Our son, Santiago Anam Tkac Flores, was born on 07.07.14 at 7:27pm at San Francisco General Hospital, but he was originally expected to arrive around August 19th – and that difference in time and development has made for an interesting start to his life with us. This is the account of his birth and the first week of his life, meant to be shared with friends and family that are interested in this story; you can decide if you are too.
We currently live in Berkeley, but when we first arrived in the Bay Area at the beginning of May we were staying with the friends that I lived with in the early 2000’s in the Mission District of San Francisco, about a block away from one of the best maternity-oriented hospitals in the region. On the good advice of friends who had either given birth there or knew of someone who had a good experience doing so, Xanat got set up with a doctor and midwife and started going to check-ups and classes there. She was so happy with the experience that she decided to continue forward with them even after we moved to the East Bay, even though that meant that the door-to-door trip (by public transportation and walking) would be about an hour.
Her pregnancy was progressing very well until about a few weeks prior to his birth (maybe the 30th week?), when she noticed that the shape of her belly had changed from a very centered and melon-like overall roundness to a lower position with a slight depression at the top. This is not so unusual for expectant mothers at that stage, but seemed to her to be a little early in the pregnancy to have this kind of drop happen. She kept bringing up her concerns about it, and after she spoke with some different people, she accepted that it was not something to be worried about (even if she still was a little). Santi was also a very active baby in the womb, and had pretty distinct movements (especially regarding which side Xanat was trying to sleep on at night) that always let her know that he was very much there, but then on the Friday and Saturday before his birth, his movements slowed down to such a degree that it was immediately noticeable for Xanat. I tried to reassure her that it was probably normal (and actually I was distracted with my own work-related drama), but she couldn’t let it go as easily as the stomach positioning issue.
On Sunday, she felt him moving a little in the morning and at lunch time, and when I asked her about it later in the day she seemed more assured, but then there was no movement again at night. On Monday morning, she didn’t feel him moving at all. By lunchtime, although she felt him move a couple of times, she decided that something really was wrong and she just needed to do something about it, no matter what anyone else said – and thank god she did!
We had plans that evening to hang out with a friend coming in from out of town, so when I got a text from her I thought it was regarding that – but then when I read that she was going to the hospital I got really worried and called her. She then reassured me that everything was fine and that she just needed to be sure, and that she would call at the end of my class to let me know what happened. In the meantime, she arrived at SF General around 4:45p, and the nurses started monitoring the baby’s heartbeat, which initially looked fine. Then they noticed that she was having small contractions (which she didn’t feel at all) and at 5:00p she had one that slowed Santiago’s heartbeat down a lot. A bunch of people then rushed into the room, and Xanat thought that something might be wrong with the machine, based on the sounds it was making and the way people were reacting. When the contraction was done, his heartbeat returned to normal, and after some more contractions everything seemed to be fine again. Her midwife (Carmen) was there (a pleasant surprise in all of the craziness), and she was a reassuring presence. Then at about 5:30p, she had another contraction and his heartbeat dropped again, and there was an immediate decision to admit her formally. This time she knew right away that the rush of people meant something big was happening, and she became very nervous and began shaking uncontrollably. She tried calming herself down by taking deep breaths, reassuring herself that this was all best for Santi, but when a doctor started talking with her about the need for an emergency c-section, she knew it was very serious.
At about 5:40pm, with no movement being detected in the baby, the doctors did an ultrasound and saw that he was in an upright, seated position but noticed that there was less fluid than needed and that the placenta was smaller and looked more “aged” than reported in the most recent ultrasound. They decided that he needed to come out as quickly as possible, fearing that the placenta was not supplying an adequate enough supply of oxygen to him. Xanat asked Carmen her opinion and she agreed that it was best to do a c-section. She called me at 5:50pm, just as I was finishing my last class for the day, and told me to come to the hospital; I knew from the tone of her voice that it was serious, but I didn’t say anything other than I’d be there as fast as I could.
More people came into the room and began talking with her about risks and signing papers and so on; she remembers the anesthesiologist in particular because she’s never been under, and was apprehensive about giving her the go ahead. She then basically put a halt to everything by telling them to wait until I arrived before she would sign anything.
I walked into the room at about 6:30pm, after taking the subway and then walking about 20 minutes (it wasn’t until halfway that I realized that I could’ve taken a cab from the BART stop, so ingrained do I have it in my own mind not to spend money on transportation when I can just walk). I was immediately overwhelmed by the energy there – so many people, such an intense vibe, my wife shaking like a wide-eyed, scared little child on the bed while someone who was obviously in charge pressed her to sign some papers so they could “begin the c-section” – and me not knowing if our baby was even alive anymore. Xanat noticed my look and called me over, saying, “I need you to keep it together for me right now, Greg, please.” We spoke for a second about the operation, and then she signed the papers and it was on!
