Fall 2008
Special Care for a Special Delivery
Special Care for a Special Delivery

Thanks to the specialized care that Paul, Tracy and Ethan –who was born almost four months early—received at Bridgeport Hospital, the Nerkowskis are home as a family.

Five months into her pregnancy, Shelton resident Tracy Nerkowski was enjoying her weekly prenatal yoga class when she noticed that her ankles were swollen. She called her obstetrician’s office and was sent to Bridgeport Hospital to have her blood pressure checked. Her OB/GYN, Emily Blair, DO, FACOG (Fellow of the American College of Obstetricians and Gynecologists), was already waiting at the hospital. “I was so relieved to see Dr. Blair when we walked in that I think my blood pressure dropped on the spot!” says Tracy. “But it didn’t stay that way, so Dr. Blair prescribed a medication to help keep it under control.”

The medication worked temporarily, but couldn’t maintain Tracy’s blood pressure at a healthy level. “Dr. Blair was so worried about me that she prescribed bed rest at home,” Tracy says. “I was allowed to get up only to use the bathroom, so every morning I set up my laptop, books, telephone and snacks within arm’s reach around our living room couch and stayed there all day long. I knew it was what I had to do to keep myself—and our baby—healthy.”

“Tracy would have walked on hot coals to stay pregnant,” says Dr. Blair. “Whenever there is a problem during pregnancy, parents are often stunned and it quickly becomes a very intense situation for them.”

But despite following her doctor’s orders, and all those hours on the living room couch, Tracy’s blood pressure kept going up. “So Dr. Blair had me stay in the hospital overnight so my protein levels and kidneys could be continuously tracked for 24 hours,” says Tracy. “Tracy was hooked up to so many monitors,” remembers her husband, Paul. “I held her hand all night—and it was a long night. We werereally worried,” he sighs. Tracy was also seen by Chief of Obstetrics, Steven Laifer, MD, one of Bridgeport Hospital’s perinatologists (obstetricians who specialize in complicated pregnancies).

After the testing, Dr. Blair confirmed that Tracy had a condition called preeclampsia—high blood pressure and excess protein in the urine (for a complete discussion of preeclampsia, visit Healthy & Wise Extras).

Today, Ethan is growing and developing well. Specialized Maternal Care
Because preeclampsia can lead to kidney failure, stroke and premature birth, Dr. Blair determined that Tracy and her baby—now at about 24 weeks’ gestation (out of 40) and about 10 inches long—would be best cared for by the obstetricians, perinatologists and the specialized staff in Bridgeport Hospital’s Special Care Maternity Unit. “I wanted Tracy to be on constant bed rest,” says Dr. Blair. Bed rest lowers a mother’s blood pressure and increases blood flow to the placenta, which provides the baby with the oxygen and nutrients needed for development, she adds. “Deciding whether or not to admit an expectant mother to the Special Care Maternity Unit depends on the seriousness of her condition as well as how far along she is. Tracy’s condition was pretty serious, and because she was she was still in her second trimester, I knew this was the best place for her to be in case there were any further complications.”

Along with daily monitoring to check the baby’s health, Tracy also received medication to speed up the baby’s lung development in case a premature delivery would be necessary.

“In the Special Care Maternity Unit, our job is to create a warm, encouraging and comforting place for our moms,” says Holly Lavery, RN, who has cared for expectant mothers for more than 20 years at Bridgeport Hospital, including Tracy. “We’re here for them. Working with their doctors, we provide the best technology and medical care to keep them healthy, along with the intense emotional support they need during this very stressful time.”

Nurses work together to meet the needs of the expectant parents. “The nurses really take a personal interest in the patients,” says Dr. Blair. “They realize how difficult it is to have a serious condition during pregnancy and how stressed the parents are. They help parents get through, day in and day out, with lots of distractions. Without distractions, parents can’t help but worry what might happen.”

