All babies are miracles. For most of us, the miracle is tucked away where no human eyes can see. But, for a select few, these miracles happen in plain sight. Some people are privileged to see the hand of Hashem at work as clearly as watching an artist creating a masterpiece. Although I know that others have had very different experiences and cannot claim to speak for all of them, this was mine and the lesson I learned.
My oldest, Ephraim, was born full term, nearly 9 pounds and perfectly healthy. He was born screaming and didn’t stop for the next 6 months. While having a colicky baby was definitely a challenge, he made up for it with his contagious laugh and beautiful smile.
My second decided to make a more dramatic entrance. Chaya Sarah was born on June 4th at 10:08pm. I had been pregnant for only 26 weeks and 3 days. She weighed just 1 pound 14 oz and was 14 inches long.
She wasn’t what I had imagined preemies to look like. I always thought they looked like a miniature doll, I was wrong. It was frightening to look at her; there was not an ounce of fat on her body. Her skin was translucent and you could see the network of blood vessels beneath the skin.
Chaya Sarah was hooked up to a respirator; she was wearing a tiny eye mask to protect her eyes from the blue bili lights. Her small body was covered in bruises from her traumatic birth and the parts that weren’t black and blue were an angry red.
She had an IV line inserted into her umbilical cord so that blood could be drawn and given. She was hooked up to IV’s for nutrition, hydration, antibiotics and antifungal medication.
We watched Chaya Sarah grow in the NICU behind the glass day after day, week after week. Each week was another rollercoaster ride of progress, complications and setbacks. With her stubborn willpower, she prevailed, and learned to breathe and eat, skills we take for granted. Eventually she gained enough weight to be discharged.
Sitting in the NICU, watching my baby that should have been still within me for another 3 months made me realize what a miracle my Ephraim was. Did I realize while I was carrying him the miracles that were naturally occurring within me, the intricacies of the womb that were allowing him to grow and thrive?
I looked at all the machines Chaya Sarah was hooked up to and realized how much was needed to create such an inefficient and clumsy imitation of what Hashem accomplishes with such ease.
When Ephraim was around 24 weeks and still nestled within me his lungs were being coated with surfactant, a soap-like substance which coats the alveoli and helps keep them open as the baby breathes in and out. At full term his lungs had been lined with surfactant and were fully developed. He was able to breathe in and out and his lungs didn’t collapse from this simple action.
Chaya Sarah was born at 26 weeks, when surfactant production had just begun. Because she was lacking surfactant her alveoli would collapse on exhalation. This made it difficult for her to maintain the correct balance of carbon dioxide and oxygen in her blood.
Doctors have created a synthetic surfactant which has increased premature infants’ survival rates but is still not as effective as what Hashem created naturally in our bodies. Chaya Sarah was given the artificial surfactant at birth but she still needed to be placed on a ventilator. Later she was placed on a CPAP machine that gave her a steady supply of oxygen under pressure. This kept her air sacs from collapsing after each breath. A complicated replacement for Hashem`s `regular’ miracles.
In an infant born full term, the medulla oblongata, the part of the brain that houses the respiratory center, is fully formed. This center is responsible for setting the pattern of breathing by sending signals to the chest muscles and diaphragm. This is how my Ephraim was able to breathe without consciously thinking about it.
When Chaya Sarah was born her respiratory center was still immature, so she had something called “Apnea of Prematurity.” Her heart rate would slow down and blood oxygen level would decrease. Sometimes she would “remember” to breathe on her own and other times she would need to be touched or rubbed to stimulate respiration. She was also given caffeine daily to stimulate the breathing center and help normalize her breathing patterns. Ephraim remembered to breathe without his morning cup of Joe.
As the days went on we waited for Chaya Sarah to gain weight. But she didn’t.
All infants have a decrease in red blood cell production after birth; however, it is more extreme in premature infants. Chaya Sarah had so much blood drawn for various test and her body wasn’t producing enough red blood cells to replenish the blood she lost. This caused her to become severely anemic and she required a blood transfusion.
Chaya Sarah received multiple blood transfusions to compensate for her lack of red blood cell production. Being that her body was using so much energy just to breathe and live, it took her approximately 4 weeks to gain a pound. Ephraim gained a pound a week after birth and I was so proud of “my” accomplishments.
Ephraim’s brain and the nervous system began developing even before I was aware of the miracle within me. Deep within the brain are a series of chambers called ventricles. These ventricles are filled with spinal fluid which circulates around the brain and spinal cord providing a cushion of protection.
When Ephraim was born his brain structures were fully developed and able to withstand the birthing process without damage. 26 weeks into a pregnancy, however, the brain is not ready for changes in blood pressure that accrues before or shortly after a premature birth.
An area in the developing brain called the germinal matrix, near the floor of the ventricles, makes both new neurons and the cells that support them. Blood vessels in the germinal matrix carry a large amount of blood and are very fragile. The vessels within Chaya Sarah’s germinal matrix burst shortly before birth, the blood spilled into the ventricles and eventually into the white matter surrounding it.
Brain hemorrhages are graded One through Four, with Grade Four being the most severe. A neurosongram of Chaya’s brain taken days after birth showed a Grade Four bleed. The prognosis for a Grade 4 hemorrhage was by no means easy to hear, risks of cerebral palsy, seizures and mental retardation were explained to us as if we were children being taught a new math concept.
Did I remember to thank Hashem when Ephraim was born that his brain was miraculously intact? I don’t think I did.
But I did remember to thank Hashem for each of the hurdles Chaya Sarah either overcame or bypassed in the NICU.
I knew to be appreciative when her ductus arterious, the hole in the heart that allows oxygenated blood to bypass the babies’ lungs in utero, closed on its own and we didn’t need to have it surgically repaired.
We celebrated the fact that Chaya Sarah didn’t acquire necrotizing enterocolitis, an intestinal disorder affecting mainly premature children that causes the cells lining the bowel wall to become injured, swollen and need to be surgically removed.
We waited anxiously until Chaya Sarah’s Retinopathy of Prematurity, An eye disorder that occurs when abnormal blood vessels grow and spread throughout the developing retina, cleared up on its own – and were so thankful that she would not require surgery.
Chaya Sarah continued to grow and thrive, she began gaining weight and slowly learned to suck AND swallow AND breathe on her own; something that didn’t even cross my mind when we fed Ephraim for the first time.
Chaya Sarah was discharged on August 12, after being in the NICU for 69 days. She was 5 pounds 3 ounces.
I have learned so much from our journey with Chaya Sarah; I have learned how to be an advocate for my child, I have learned to be a better mother and to appreciate the everyday gifts that Hashem gives us. Most of all I learned to appreciate that every second of a baby growing in the womb is a miracle, from the moment the child is conceived until birth.
Pregnancy is hard and long, very long, but it is long for a reason. There is a lot your baby has to accomplish until we can meet them for the first time. We should cherish every moment our children are granted the Bracha of remaining within us, because miracles are meant to remain hidden.