Very quickly she was shipped out to the operating room and an epidural process began. I was standing outside of the operating room looking through a small window, with most of the view obscured by machinery and the backs of medical staff, so I spent those seemingly eternal minutes pacing back and forth. The doctors were having trouble finding a good open spot on the spine, but then her legs finally went numb and I was allowed to come into the room at 6:50pm.
Xanat had her right arm outstretched to the side, so I sat down there and held her hand. There was a set of curtains (which were jokingly referred to as “the drapes”) separating us from the rest of her body so we couldn’t see what was happening, and I didn’t dare look over it knowing that the sight of my wife’s cut open torso would freak me out. And she was freaking out on her own already, so she told me to just talk with her about anything to keep her mind off of what was happening. I had a whole bunch of stories to tell her about my day at work, so I just kept talking and trying to keep her occupied while keeping an ear open to what was happening. She felt a lot of pressure in the lower half of her body but no pain, and I remember at one point it looked like they were twisting her around like a rag doll as they maneuvered Santi out of her womb. She didn’t feel a thing, and I didn’t say anything about it what I saw, and it was all completely surreal.
At 7:27pm, one of the doctors rushed passed us with a very limp Santiago in her hands, and since I didn’t hear any crying, I began imagining the worst – but turned to Xanat and spun it in the best way I could. There was another small window with a view into a side room where I saw them put Santi on a table and begin working on him, and then that view was completely blocked with green medical gowns and Carmen’s smiling face. Xanat kept asking what was happening and they didn’t have much to say, until we heard his sweet little cry piercing through the commotion. At that point I totally lost it and started crying myself, as did Xanat, so relieved were we to know that he was okay. My plastic face guard was completely fogged up at that point and that was my impetus to stop crying, since I couldn’t be the “strong” one if I couldn’t even see what I was doing.
The staff were busy working on Xanat the whole time, but this obviously routine part of the after-birth procedure meant that some were finished with their main task and had time to relax and hang out with us. I remember one casually describing how Xanat’s organs were all outside of her body so the doctors could “clean them up a bit” before they stitched her back up; that was almost a little too much information for the both of us, and they quickly changed the subject to congratulating us and telling us how well Xanat had done in the procedure.
Eventually we were taken back to the room we began in, and thankfully there wasn’t another patient to share it with, because I think we both fell asleep for a while (and I was allowed to stay there for the entire week, day and night, that she was a formal patient in the hospital). Around 11pm we saw him for the first time, wired and tubed up to the gills, and in the incubator (as he has been the entire time), but we were so happy to know that he was okay that it didn’t matter.
In the days following, we learned about the types of health problems that he had, all related to the fact that he was underdeveloped. One of the first problems they noticed was that his belly button (which had a veinal tube put in right away to administer medicine and take blood samples) was not clotting as it should, but rather “oozing” blood. This meant that his blood was not as developed as it needed to be, and so the first step was to give him a plasma transfusion in an attempt to help build the proper clotting factors. This worked well, but then other issues came up (like not being able to exhale CO2 efficiently and bilirubin building up, which required phototherapy), and he was given a platelets transfusion to further boost his blood. He had several of both transfusions in the following days. Related to this process is a problem with fluid retention and swelling, especially in the abdomen and the groin, and this week they began giving him albumen to deal with this. His swelling has since gone down. His blood pressure has was also low, so they administered dopamine to keep it up, which in turn made sure that his circulation reached even the furtherest parts of his body from the heart in the best way possible. Having a dopamine drip meant that he can not have food in his stomach though, so he wasn’t allowed to breastfeed. A PICC line was established early on to try to get nutrition and medicine as close to his heart as possible, but it was never in an ideal position, and there was talk that he would get a new one, which would mean more x-rays to finalize its position, and we were not happy with that. Then, a decision was made to keep the PICC line in and try some new things. On Monday, July 14th, they discontinued the dopamine drip, added a feeding tube through his nostril to begin administering some of the colostrum that Xanat has been pumping since day 1. His body accepted it well, meaning that it allowed some bacteria to begin growing in his stomach and intestines to help with digestion, and after several more sequentially bigger feedings, he had his first feeding directly from the breast on Tuesday, July 15th. It was a beautiful and amazing moment for us, as it was also the first time she had skin to skin contact with him, and since he latched on well and drank 4 ml on his own, the prospects are good for this to be a regular event now.
And that’s it for now. Santi will probably be in the hospital until about his previously expected due date (August 19th), but he’s getting stronger and healthier everyday, so we are hoping for the best and welcome him into our home as soon as possible. Thanks for reading, and feel free to check out my FB page to see photos and video of him there.