October 2nd - Toby's Birth

Spina Bifida is a neural tube defect.  It occurs in the very early days of pregnancy before a mom even knows she's pregnant.  The bones of the spinal column don't close around the spinal cord causing a defect in the spine and typically an open hole in the back or causing the most severe form called Myelomeningocele.  There are other forms as well - and you can read about them here

It is the result of genetic and environmental factors.  Many experts say that taking folic acid or having a diet rich in folic acid can help prevent, but it's not a "for sure" thing.  My husband actually has a first cousin that had Spina Bifida on his dad's side.  Just recently my daughter was diagnosed with the MTHFR gene mutation at gene 1289C and C677T, which means she cannot absorb non-methylated forms of B vitamins.  She has to take special B vitamins called methylated B Vitamins so her body will absorb them.  Most over the counter B vitamins are non-methylated, so we get methylated ones through her doctor's office.  I've read that if you aren't able to absorb B vitamins, they can actually become a toxin in your body. I am no medical expert and do not understand all of this, but I have my theories related to this gene mutation and Spina Bifida.  I have not been tested for this gene mutation, and her pediatrician tells me that 40% of the population has this gene mutation and doesn't know it. I find that interesting because Spina Bifida is the "most common permanently disabling birth defect in the United States."

So, on to Toby's birth.

Today, I want to feature Toby's birth.  I was actually due on January 12th or 13th (I can't remember now, isn't that awful), but because of the risk of infection with a vaginal birth and the open hole in his back a cesarean section was our only option.  It took us awhile to choose a good date for his birth. They were coordinating between the days my OB was in the operating room, Toby's neurosurgeon's surgery days, and the most important thing - having the baby before the end of 2006 for a tax credit. You can just guess who in our family pushed that one!  At 39 weeks at 9:59 a.m., Jacob Tobin Holt was born.  He weighed 5 lbs. 11 oz. and was 18 1/2 inches long.  During my pregnancy I began reading a book called Living With Spina Bifida.  There's a part in the newborn chapter that discussed how some time babies can have severe side effects from their Chiari II Malformation such as: stridor, weak cry, difficulty breathing, central apnea, feeding and swallowing disorders, reflux, and failure to thrive.  I was fairly familiar with some of these things because some very close friends of ours have a son the exact same age as Conor who has a trach and a ventilator.  In Spina Bifida, it's fairly rare for kids to run into all of those things at once, but for some reason they caught my attention, and I began to pray that Toby would be able to nurse well, have a good strong cry, and avoid all of the above list.

When he came out, he was screaming and later in the NICU, he peed and pooped on his own, his legs were moving really well, and so we were feeling much better about everything.

Why Jacob Tobin?

Most people don't realize that all three of our boys go by their middle names, and so does my husband.  It's a family tradition, and in spite of my objections, I lost that argument before we had even conceived our first child.  The conversation went something like:

I fell in love with the name Tobin.  It sounds silly, but I first heard the name of a character in a movie, and I liked the way it sounded.  I can remember telling my mom what we thought we might name him and her words were (I don't think she remembers this), "I don't like it!".  My mom and I are very close, and I wasn't offended.  After his diagnosis and some research, we had more reasons to like Tobin and the nickname that we really wanted to call him "Toby.  They both come from the name "Tobias", which means "God is good". It fit perfectly.  Even in the middle of those dark days, God was faithful, and He is very good.   The "Jacob" piece came from realizing that both Conor and Garrett have Biblical first names (Benjamin Conor and Matthew Garrett).  We concluded we may as well stick with the trend, and Jacob Tobin was decided in the car on the way to his delivery!

I wasn't able to hold my baby after his birth. I remember sitting in the post-op area in extreme amounts of pain sobbing.  Bruce and my mom were in the NICU with Toby, and I was alone.  It was awful.  They said I could see him and touch him before his transport to Nationwide Children's, and finally after what seemed like forever, they began to move me to the NICU so I could see him.  We met in the hallway.

That evening my dad brought a photo of Toby to me so I could look at it while I was pumping.  One of my heart's desires were to nurse this baby, and so I pumped as if my life depended on it.  I pumped so much my milk came in before he even really tried nursing.

Around 5:00 p.m. that evening Toby also had surgery to close the open hole in his back.  He came through like a champ.

The next day, my doctor released me from the hospital for a few hours.  I was still cringing in pain from my c-section and was doped up on pain medications.  This day we held him for the very first time:

One of the biggest lessons I learned during this time was a reliance on God like I've never known.  It was so difficult being separated from my baby. Riverside Hospital graciously put me at the end of the hallway away from the nursery and the other moms.  I also learned to cry out to Him in our pain and suffering.  I read the book of Job, and realized that he was identified as a man after God's own heart, but he didn't sit quietly in a corner while he suffered.  He lamented, wept, and I was shocked that God allowed him to talk to Him like that.  It really taught me that it's okay to NOT BE OKAY.  It's okay to grieve though my circumstances, and lay it all at his feet.  That open communication with the Father creates an intimate relationship - and a trust like I had never known before.

Four days later they put in his shunt to treat his hydrocephalus.  Hydrocephalus is where the ventricles in the brain are over producing too much cerebral spinal fluid.  All of our brains produce CSF in the ventricles, but because of Toby's open hole in his back, the ventricles are programmed to produce too much because it's leaking out that hole instead of being recirculated through the CSF system.  Once the back is closed it can cause the brain/head to swell and ultimately death.  This little invention called the shunt is a small catheter inserted in the brain that drains the excess fluid from the brain into the abdominal cavity.

We also learned to straight cath at that time.  Even though he was peeing on his own, all families at NCH learn to straight cath before taking their babies home from the hospital.  I was devastated that he needed cathing, and I remember being ecstatic the first time he peed on myself and Bruce.

On January 4th we took Toby home from the hospital.  I love these photos because he doesn't have a trach yet. I remember feeling completely overwhelmed.  He needed straight cathing every three hours, nursed every 2-3 hours, and we were having to change make sure poop didn't get on his bandage or into his incision on his back.  The straight cathing and nursing didn't necessarily coincide on that every 3 hour schedule, which made for a very tired mama, and the other two boys (3 years old and 20 months weren't even home yet).

When they came home to see Toby, they fell in love with him at once. I  laugh at these pictures, but poor Conor's little eye was turning inward so badly.  He needed surgery to fix his eyes, the glasses just weren't cutting it.  This would happen a few months later.