The lil' scribbler arrives

Six days late. Less than three hours of labor. A pound lighter than his older brother.

Finally, the new lil' scribbler has arrived! He made his grand entrance ten days ago, on Mother's Day (traditionally called Mothering Sunday here) in the United Kingdom. And, thank goodness, he came without all the medical drama his big brother made us endure.

Frankly, the lil' scribbler's entrance was . . . not to put too fine a point on it . . . boring.

Recovery from any British birth requires a proper cup of tea.

Wonderfully boring!

The whole labor and delivery thing was a breeze. {Ed.'s note: Easy for you to say. Try giving birth.} Kate's first contractions started around 1:30 in the morning. Her body decided to skip the introductory contractions. Instead, she dove straight into the full-on powerful ones. We waited an hour or so and then headed off to the hospital.

The maternity ward was packed. Who knew 2:45 am on a Sunday was such a popular time to deliver? In truth, the maternity ward was simply so understaffed that they couldn't even operate an entire wing of the ward. Understaffing is one of the National Health Service's not-so-secret methods of cost controls. Anywho, during our drive to the hospital they called and sought to redirect us to another hospital across town. But we missed the call — the phone was tucked away into Kate's bag — and we showed up at the hospital to crash the party.

Sleeping while momma takes a shower.

They made room for us, grudgingly.

We didn't take up much of their time. Our new baby boy, Finley, was born roughly an hour and a half later. Nor did we take up much of their resources. Unlike in the U.S., where most births are overseen by obstetricians, most births in the U.K. are overseen by midwives. Our midwife managed everything on her own. If there had been any complications, further medical staff was around. But generally the approach to birth here is less "medical" and more "natural," though circumstances or personal preferences can of course dictate otherwise.

Jackson met his new little brother, Finley, for the first time.

Kate's mom ("Grammar") holding Finley in the hospital.

In general, if it's a mother's second (or third, fourth, etc.) baby, they aim to send momma and baby home from the hospital within six to twelve hours. This has shocked some of our U.S. friends, who spent a day or two in the hospital after giving birth. But so long as both the mother and baby are doing well, and the baby is nursing successfully, they urge you to go home.

Ready to go home.

But going home doesn't mean you're suddenly on your own. A midwife comes to your home the next day to check on the baby and mother. If all is well, another midwife visit is scheduled for two days later. After two or three further days, you see a midwife again when the baby gets a poke for routine blood screenings. Several days later, you have another evaluation to make sure all is well and the baby is growing as expected. At that point, your medical supervision is handed over from midwives to a "health visitor," who makes periodic visits to babies and toddlers and follows their development. The usual vaccinations and other routine medical checkups are passed over to a general practitioner (GP), your family doctor.

Born early in the morning and home in time for dinner. We let Jackson, his devoted big brother, pick the clothes we bought for Finley to come home from the hospital.

I've been asked several times whether Finley, having been born in England, is a British citizen. He is not. Like the vast majority of countries in the world — including all of Europe and nearly all of Asia, Africa, and Oceania — the U.K. grants citizenship on a jus sanguinis basis (i.e., by "right of blood"). That means one parent must be a British citizen, or at least that immigrants like us need to be "settled" and have permanent residence status. However, if or when Kate and I gain U.K. citizenship in a few years, our children can also gain citizenship at the same time. Additionally, if Finley continues to live in the U.K. until he's ten years old, he becomes eligible for citizenship regardless of the citizenship status of his parents.

So, if the lil' scribbler isn't a British citizen, is he an American? Yes. In the U.S., like much of the Americas, citizenship is granted automatically on a jus soli basis (i.e., by "right of soil"), so anyone born within American territory is granted citizenship. Finley doesn't qualify on that basis. But generally speaking, the U.S. also grants citizenship to children born to U.S. citizens living abroad, as long as a few minor conditions are met. Finley (and his parents) check those boxes.

(Nearly) favorite photos of places we visited our second year

In February I shared our favorite family photos, and our nearly favorite family photos, from our second year in Scotland. They're not from the calendar year of 2015 but rather from our second year, running from mid-June 2014 to mid-June 2015. Many apologies for my lack of efficiency.

The photos below I thought were striking in one way or another. They're not necessarily, however, our favorite places we visited. Rather, they're some of my favorite photos of places: landscapes, ruins, cityscapes, and so on.

Stay tuned for the upcoming post of my true favorites in the next week or two.

Peeking over the wildflowers outside St. Andrews Castle, Scotland.

Piercingly bright day at Hampton Court Palace, in Greater London.

Lantern outside the Old Presbytery bed and breakfast in Kinsale, Ireland, one of our very favorite B&Bs in Europe.

