Charlie's Birth Story

A text book pregnancy until the last month, Chris' doctor grew concerned that her belly was a bit smaller than it should be for someone more than eight months pregnant. An ultrasound was performed and revealed low levels of amniotic fluid. Such a condition means that the baby lives in cramped quarters, and can even crush the umbilical cord, cutting off life-sustaining oxygen, food, and internet service. Concerned about this, the doctor quickly made the decision to induce labor two weeks before the due date.

At 7:30am Thursday, October 25 we arrived at Evergreen Hospital prepared to bring Charles William Richter, III into the world. Morning activities included adjusting the dose of the induction hormone pitocin, roaming the hallways of the maternity ward, listening to CDs, checking email, and bouncing on the birthing ball. Even disguised in doctor's scrubs, Chris recognized Chuck and told him that only the real doctors could adjust the level of drugs. Dooh! When not roaming the hallways, Chris was connected to contraction and fetal heart-rate monitors. For most of the day, Chris found the hunger pains associated with missing lunch (and the thought of missing dinner) greater than any labor pains. In her more spiritual moments, Chris thanked God for the little Jell-O snacks that comprised the Acceptable Items To Eat list.

The hunger pains were forgotten around 2:30pm when Chuck saw in Chris' face, a painful grimace. Soon we were in an intense and regular labor pattern. The Jacuzzi tub helped the mom-to-be ride out the more painful contractions. Her uterus progressed from about 4 cm to 9 cm within 3 hours, of which only two hours were pretty painful. Feeling oh-so-grateful once being allowed to follow through on the urge to push, within 30 minutes our sweet Charlie was born at 6:26pm.

Chris hoped to snuggle with the little guy immediately, but the nurses whisked Charlie off to a small station where they probed and poked him. While his heart patterns had been excellent throughout the labor, they were now saying that he had low apgar scores: 4, 6 and then an 8.0 from the Russian judge. The doctors and nurses seemed a bit anxious, reporting that at 6lbs, 8oz, Charlie looked smaller and a couple weeks younger than expected. He livened up after being warmed under a heater, and soon a very happy mom got to hold him while being fed dinner by her husband, proud of his new status and title as dad.

The clinic had wall clocks, but none of them had the little cuckoos that pop out to announce the hour. Instead, a nurse would come poke Charlie's heel and take some blood. A few hours after the birth, concerns arose over his low blood sugar level. This meant that he was not getting food, so Chris tried jump-start Charlie's glucose level by getting him to nurse. He simply wasn't interested in being active. Chris stayed awake all night waiting for his most active moments when she could nurse him. There were only about 25 minutes of sucking action. Another low blood sugar reading Friday morning at 6:00am resulted in his transfer to the special care nursery. With limited success, we attempted to feed Charlie sugar water through a small tube taped to dad's little finger.

While he was in the nursery, a very astute nurse Karen Brilli (thank you Karen!) detected different blood pressures in Charlie's legs than in his arm. She persisted in checking and re-checking them. Not content to wait for our pediatrician who had been called to come in, Karen asked a neo-natologist who happened to be in checking on another baby to investigate. Dr. Gwinner suspected that he could have narrowing of the aorta. Taking initiative, she ordered an echo-cardiogram and made arrangements for a same day confirmatory evaluation at Children's hospital in Seattle (thank you, Dr. Gwinner!). Less than a day old, Charlie's first ride was in an ambulance with mom, with dad following closely behind in the Jeep.

Less than a day old, Charlie's first ride was in an ambulance

At Children's Hospital, Cardiologist Dr. Johnston confirmed Dr. Gwinner's diagnosis. Charlie had aortic coarctation, a serious and potentially fatal problem. The good news was that successful corrective surgery on babies had a 95% survival rate, with only 20% experiencing complications that require treatment later in life. Charlie was admitted to the infant ICU for monitoring until surgery. The testing and monitoring meant that Charlie was hooked up to lots of equipment via wires and tubes. Even so, we still got to hold (Chris likes to say "snuggle with") Charlie for a few hours every day.

The hospital assigned us a pager that they would call if any problems arose. While Charlie was in the hospital for repairs on his heart, his parents headed home with broken hearts at the sight of the empty car seat in the back of the jeep and the newly painted cradle empty and waiting. Even though we didn't bring him home that night, we counted our blessings. Our boy was in the hands of wonderful doctors and nurses. Had it not been for his low blood sugar readings, and the care provided by the folks at Evergreen, his condition might not been diagnosed, and we might have learned about his heart problem when it was too late to respond. Fortunately Chris' smooth delivery meant that she could be discharged only 18 hours after giving birth, allowing her to focus energy on Charlie's needs.

