Birth Plan Decisions

We now have some big decisions to make as far as the after birth care we want for Eli. The doctor's think that since I have no fluid and Eli's chest is measuring small, he will be unable to breathe after he is born. The small chest measurement indicates that his lungs are very small and without fluid his lungs are most likely unable to develop. Therefore we have a couple options for Eli's care after birth.

1. We can do nothing. Just make him as comfortable as possible for the hours he is with us. He will spend all of his time with us and we will get to say our goodbyes. He is expected to only make it 1-12 hours with this option.

2. We can have the NICU staff examine Eli and attempt to bag him with a face mask to get a feel of how stiff the lungs are and how well he can be oxygenated. If that is successful only then would he be intubated as a trial and then go to NICU. If after 2-3 hours, ventilation is not successful as evidenced by blood gases and care is not producing results then aggressive curative treatment, including the ventilator is removed so Eli can be with us. If after delivery, Eli’s chest is exceptionally small or attempts to handbag cannot provide adequate oxygen per pulse oximeter, resuscitation efforts would stop and Eli would remain with his parents in L & D and comfort care would be provided.

Currently, we are definitely thinking of going with option #2. The only thing we are struggling with is how long we would want Eli to remain on the vent. The doctor's suggested 2-3 hours as an appropriate time to see if anything improves, but I'm not sure about that decision at this time. I have read many stories online about babies with similar situations whose blood gases did not improve in the first few hours. In some cases it took days to see an improvement. The doctor's did explain the risks of a pneumothorax while he is on the vent which means a collapsed lung. If this happens they would have to insert chest tubes to pull the extra air out from around the lung so it can expand more fully. All of these extra treatments mean more discomfort and pain for Eli. So, it's a very hard decision on how far we want to go. We don't want to put him through unnecessary pain if it will not help him. I also think I will be filled with regret if we do not try everything we can after we have come this far.

We are currently working on an after birth plan for Eli with the Palliative Care department at the hospital, so that is why it is necessary for us to make some of these decisions. However, no matter what we decide, we can always change our minds later. So, whenever Eli decides to come, we can always throw that plan right out the window and do whatever we feel is best at the time. But it's good to think about what we want to happen in different situations now so that we are prepared. Eli's quality of life is so important to me and I don't want him to be in any unnecessary pain. I also want to be able to spend time together with him. I really think the alone time, just the three of us is so important. We need that time to say goodbye if that path in inevitable. But I still have a tremendous amount of faith at this point. Even though the doctor's think Eli will not make it, I have faith in God's miracles. No one knows with 100% certainty what will happen and I know God has the ability to make Eli perfect if that is his will.

So, just like this whole pregnancy we have to continue to wait and see what happens. I'm praying that Eli comes into the world wailing as loud as he can and peeing all over the doctors! These would be sure signs of a miracle meaning his lungs and kidneys are both working! Thanks everyone for the continued thoughts and prayers. Nick, Eli and I love you all!!