On move-in day for the couple, Paul brought in comforts from home—to help take their minds off their fears. “We brought in favorite clothes, puzzle books and our laptops, everything we’d need over the next several weeks, because we didn’t know how long we’d be in the hospital,” says Paul. They hoped it would be for weeks, because each additional day that Tracy was pregnant meant another day of development for the baby.

“We knew that we would receive excellent medical treatment in the Special Care Maternity Unit, but we were happy to find out that our ‘regular life’ could continue for both of us,” says Tracy. The 10 specially equipped rooms on the unit provide family members with wireless computer access and are furnished with TVs, DVD players, refrigerators and beds for dads-to-be.

“Between Tracy’s daily tests and ultrasounds, we worked remotely,” says Paul. “My boss could get in touch with me and I could answer questions from the office. We also listened to books on tape and started a webpage about Tracy’s progress.”

“We know how stressful the waiting and worrying can be for expectant moms, so the hospital is delighted to offer them massage therapy (after getting clearance from the doctor), visits from hospital chaplains and consultations with our childbirth educator and certified lactation consultant,” says Holly.

Tracy and Paul also met regularly with Chief of Neonatology Robert Herzlinger, MD, who is also medical director of Bridgeport Hospital’s Newborn Intensive Care Unit. “Dr. Bob helped us understand what to expect with a premature baby. We knew our baby was going to be early, we just didn’t know how early,” says Paul.

“We try to educate parents as much as possible before the baby arrives so they are equipped with the information they may need in terms of what to expect and what kinds of care may be necessary for the baby,” says Dr. Herzlinger.

While in the hospital, Tracy was seen frequently by her doctors, including perinatologists who checked the baby’s status. Then, at the beginning of her second week in the Special Care Maternity Unit, the baby’s heart rate and ultrasounds were beginning to show that the baby was in distress. “I remember looking at the baby’s heart rate monitoring at the end of the day and seeing that it looked more concerning than it had earlier that morning,” says Chief of Maternal-Fetal Medicine and perinatologist Robert Stiller, MD.

“My doctors and the perinatologists determined that the time to deliver was now or it could be too late,” says Tracy. “I remember how quickly Dr. Menzies [neonatologist Cheryl Menzies, MD] appeared at my bedside to answer my last-minute questions and prepare me for the level of care the baby would require after delivery.”

Finally, it was time. “I was told to put on these special scrubs while nurses prepared Tracy for the birth,” says Paul. “I was so excited that I’d soon meet our baby, but I wasn’t sure what to expect in terms of the baby’s health.”

Tracy was wheeled to a prep room where she received a spinal block. The anesthesia was injected into an area below her spinal cord. “I’ll never forget the nurse’s expressive eyes at that moment,” says Tracy. “Her caring nature came through her eyes at that critical time. That will always be etched in my memory.”

That evening, April 7, Tracy and Paul welcomed baby Ethan into the world. Delivered at just 25 weeks’ gestation via cesarean birth by Dr. Blair’s colleague, OB/GYN Steven Cassell, MD, “Ethan weighed 1.5 lbs. and measured 11 inches long,” says Dr. Cassell. “He had gained an inch and about half a pound in just one week—which are very good things in terms of his health and strength.”

Tracy recalls the first few moments they officially became a family. “When Ethan was born, I heard one little cry and saw his arm from the elbow to his fist, which he was pumping in the air as the doctors whisked him next door to perform their preliminary check,” she remembers. “Shortly thereafter, Dr. Menzies brought Ethan back into the room and Paul and I had our first look at him, which lasted only a minute or two. No touching, no kissing, no holding— just looking at this tiny little child of ours and wondering what was in store for him.” After that, Ethan was transported to the Newborn Intensive Care Unit (NBICU), where he would be cared for during the next four months.

“As parents of a premature baby, you experience different emotions than during a typical birth,” explains Tracy. “There is obvious joy that your child is alive, but that joy is hampered by his condition and knowing that critical days are ahead. You truly start living moment-to-moment, as each moment is so important to the baby’s health.”