Winter festivities in St. George's Square in Glasgow, Scotland.

The dolmen portal tomb in The Burren, Ireland, is a Neolithic masterpiece.

A view of mainland Scotland from the Isle of Skye.

The entry gate to Edinburgh Castle in the evening, just before a performance at the Royal Edinburgh Military Tattoo.

Springtime at the St. Andrews Suspension Bridge, a pedestrian walkway in Glasgow, Scotland.

You get expansive views of Athens from the neighborhood of Anafiotika, at the base of the Acropolis.

A fantastic specimen of a Highland hairy cow (a "hairy coo") in Kilmartin Glen, Scotland.

View from the Grand Battery of cannons at Stirling Castle toward the William Wallace Monument.

The Rock of Cashel sits on a limestone plug in County Tipperary, Ireland.

Cloisters on the campus of the University of Glasgow.

A bridge on the grounds of Inverary Castle in Argyll, Scotland.

A gorgeous afternoon on the island of Inchcailloch in Loch Lomond, Scotland.

We enjoyed an Easter egg hunt at Pollock House in Glasgow, Scotland.

Sheep graze on the windswept golf course on the Isle of Iona.

A glimpse of the ruins of Urquhart Castle on the banks of Loch Ness.

The Dugald Stewart Monument, derived from the famed Lysicrates Monument in Athens, sits on Calton Hill in Edinburgh.

The magnificently sited Drombeg Stone Circle in County Cork, Ireland.

Did you enjoy those? Here are my favorite family pics of our second year in Scotland:




Favorite family photos of our second year in Scotland




 
 
(Nearly) favorite family photos of our second year in Scotland







Want to see more? Here are the favorites from our first year in Scotland:





Favorite photos of places we visited our first year






(Nearly) favorite photos of places we visited our first year






Favorite family photos of our first year in Scotland






(Nearly) favorite family photos of our first year in Scotland

Meconium aspiration is a crappy start to life

The day my son was born was the worst day of my life. It was his worst day, too.

Perhaps I should explain.

Let's start with the crap, shall we? Literally. Meconium is a baby's first poop, made up of the things a fetus ingests while still in the womb: amniotic fluid, mucus, epithelial cells, water, and so on. It's not pleasant to look at, to the say the least, typically dark green or brown or dirty yellow. Moreover, meconium is thick and sticky, like a glue paste.

Imagine breathing all that in and coating your lungs with it. Tiny baby lungs, which have just begun to be put to use outside the womb, are delicate enough. Breathing in mouthfuls of meconium — i.e., aspirating it — renders the lungs almost immobile. Even if the lungs could move, little or no oxygen can make it through the thick meconium goo into the baby's circulation.

It's not uncommon for a fetus to poop in utero. Estimates for the number of babies who do so range from 1 in 20, to as many as 1 in 5. Generally, the meconium doesn't cause any problem. Of all the babies who do poop in utero, only about 5% end up with some kind of meconium aspiration.

And then there are the cases like Jackson. The ones who have severe meconium aspiration syndrome.

Y'know how nearly everybody has those sweet pictures of a tired mother cradling her newborn child, all smiles and love and happiness? Not us. Jackson was whisked straight over to a waiting team of nurses who immediately assessed him for signs of meconium aspiration. They were ready for him because during labor he had briefly registered fetal distress, sending all the machines into a tizzy. It lasted less than a minute during the multi-hour labor, but the distress likely was when the meconium appeared.

The nurse team found gobs of meconium in his mouth and throat. They suctioned what they could. But he was barely responsive. His Apgar score, which provides a quick measurement of a baby's health after birth, was a 1 out of 10.

Zero is dead.

Soon after birth, the doctors and nurses placed Jackson on a ventilator. The doctors and nurses explained his prognosis was grim and they gently prepared us for the likelihood he might die. It was a very severe case. However, after some pointed encouragement from me, they set about finding specialists and surgeons who could provide him the best possible care. Within an hour a specially-equipped ambulance arrived and ferried Jackson from our hospital to a neonatal intensive care unit (NICU) at the University of North Carolina. We were heartened by this development.

First day on ECMO, with cannulae running into his vein and artery at his neck.

At the new hospital, however, we were again told his situation was dire. The resident who first broke this news to me was a newbie, having just started her residency a few days before. She couldn't conceal that she thought Jackson was going to die. The doctors explained Jackson's best chance would be if they could place him on extracorporeal membrane oxygenation (ECMO). Essentially, ECMO is a heart and lung bypass, with machines siphoning Jackson's blood, adding oxygen to it, and reinserting it into his bloodstream. There were surgeons on staff who had performed an ECMO surgery years ago, though not on a newborn. In the span of a couple of hours, they would need to reacquaint themselves with the procedure and then perform it on an hours-old infant.

