Every birth is as unique as the life it begins, each with its own radiance and drama. But for all the difference, each birth ends (if it ends with life) with the same thing—the first breath. With all that science says to explain it, there is still something miraculous in that first breath. The little person, emissary into the world, comes from the watery darkness into light and air. Smeared with slime and blood as if vomited from the grave, it looks perfectly natural that they would not breathe—and yet they do. Billions upon billions have taken their first breath and my mind knows this but each time I come to the birth of another one of my children there is a tiny little voice that whispers when the child comes out, “Maybe this one won’t breathe.” It feels like such an improbable miracle—how can it happen each time?
Last week the latest baby joined our family, a beautiful girl. What had been perhaps the easiest labor became something more fraught at the journey’s end. Technical words are so clean: Aspiration of meconium. They are words dry and neat and don’t feel sufficient to tell you that when my baby girl came into the world she gave a first abbreviated cry and then sludge oozed from the corner of her mouth. To say that it did not look right would be an understatement.
Meconium aspiration is a condition where a newborn baby breathes in meconium, a dark green, sticky substance that is the first stool which is ideally passed after the baby is out of the womb. Under certain conditions the baby can release their first stool inside the womb where it mixes with the amniotic fluid and then can be inhaled prior to birth. In layman’s terms, it is something like inhaling liquid diarrhea and is about as bad for you as that sounds. Meconium can block the airways, causing inflammation and respiratory distress. It can also damage the lungs and lead to infection.
The doctor saw my concerned expression and said, “It’s okay, the baby is still getting oxygen through the umbilical cord.” Whatever comfort was supposed to be provided by this statement was annulled as the doctor clamped the cord and offered me the opportunity to cut it. The NICU team was already on standby and whisked the baby to the other side of the room to begin their work.
For the woman giving birth there are many difficult aspects of labor and delivery of which I have no part. But for me in my role, one of the hard things in this journey is that I can do nothing to change anything. I can offer encouragement and support and comfort—and these are not small things—but none of those things fix problems. I like to be a fixer and accomplisher, and in this sphere of bringing a child into the world I can do nothing to fix or accomplish. I am stuck in the proverbial cheering gallery for wife and child. It is important to do that well, but there are specific moments where I feel the hard limitations of this role. If the baby should ever become stuck, I cannot get the baby unstuck. If my wife is bleeding I can do nothing to stop the bleeding. If the baby is struggling to breathe, I cannot give breath. There is a freedom in being able to do nothing, but also a hardness. Especially when your baby is struggling to breathe and you want to do something.
It also feels like a blessing and a curse to know more than the average layman. The blessing is the knowing, the curse is in having more things which I understand but can do nothing about. I am not a labor and delivery nurse, but in nursing school I had the basic education in labor and delivery. Beyond that, I also know the general nursing skills of reading oxygen saturation, heart rate, and breathing. I can’t recall everything on the APGAR score for newborns, but I know that it is the evaluation the nurses do immediately upon birth. Which is to say that I had a much better idea of what was going down over in the corner than the NICU nurses knew that I knew. There was some comfort in understanding what they were doing, but it was also nerve wracking knowing what they were struggling to correct and not understanding how successful they felt they were being.
Suction, then give oxygen. Repeat. Evaluate. The three NICU staff (I think two nurses and an NP) were playing it cool and speaking in low voices but I could tell they were not happy. They would voice out stats to each other in a low tone, probably speaking out the APGAR score and vitals. One of the nurses was chewing her lip, which made me more nervous. They hadn’t called a code yet, but were clearly not happy with the situation and didn’t seem certain which way things would go. They kept suctioning and checking—the checking which I guessed was monitoring the O2 saturation. I was caught between trying to evaluate what was about to go down with the baby and deciding if I should say something to my wife. “We might lose the baby” felt too alarmist especially since nobody else had said anything and I was still trying to take my own measure of the situation. But I was starting to think a “Dear, the baby is having trouble” might be warranted even though my wife was still in the midst of being put back together herself. The comment seemed pertinent and pressing, but I didn’t want to be the one to make that pronouncement. I wanted someone else to speak up.
The work on the baby had been going on for several minutes (I am not sure exactly how long—in moments of high stress time can sometimes seem longer than it actually is) and I was trying to get a read of what the NICU nurses were seeing for the O2 level. I finally deciphered it was the 79% number in green on the large display. I couldn’t decide if I was relieved or more worried—the ideal is 95-100% and 79% is far short of that. It is not in the “about to die in the next minute territory,” but given how much time had passed with suctioning and giving air to the the baby the level of 79% oxygen saturation was not as good a result as I would have hoped. They were clearly struggling to get the situation to where they wanted it to be.
I knew I couldn’t fix anything, I was stuck observing. But it was now clear that they were unable to fix the situation at bedside and a NICU visit had suddenly loomed in our future. I met my wife’s gaze, and tried to convey some sense of “Things aren’t great” but was saved from having to try to figure out what to say by the NICU staff saying, “Dad, you can come over,” as if everything was peachy and it was the most natural thing to have me join them and why hadn’t I come over sooner. In that simple statement I realized (with relief) that they felt they had the situation stabilized and where ready to publicly present the matter.
“So she is doing good, but is having a little problem,” one of the nurses said in a cheerful explain-to-the-ignorant-person voice and ran through what had just happened ending with, “She’ll need to spend a little time in the NICU but she’ll be just fine.”
It was a moment of warring feelings. With a breathing mask the baby was now making 92% oxygen saturation which did indicate they had managed to clear the lungs enough that the worst was hopefully over, but the sentence also brought an end to any hopes for the typical quiet family bonding time right after delivery. Instead of snuggling and staring into sweet fresh eyes, we saw our baby whisked away and were left sharing worried and wondering looks, thinking what all this might mean.
There were tears and hard minutes of waiting, but the end of the story was good. By twenty-four hours the little peanut was off all breathing support. Four days out she was allowed to come home. One nurse—whether just attempting to temper out hopes or laying out blunt facts—had told us on day three that it was a miracle she had progressed as quickly as she had and to not have expectations about discharge because babies who had aspirated meconium could easily be in the NICU more than a week.
We are grateful it was only four days. We are grateful for the first breath, and every breath God gives. We gave her a first name that means “Truth” and a middle name meaning “Free Woman,” in the hopes that she might breathe the air we all need and know the truth and be free.