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Natasha and Alan Hendren led a quiet life. The young couple met seven years ago working at UK Good Samaritan Hospital. They married five years ago, worked, went to school – Natasha, now 29 and an RN, to finish her bachelor’s degree, and Alan, 28, and a nursing tech, to earn his nursing degree. Beyond work, they mostly kept to themselves.
“We used to joke that if we wanted to have a party, who would we invite?” said Natasha.
Then along came baby Natalan, named for both of her parents, born at 30 weeks and 2 days, weighing 3 lb., 6 oz. She’s been called a miracle baby by more than one of the seasoned medical professionals who had a hand in her care at Kentucky Children’s Hospital’s Neonatal Intensive Care Unit (NICU). The efforts by High-Risk Obstetrics and Maternal Fetal Medicine to keep Natasha safe during a difficult pregnancy and of Neonatology to save Natalan’s life brought many important people into the Hendrens’ lives.
So when September 3, 2016 – Natalan’s first birthday – arrives, the guest list for her party will be long.
“There are going to be so many people to invite to the party,” said Natasha, who marvels at how her tiny baby knitted together such an incredible network. “Now that we have these people, well, I know if something happened, they would be there for us.”
Natalan’s nursery is littered with toys and gifts from family, family friends, and the Hendren’s extended UK HealthCare family. There are many reminders throughout of the support Natasha, Alan and Natalan received from all.
The Hendrens were elated when they learned Natasha was pregnant with their first child in March 2015. They made a pact to keep the news to themselves, but within hours, Natasha had told her mom and Alan had told his sister.
Just a few weeks later, their excitement turned to fear when Natasha began bleeding. Obstetricians at the
UK Birthing Center triage determined that she had a subchorionic hematoma, an accumulation of blood between the
uterus and the placenta. Subchorionic bleeds usually resolve on their own, and women go on to have normal pregnancies.
Natasha was relieved, and even more so when she had a discharge a few weeks later and saw not blood but clear fluid. The couple thought the hematoma had finally resolved. Little did they know that leak signaled a much more serious problem.
Natasha and Alan got back to the fun of being expectant parents. They planned a family get-together to “reveal” if the baby was a boy or girl, and headed to a business that does ultrasounds at 16 weeks so parents can learn their baby’s gender. The ultrasound tech there started the exam, then stopped and stared at her screen. There was a problem, she said.
Natasha and Alan went straight to UK Birthing Center triage, where another
ultrasound showed that Natasha had had a
preterm premature rupture of membranes (pPROM), a complication that occurs in roughly 3 percent of pregnancies. In a large number of cases, women go into labor soon after their membranes rupture.
Patients like Natasha see a team of physicians who specialize in high-risk pregnancies. Over the next two days, two of the specialists from
Maternal Fetal Medicine would meet with the Hendrens to explain the complications posed by pPROM and lay out the options.
The first doctor they saw,
Karen S. Playforth, MD, had seen other cases of pPROM, but none as early as 14 weeks, which was when Natasha’s membranes had ruptured. “It was the earliest, and the worst case I had seen,” Playforth said.
“She explained to us that babies use the fluid to make their lungs develop, ” said Natasha, “and it also allows them to move so that their musculoskeletal system gets strong.” Without it, Playforth explained, the baby could be born with little or no lung tissue and have mobility issues or even cerebral palsy. Natasha would be at risk for infection.
Given the circumstances – the loss of fluids so early in the pregnancy and the fact that there had been no reaccumulation of fluid, the outlook was not good, Playforth said. “Could the baby make it?” Natasha asked. Playforth sadly shook her head.
“Our world just stopped,” said Natasha. “I thought it was all over.”
Playforth encouraged the couple to take time to think about how they wanted to proceed. Termination of the pregnancy was an option, she said.
Initially, the Hendrens considered it, but after an evening of prayer, discussion and some research that turned up little to help them, they agreed that unless Natasha’s life was in danger, they wanted to go forward.
