feeding. I felt even more guilt and failure because of this. It is still a huge challenge now at four weeks.

I struggle to see the good in any of this experience, but I know it’s there, and I can see glimpses of it. I’m not able to honestly say that the good has outweighed the bad; but maybe someday I will.

His early arrival caught us unprepared and without a plan. We had to move five times in four weeks, and we had to ask for a lot of help, which was hard to do sometimes as I began to feel like a great burden on others. But as “Josiah” means in Hebrew: God supported us. Friends provided homes, rides, meals, money, baby items, help and support. It was beautiful to see the way the Body of Christ worked as many friends were Jesus to us. I am profoundly grateful to be a part of His church.

I’ve developed a great empathy and greater compassion for the women I hope to minister to: those who are pregnant, alien and alone. I had the support of a loving husband and friends, but I can imagine now how difficult it is and how much love and support lonely women need.

Many people said things in that week that were meant well, but actually hurt. I found that I did not like to hear people say “congratulations.” My first thought was “For what?” I did not feel that there was anything to congratulate. And then I would realize that this is the typical response after a baby is born – of course people would say it; but it still didn’t feel right. The only good thing I could see was that we were alive – we could have died, but we didn’t. It was not good that he was born early, small, was separated from me and that I now had to recover from major abdominal surgery.

“I’m glad you’re ok,” was another one. A thoughtful thing to say, yes; but I didn’t feel “ok,” and I didn’t think Josiah was “ok.” He was upstairs locked away in a nursery not being held, or rocked or sung to or breastfed, or able to see his parents more than an hour a day. We were not “ok.” Alive, yes – ok, no.

While separated from him people would say, “You’ll look forward to the day you can have a break from him,” or “Somedays you’ll want to kill him,” or “Enjoy the rest now, while you can have it.” I know people meant well, but these were some of the most difficult things I could hear then – when everything in me ached and longed to be with my baby. I didn’t care to think about weeks and years down the road, what mattered was now; and right now I wanted my baby.

Four weeks later we are still recovering. We’ve been able to be in the same place for a week now, and will be able to stay here for another 6 – 8 weeks before we return to the U.S. We have a lot of space and privacy and freedom to relax. Breastfeeding is not going well. I was not emotionally ready to really make an effort of it until a few days ago, and the whole process still brings me to tears sometimes because it just isn’t working.

I grieve the loss of a natural birth, and the loss of being able to be with him that first week. Until I reached 39 weeks gestation a couple of days ago, I kept thinking, “he shouldn’t be here, yet.” Though I also feel blessed to have been able to have him these past four weeks; and feel guilty for wishing he hadn’t yet come.

I don’t understand why I got HELLP syndrome, and believe that had I been in the U.S. it would have at least been detected sooner; and possibly controlled. I’m frustrated and angry that my doctor took the word of the nurse who quickly took my blood pressure in the office that day, and ignored the other symptoms I presented with of extreme weight gain, swelling and a baby with restricted growth. Her advice to me was opposite of what I should have done: she encouraged me to exercise more, and what I should have been doing was resting more.

It scares me that I could have died, that I ignored the symptoms for a week before going in to the hospital, and even as we were on our way was thinking, “I’m sure this is nothing.”

I regret not being more forceful in my questions about what was happening and why the day I went to the hospital. I wish that I could have had more time to prepare myself mentally, emotionally and spiritually for what was going to happen.

And I don’t know how to deal with this with God. I feel profound disappointment in the whole experience – He knew how desperately I wanted a natural birth, and how much preparation and prayer I had put into it. He allowed us to return to Spain and go to school, we would have been able to graduate if we had missed only four weeks as we had planned; but now we won’t.

Yet I also feel humility in knowing how close I was to death, and thankfulness that I went to the hospital and that the doctors detected the problem, and didn’t just send me home to rest. I thought He told me everything would be ok. Others told me they felt like God was telling them everything would be ok; but as I said before: alive, yes – ok, no.

I think the healing will take awhile. I’m closer to “ok,” most of the time; but not completely there yet.

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