Jackson was enveloped amidst the ECMO machinery.

Even if they succeeded with placing him on ECMO, his prospects were still tenuous. For several days, technicians would watch him round-the-clock, constantly checking and adjusting the levels of his blood and oxygenation. He was in severe danger of either blood clots or, if the blood got too thin, of strokes. Either could kill him. It was a high-stakes balancing act.

Furthermore, after ECMO, his prospects were likely dim. Assuming he ever came off ECMO and a ventilator, we had no way of knowing how much the oxygen deprivation affected his brain. There was a decent chance he would be a vegetable, or suffer from debilitating deficits. At minimum, he faced a high likelihood of developmental issues or delays.

His ECMO surgery, thank the stars, was a success. The NICU team began its vigil, always with at least one technician in the room monitoring and adjusting the machines.

Day after day, under their watchful eyes, he persisted.

He prospered.

Meanwhile, we hovered. Watched the machines. Stroked the tiny bits of baby skin that were left bare, careful never to shift or move him. Although he wasn't in a coma, he was completely sedated. We nevertheless read books to him, chatted with him (okay, soliloquized), sat in the room all day listening to the whirring machines. We bought coffee and donuts and treats and set them outside his room, openly trying to make Jackson a hub for activity and interest for all the doctors and nurses. For me and Kate, time stopped. The outside world essentially disappeared. His battle became our sole focus. All we could do was watch. We were hopeful but nonetheless fearful about the many unknowns of Jackson's, and our, future.

On the fourth day, he came off ECMO. But he was still on a ventilator.

Less puffy after ECMO, without all the extra fluids.

Can you believe this was progress? At one point I counted more than 50 wires attached to him.

All of this was tough on me. As I said, that first day was the worst day of my life. By the time Jackson was on ECMO, we had been up nearly 48 hours. We were on a roller coaster: the joy of his birth followed by his possible demise. We were told by medical staff multiple times to prepare for his death, only to have a short-lived reprieve. Then, when he was finally stable on ECMO, we faced the prospect of a troubled future.

This was our very first family selfie. It was my own first ever selfie, for that matter.

But I had it easy compared to Kate. She gave birth with no epidural. An hour after birth she was dressed and on her feet, waiting at Jackson's side. An hour later she was in a car headed to another hospital, her newborn tucked away in a special ambulance. She was like the mythical stories of yore, the peasant woman giving birth and then immediately getting back up to work in the fields. Kate met the roller coaster head on, sad but resilient. Although her physical pain paled beside the emotional beating, her sheer endurance was remarkable.

During his first week in the hospital, we couldn't do hardly anything for him. We tried to find ways to stay involved and connected. Since Jackson obviously couldn't breastfeed yet, Kate pumped milk and froze it. And pumped more milk. And more, and more, and more. The hospital could give him a little of it through a tube into his stomach, but Kate ended up producing so much in the first several weeks that ultimately she was able to donate a large amount to a breast milk clinic for use by other needy families.

The only clothing Jackson could wear was socks.

He was still sedated, but we decided to accessorize him with shades.

The NICU loved his progress and called him a "rockstar." We found an appropriate onesie.

He opened his eyes for the first time on day six.

Finally, by day six, they could reduce Jackson's sedation enough to allow him to wake up and open his eyes. It was the first time he saw the world outside momma's womb, but he couldn't really move or even breathe on his own. Still, what a wonderful feeling for us to finally be able to look into his eyes and smile, as well as to talk and read and laugh to a non-sedated baby.

On day eight, we had our first chance to hold Jackson. In truth, Kate had had thirty seconds to hold him right after he was born and before he was hooked up to machines, but nothing since then. Early on, I had been frightened my child might be born, live, and die while I would never have had a chance to ever hold him. While that fear faded as the days went on, the nurses were sure to give us a chance to hold our baby as soon as it was feasible.

It took several nurses to get Jackson and all his wires onto my lap.

I could finally hold Jackson! He was still hooked up to a ventilator.

Kate got her first real chance to hold her baby.

Grammar, Nana, and Grampa Bill got to watch but not yet hold him.

Our second family selfie.

Our cyborg baby on standby.

After day eight, the pace of changes and improvement increased mightily. On day nine, following some debate, the NICU team decided to take Jackson off his ventilator. They were taking an aggressive approach with him overall, to which he responded well. Although they weren't certain his lungs were ready to breathe on their own, they decided that if he struggled they could simply reinsert the ventilator. He did struggle immediately, and at one point we heard the machines make the dreaded flatline sound. (For anyone who might have the chance to be present during a family member's medical procedure, I'd strongly advise against it. They offered, we accepted, and I wish we hadn't.) But Jackson's lungs did lurch into use, and he never again needed to be put back on the ventilator.