Looking at the ultrasound, Natasha had seen a perfectly formed baby. “And when I could see nothing else, I could see a heartbeat,” she said. “I did not give her a heartbeat; it wasn’t my place to take it away. I was willing to accept that she might not live or she might be born with disability.
“I was going to put it in God’s hands.”
They requested a second opinion and within a day met with high-risk obstetrician
Wendy Hansen, MD, at the time chief of Maternal Fetal Medicine, now chair of obstetrics and gynecology.
The Hendrens felt an immediate connection with her. “She came in, patted my leg and said, ‘You guys have had a hard week,’” said Hendren.
Like Playforth, Hansen believed a good outcome was a long shot. She estimated the baby’s odds of survival at 10 percent. But she also offered something the Hendrens needed to hear – that no matter their decision, they would have the support of the high-risk pregnancy team.
Natasha’s health would be the high-risk obstetrics team’s focus until the pregnancy reached 24 weeks, when fetuses are considered viable. If Natasha reached that point without going into labor or having a serious infection, she would be admitted to
UK Chandler Hospital, where she would be on bed rest until the baby arrived.
In the meantime, her doctors instructed Natasha to take her temperature twice daily, watch for signs of infection, and return to the hospital for a weekly check up. “We checked fluids and heart tones and made sure everything looked stable. Once a month, we would check growth,” said Playforth.
Beyond the checkups, there were no interventions or medications for the condition. Natasha returned to work. And to everyone’s surprise, including hers, she reached the 24-week mark and checked in for her prescribed bed rest. “I felt like I had won the lottery,” she said.
Even though she had never been hospitalized, as a nurse Natasha knew how to be a good patient. “I decided I was going to get up, make my bed, walk the halls.” But those plans went by the wayside as she became depressed and despondent. Her days were filled with worry. To console herself, she started an Instagram
#babyhendrensjourney. “I thought maybe if I lose her I might want to look back on this,” Natasha said. “I tried not to let it show, but I was so scared. I felt like, ‘Am I carrying this baby this whole time and it is just going to die?’”
When Natasha did get out of bed, she often bled and each time that happened, she would be rushed to the labor hall, where she would spend the night, only to return to her room for more waiting and worrying. Doctors gave her a round of antibiotics to protect against infection and steroids to help encourage whatever lung tissue the baby had to develop as fully as possible before she was born.
Hansen tried to brighten her patient’s spirits in small ways. “She saw a change in me that no one else saw,” said Natasha. “She would go and get the ultrasound machine and come in and take pictures for me to keep. She knew I needed every little bit of happiness I could get.”
Two weeks before Natalan was born, Hansen sat down on Natasha’s bed to talk.
“She said, ‘We all hope this is a miracle baby, you know that. But I want you to remember this can still be a very bad situation.’ I think she was trying to prepare me.”
On September 3, 2015, Natasha went into labor and was rushed to the labor hall. She had reached 30 weeks and two days.
John O’Brien, MD, a member of the high-risk obstetrics team, had talked to Natasha two weeks earlier to explain how the
cesarean section would go, but because the baby’s heart rate dropped, Natasha had an emergency C-section.
When O’Brien delivered Natalan, she was handed over to the Neonatal Intensive Care Unit (NICU) resuscitation team. Because the baby was not breathing, the team intubated her and performed
CPR. Her heart was barely working, her limbs were contracted and her condition was grave. “Her
Apgar score was 1; the best is a 10,” said Alan Hendren of the evaluation system used to rate the wellness of newborns minutes after they are born.
Neonatology fellow Enrique Gomez, MD, and
Janell Hacker, MSN, APRN, were among those involved in Natalan’s resuscitation and initial care. “The first day, Natalan was critically ill, one of the sickest babies we see in the NICU. It was all hands on deck; we didn’t sit down for hours,” said Hacker.
The team that handled Natalan’s care those first difficult days included two neonatology physicians, a neonatal fellow, four advanced practice providers, a pharmacist, a respiratory therapist and multiple staff nurses. They ordered medications, placed central lines, inserted chest tubes, reviewed labs and test results, and made minute-by-minute decisions.
