October 2001
Expect the Unexpected

For the birth of their first child, Kelley and Brian Hayes chose The Birthplace at Bridgeport Hospital because they had heard that Bridgeport Hospital had the best maternity services and the only Newborn Intensive Care Unit in the area. Kelley didn't expect to need them, but she wanted them available. For the birth of their second child, they chose The Birthplace because this time they knew, from personal experience, that it's wise to...Expect the Unexpected

Milford resident Kelley Hayes, 33, was not expecting trouble. Neither were her obstetricians, Drs. Steven Cassell, Emily Blair, Philip LaMastra, Sapna Tandon, and Peter VanDell of OB/Gyn of Fairfield County. Her pregnancy had been perfectly normal. But a week before her due date, an ultrasound showed that her amniotic fluid levels were low. Amniotic fluid surrounds and cushions the infant in the womb. Levels may rise and fall, and low levels are not uncommon in late pregnancy. However, a follow-up ultrasound showed that the level had continued to decrease. This could cause problems. Knowing she was near term, Kelley's doctors decided to induce labor.

Her labor was normal, but long. Because of the slow progress, and because Kelley was becoming exhausted, it was decided that the baby should be delivered by cesarean section.

This initially went well. Kelley had epidural anesthesia (a pain block that leaves the mother awake but pain-free during the birth), and when the baby was born, she heard the doctor say, "It's a girl!"

But something was wrong. The 8lb. 4oz. baby was beautiful-but she never cried.

The two pediatric resident physicians in the delivery room immediately huddled over the baby, performing chest compressions and providing oxygen. "But she wasn't breathing," Brian says. "I could see her turning blue. I thought she was gone." He shakes his head and looks away, unable to bear the memory.

"Brian was trying to assure me that everything was fine, because he didn't want to upset me," Kelley recalls. "I could tell by his tone that he wasn't telling me the truth, but because I couldn't see what was happening, I didn't realize the intensity of the situation. Then someone said 'We need Dr. Herzlinger, stat!' and her voice sounded urgent. I still remember those words-as clearly as if they were just spoken to me."

Robert Herzlinger, MD, chief of Neonatology at Bridgeport Hospital, arrived in the delivery room at a run. Quickly assessing the situation, he carried the limp little body into the special resuscitation area. He and his team went straight into action, each member knowing exactly what to do.

They put a tube into the baby's airway to provide oxygen, while a ventilator pushed air in and out of her lungs. Since her heart was not beating, team members did chest compressions on her little body to force blood out to her organs.

A catheter was placed in an artery to deliver fluids to her body. A blood transfusion was also required. Dr. Herzlinger ordered medications to increase the baby's heart rate.

Then one little lung collapsed, squeezed by pressure from air that was trapped in the sac that surrounded the lung. The team knew immediately what to do: To reinflate the lung they placed a tube between two ribs and suctioned out that trapped air.

Within ten minutes, the little blue body began to turn pink as the baby responded to the Newborn Intensive Care team's coordinated efforts. Dr. Herzlinger went to the recovery room to tell the Hayeses that their daughter had been resuscitated, but was critically ill and had been taken to the Newborn Intensive Care Unit.

Brian went up to Newborn Intensive Care to see his daughter. "At 8 lbs. 4 oz., she looked enormous next to the tiny two- and three-pound preemies in the other incubators," he says.

Neonatologist Richard Freedman, MD, was in Bridgeport Hospital's P.T. Barnum Pediatric Center that day caring for patients of Pediatric Healthcare Associates, so he came in to examine the baby, consult with the Newborn Intensive Care team, and talk to the Hayeses. "He used the word critical, too, but he was optimistic," says Kelley.


As the hours passed, she began doing better, but the Newborn Intensive Care team stayed vigilant, knowing how quickly this fragile little life could slip back into critical condition. And it did happen. The baby's other lung collapsed, she went into cardiac arrest, and suffered a seizure. Newborn ICU nurses immediately realized what was happening. Thanks to the availability, 24-hour-a-day, of neonatologists and pediatric specialists, swift action brought her back again.

"This time it was even scarier, because by now, we had begun to bond with the baby. We named her Olivia Katherine," says Brian. He went up and spent the night in the Newborn Intensive Care Unit, watching Olivia's every breath. As medications began to control the seizures, Olivia began what Brian calls "a rocket-ship climb toward getting better."

She had help from some of the many sub-specialists available through the Newborn Intensive Care Unit. Seizures can indicate damage to the brain, so it was important to find out if, during the ten minutes before Olivia began to breathe, her brain had suffered from the lack of oxygen. Pediatric neurologist S.K. Nallainathan, MD, performed an electroencephalogram (a test that records the brain's electrical waves), which showed that her brain was normal.

An MRI also showed no bad after-effects from Olivia's rocky start.

"Technically, Olivia was a stillbirth," says Dr. Freedman. "What's so dramatic is how unbelievably sick she was, and how remarkably healthy and normal she is now. You know, you can have a completely normal pregnancy, and then unexpected and unexplained problems can occur. You never know when you're going to need an experienced, totally coordinated Newborn Intensive Care Unit."

Amazingly, Olivia went home after just seven days in the Newborn Intensive Care Unit.

In addition to regular well-child visits to Dr. Freedman, Olivia took part in the Newborn Intensive Care Unit's Follow-up Program. The only one of its kind of Fairfield County, Bridgeport Hospital's Follow-Up Program monitors the development of at-risk Newborn Intensive Care Unit "graduates" and arranges rehabilitation services if any problems arise. Olivia visited neonatologist Christine Butler, MD, at 12 months and 15 months. At the 12-month visit, when she was not pulling herself up, Dr. Butler and the Hayeses discussed the option of physical therapy. But when the family got home that day, Olivia did pull herself up, and then continued to progress well without the need for therapy.

After their frightening experience with Olivia, the Hayeses decided one child was plenty. But life decided otherwise, and two years later, Kelley was again expecting. There was no question as to where this delivery would take place. Once again, the pregnancy was normal, and once again Kelley's cesarean section went smoothly- and once again, their baby ended up in the Newborn Intensive Care Unit . "Brian, Jr., had fluid in his lungs-not uncommon with cesarean babies, I understand," says Kelley. "In just a few days, he was fine. But we were so glad we were at Bridgeport Hospital!"

The Hayeses think their family is complete now. But if they ever became expectant parents again, they know where they'd come to deliver a third child. No doubt in their minds. They've definitely learned to expect the unexpected, and to take no