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Apart from being nearly four months premature, Ethan’s health obstacles during the first 16 weeks in the NBICU ranged from a collapsed lung to possible bleeding on the brain. He was hooked up to a ventilator (to help him breathe), intravenous medicines, lots of monitors and a feeding tube, because, like most premature infants, Ethan had not yet developed the sucking reflex. “The goal was to maintain adequate levels of oxygen, blood circulation and nutrition while his lungs continued to develop,” says Dr. Herzlinger. “It was frightening to think about the ‘what ifs,’ but we knew he was in the right hands,” says Paul.

Tracy and Paul went home about a week later, with Ethan remaining in the NBICU. “He was still so tiny and fragile— his diapers were about the size of four cotton balls— but we were comforted knowing there was a team caring for him,” remembers Tracy.

“Tracy and Paul visited Ethan every day, spending hours singing to him, reading stories to him and talking to him,” says Michele Covino, RN, BSN (Bachelor of Science in Nursing), Ethan’s primary nurse, who quickly became part of the couple’s new hospital family. “That stimulation from his parents helped in his development,” she adds. But because Ethan had help breathing with a special ventilator, they still weren’t able to hold him.

Finally, on April 29—more than three weeks after his birth—Tracy had the long-awaited opportunity to feel Ethan in her arms. “I finally got to hold him,” says Tracy. For a brief but momentous 90 seconds before he needed to go back on the ventilator, the couple embraced their tiny son, strengthening the bond already building among them.

“You know the saying, ‘It takes a village to raise a child.’ Well, at Bridgeport Hospital, it’s true,” says Tracy. “There were so many people who took care of him. And during each phase, people would step in to make us feel better, especially Michele.”

“Our goal in the Newborn Intensive Care Unit is to plan for the baby’s trip home,” says Michele. “Every day, our job was to help Ethan get strong and healthy and to teach Tracy and Paul how to take care of him—from bathing to feeding to working his special equipment and knowing what to watch for. Tracy and Paul are incredible people. They put their trust and faith in us and were very eager to learn how to care for Ethan.”

In addition to providing top medical care for Ethan, NBICU nurses made lots of mementos for Paul and Tracy, who were both back at work during business hours. (Tracy decided to save part of her maternity leave for when Ethan was home.) Nurse Amy Puffer, RN, BSN, took photos of Ethan and created three-dimensional collages. Nurse Dawn

Serreti, RN, BSN, made prints of his hands and feet. Nurse Connie Anderson, RN, BSN, made him tiny hats with the name of Paul’s favorite hockey team written across the top. Nurse Karen Carroll, RNC (Registered Nurse Certified), always made sure Tracy and Paul laughed. “They made us birthday cards, Mother’s and Father’s Day cards and a sign with a photo of Ethan when he weighed 32 ounces,” says Tracy. “I’ve saved everything in scrapbooks and memory boxes to share with Ethan when he’s older.”

On August 12, Ethan, who weighed just over 7 lbs., was finally ready to go home. After a tearful goodbye to the team who cared for them during those four months, Michele walked Tracy, Paul and Ethan to their car.

“Today, Ethan is developing well,” says his pediatrician Richard Freedman, MD. “He’s off a few medications and continues to gain weight.” Tracy and Paul are still in close contact with some of Ethan’s former Bridgeport Hospital caregivers. When Ethan is a few months older, he will participate in Bridgeport Hospital’s Newborn ICU Developmental Follow-Up Program. The only one of its kind in Fairfield County, the program evaluates the mental and physical development of at-risk NBICU graduates to determine early on if these infants might benefit from interventions to address any of their special needs.

“We really miss the people and the other parents we saw every day and got to know,” says Tracy. “We are so grateful to the Bridgeport Hospital team for helping us become a family. Without them, we may not have had a son to bring home.”

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