Sunday morning, after having met Drs. Jones, Johnston, Anderson, Jackson, and others, we met with Dr. Lupinetti, the chief cardiac surgeon, his assistant Dr. Dabal, and Dr. Eisses an anesthesiologist who spoke with us long enough and thoroughly answered our questions so that we almost felt qualified to perform the surgery ourselves. Each one of the doctors we met with was awesome. They went over the major risks, and left us feeling quite confident about the outcome. Because Charlie was monitored round the clock, we felt comfortable sleeping at home. However, around 2am Monday morning we had a few tense moments when the hospital pager went off. We were informed that he was having episodes of apnea (interrupted breathing) induced by some of the medication. They kept him breathing by inserting a ventilator tube into his airway. Learning that this was required for the surgery anyway allowed us to breath more easily.

At 3pm on Monday afternoon, the surgery began, and by 3:40 we were informed that Dr. Lupinetti wanted to meet with us--what would cause him to leave the surgery so early??!! Fortunately, he said everything went well. God must have been guiding the Doctor's skilled hands for him to have finished successfully in such a short amount of time.

The ventilator tube was removed on Tuesday evening, and they began weaning him off of his morphine. It was uplifting to see something finally being removed rather than being inserted. Soon the tube draining fluid from his chest was removed and one-by-one the IV lines came out of his hands, legs and head.

Out of the frying pan into the fire: We moved down to the surgery recovery ward after a few days for further recuperation. Those were the hardest days. Unlike his high-tech, quiet, private room with his own nurse in infant-ICU, in the recovery wing we shared a room as many as 4 other pediatric patients (depending on the night) and one nurse busily tending to all of them. Chuck had returned to work, and was sleeping at home. Chris spent too-many nights (swears it was a week if it was a day) sleeping by Charlie's bedside on a chair that folded out into the shape of a semi-reclined chair. Sleep came with great difficulty in that room-especially with the symphony of crying, vomiting and coughing children, punctuated by alarms and bleeping equipment.

Day and night, Chris arose every three hours to pump and store breast milk, and traded off with the nurse on feeding Charlie through the tube. Charlie was fatigued as his body healed. His elevated bilirubin levels (jaundice) further fatigued him. He wouldn't or couldn't suck from a bottle, and his feedings were through a naso-gastric tube. After a few days, with Charlie still not sucking, Chris asked how long he might be on the tube-the nurse replied honestly that it could be as long as one or two....MONTHS!!! Thinking that we'd be bottle feeding before going home, Chris was stunned. Not to worry however, we would be taught how to place his feeding tube down his nose into his stomach before going home.

On November 7, Charlie's bilirubin levels normalized and two proud parents took their baby home- feeding tube and all. Two sessions with an occupational therapist/lactation consultant taught us the basic skills we would need to elicit Charlie's sucking skills. It was clear it would be a long road before he would be feeding normally. We worked with Charlie and within two weeks of being home, he was taking all of his feedings by bottle. One more week and Charlie transitioned beautifully to a full-time breast feeder. Where full-time means just that-he cries if we take him off.

Today, thanks to the miracle of modern medicine, our baby thrives- keeping his parents up at night like any other newborn. We are thankful for the nurses and doctors at Evergreen Hospital with their wonderful training, overwhelming compassion, and their wisdom to follow and act on their instincts, and the top-notch pediatric cardiovascular surgeons at Children's Hospital just miles from home. A loving and supportive network of family and friends, on whom we continue to rely, was essential. We appreciate all of the good thoughts and prayers. We look forward to celebrating his first Christmas as a family.

Chris, Chuck and Charlie Richter

Aortic Coarctation

Coarctation (constriction) of the aorta is a localized narrowing in the aorta. The aorta is the great artery that supplies the body with oxygenated red blood as it is pumped from the left ventricle of the heart. All the arteries in the body can be traced back to the aorta. The constriction obstructs forward blood flow through the aorta to the rest of the body. The degree of obstruction can vary from mild to severe. It is a relatively common type of congenital heart defect found mostly in males and has an increased incidence of recurrence within families. It is not uncommon to have this defect go undiagnosed until early adulthood. In 25% to 50% of people with coarctation a bicuspid aortic valve is also present.

The obstruction causes the heart to work harder in order to pump blood forward past the obstruction. Over time the heart may not be able to keep up with the extra work load and the left ventricle may become enlarged, inefficient and eventually fail. People with coarctation of the aorta, repaired or not, are at increased risk for infective endocarditis (infection inside the heart and valves of the heart) and endarteritis (infection of the inside layers of an artery) because of altered arterial wall structure and the effect of abnormal blood flow and pressures. This risk is increased further if a bicuspid aortic valve is present. Endocarditis precautions are necessary for life.

Coarctation of the aorta is generally treated surgically by removing the area of obstruction. Learn more about it at:

http://www.mayo.edu/cv/wwwpg_cv/congenit/coarct.htm