Natasha was comforted by the NICU nursing care, which included loving touches like bows for Natalan’s head and photos taken for the parents.
Gomez and Hacker agree that Natalan’s successful care was the result of a team that worked together. “With UK being an academic institution, there are a lot of people involved,” said Hacker. ”It is not one person making a decision. All of us were putting our heads together to come up with the best solution.”
For the next three days, Natalan’s fate was uncertain and the constant ups and downs were torturous for the Hendrens. “One thing we say to the parents is that this is an hour-to-hour situation,” said Gomez. “One hour the baby might be a little better, one hour worse, one hour the same, so just don’t lose all hope.”
It was hard not to. Natalan’s condition became so grave that NICU staff told the parents they should be prepared to say goodbye. Alan and Natasha prayed together in Natasha’s room. Before long, news came that Natalan had made a “360-degree turnaround” the staff could not explain. Natasha remembered, “One nurse said, ‘I think the Hendren family was praying.’”
In his training in the NICU, Gomez has seen babies’ conditions rapidly and inexplicitly improve or decline. “It is why we tend to give these kids a chance, because kids can surprise you and Natalan is one of them,” said Gomez.
After that turnaround, Natalan “seemed to never look back,” said her mother. She did have other problems, but none as traumatic as those in the first days of her life.
Their baby was in the NICU over two months, but the Hendrens found comfort in the NICU nurses’ care. Dawn Waldrop, RN, would take photos of Natalan and send them to the Hendrens. She put bows in Natalan’s hair. Ellyn Willmarth, BSN, RN, did much the same.
“It was hard going home at night, knowing that she might die alone without us,” Natasha said, “but it helped knowing that there were nurses there that loved her and that Natalan loved. It was those kind of people who really helped us get through it.”
Throughout the long stay, the Hendrens’ co-workers lightened the load. Jennifer Forman, MSN, RN, CNML, Natasha’s supervisor, and Theresa Crossley, BSN, RN, CNML, Alan’s supervisor, were at the hospital when Natalan was born and visited her nearly every day. The Hendrens made
them the only two people allowed to visit the baby without being accompanied by the parents.
“We were really rooting for a good outcome and wanted to be supportive through their hard time. I found it incredibly brave of both of them,” said Crossley.
“We cared for [Natalan] as a family member would – we got to hold her, change her diapers and feed her,” said Forman.
With the Hendrens’ permission, the two let others at Good Samaritan know how Natalan was doing. Other co-workers had prayer circles, held fundraisers and set up a GoFundMe page. When they learned that Alan and Natasha had had no time to prepare Natalan’s nursery, they bought
furnishings and other items needed for the baby’s room.
On day 72, when Natalan was finally discharged, Forman was there to help Natasha and Alan take Natalan to their car. She shot a video to mark the landmark occasion.
Now, more than a year since Natasha’s troubles began, the Hendrens are enjoying parenthood. They both still work at UK, and Alan has graduated from nursing school. Natasha works weekends at UK Chandler Hospital. They make frequent trips to Lexington for
Natalan’s medical appointments. Like most premature babies, her development is behind schedule but through the care she is receiving at the NICU Graduate Clinic she is catching up.
The Hendren family has taught those around them a number of things.
“It is,” said Hansen, “a remarkable story of incredible determination and tenacity by a mom and a really good outcome.”
When Playforth did her residency and fellowship in New York City, most of the women she saw there with pPROM elected to terminate their pregnancies. “Here, in Kentucky, the culture is different,” said Playforth. “Over the last six years back in Kentucky, the interactions
I’ve had with wonderful people like Natasha has made me appreciate more and more that it is important to respect the patient’s wishes and their views, to give them the information they need to make decisions, and then support them in that decision.”
Natasha says her experience has made her a better nurse. “As I’m taking care of patients now I keep in mind that you never know what their family is going through. UK is all about patient-centered care but now I think about the family as a whole.”
She also hopes her family’s story will give others hope when things seem hopeless. “Natalan is such an inspiration. I want people to know not to give up. God put the right people, the right support in our lives. I never believed in miracles. But I am a firm believer now.”