When he had two solid days of breathing, the NICU team determined that Jackson could graduate from intensive care to the children's wing of the hospital. He still had an oxygen tube in his nose, which gradually was weaned from all day to just at night.

Jackson's first day off the ventilator, gazing at mommy and Grammar.

Our new room in the children's wing, with bed for mom and dad.

So much quieter and more restful out of the NICU.

He was a great success story, and drawing admirers. Shades for style.

Still some wires attached, but so much more interactive.

Once he was breathing normally, it was time to start breastfeeding. This was more challenging than it would have been had he had a typical post-birth introduction, but all things considered not too big a struggle. By this point Kate was a mass-producer of milk and Jackson was just learning to have an appetite, so she continued to pump large quantities for the milk bank.

We were also now able to take Jackson out of the crib and handle him delicately, but like a typical infant. We now had to do things such as change his diapers, where before the nurses in the NICU handled all those tasks. We could play and take walks around the halls.

Day by day, his breathing and oxygen saturation levels improved. And along with those things his energy and interaction levels boomed, too.

About to begin a new life challenge: breastfeeding.

Breastfeeding is exhausting.

At birth he weighed about 8.5 pounds, but by the time he was out of the NICU he had dropped to around 6 pounds, losing about 30% of his weight in ten days. To make sure he was on track with breastfeeding, we weighed and tracked his gains after every meal.

Eventually, he spent most of his day without an oxygen tube in his nose (though with tape on his face).

Jackson's first nap outside of the crib. Still with oxygen while sleeping, however.

The last few days in the hospital came with a sense of relief. Jackson was improved to the point of nearly being able to go home. Nonetheless, we still had the tedium of waiting around the hospital all day. At night we slept in his room, regularly awakened by nurses' checks as well as by Jackson's oxygen machines, which beeped furiously every time his oxygen saturation (his "sats") dropped below 90%. We slept fitfully.

Darth Vader and Jackson both had their share of respiratory issues.

As another side effect of his time on ECMO and a ventilator, Jackson lost his voice for a couple of weeks. He would cry (like any other infant), but no sound would come out. He would just silently mouth his distress and shed tears. We rooted for him to regain his voice, though of course who really wants to hear a crying baby? We did. But not too much, dear boy!

Finally, by day 21, Jackson could sleep at night and regularly keep up his oxygen sats. We were able to go home. This was exciting but also a little scary. We were safely cocooned within the hospital, medical staff at the ready if Jackson had any challenges breathing. He was coming home with an oxygen tank and a machine to measure his saturation levels, which ultimately he used at night for nine months. Think it's hard to get a normal baby to sleep peacefully through the night? Try adding wires taped to his face and the beeps of a machine if he shifts or doesn't take a full breath. Leaving the hospital meant losing security and comfort in case of trouble.

At last in the car seat, ready to head home for the very first time.

But of course we wanted and needed to take him home. At last!

By the end of his three weeks in the hospital, Jackson had gone from life-threatening meconium aspiration syndrome to nearly complete health. We had been on the brink of losing him several times, and now had an apparently normal and mostly healthy baby. For awhile we met regularly with a pulmonologist who assessed Jackson's breathing, but he steadily improved to the point where we no longer needed the oxygen tank at any time, though we kept it nearby in case of some unforeseen emergency.

Finally, home with the bebé.

His developmental milestones were checked regularly, as well. Besides the normal meetings with pediatricians, he was enrolled in a special infant care clinic. Every few months several experts measured whether he was meeting his milestones, and he was on track every time. In fact, by the time he was 20 months he was exceeding the milestones and was actually ahead of the curve. He did so well they eventually told us he no longer needed to have his development tracked.

No one could have predicted this kind of result. At the beginning it wasn't certain if he'd survive, and if he did, the question became what problems would he have. So far, as we approach his fifth birthday, there have been none. At all. Quite simply, an amazing turnaround.

I'm still watchful, and now that he's been thrust into school in England we have more developmental milestones to track.

As next week approaches we're staring down the due date for baby boy #2. I've been reflecting rehashing reliving the nightmare, wondering why I'm willing to go through having another. Jackson's story turned out to have a very happy ending. But what if the new lil' scribbler's path doesn't?

I'm excited and terrified. Rationally, I know there's almost no chance the lil' scribbler will have meconium aspiration. Nor is there much chance we'll have any complications. Nevertheless, I can't banish all my worries. I'm a planner by nature, and I simply have no control or plan that I can exert.

My excitement is inescapably tinged with trepidation.

Deep breaths and embrace the wonder of childbirth. Deep breaths. Deep breaths.