Beyond a birth story

Winter 2013

A mother in critical care delivers twin boys at just 28 weeks pregnant

Six months after receiving news she was pregnant and just 28 weeks into her pregnancy, Courtney Johnson began experiencing early labour and unexpected critical medical complications. On Nov. 30, 2012 she gave birth to two tiny baby boys during an emergency caesarean section at London Health Sciences Centre (LHSC), after which Johnson and her newborn sons, Jaxson and Jacob, all began fighting for their lives. This is their story.

June 2012
After being told years earlier that she would never be able to conceive, it was an incredible surprise for Courtney Johnson and her spouse Chris Cartmill to learn that she was pregnant. A few weeks later, that feeling of astonishment doubled when they learned she was carrying fraternal twins.

“After I heard the word twins, I was beyond surprised – I don’t think I heard another word that was said during the rest of the appointment,” says Johnson. “It was an overwhelming moment, but also really exciting.”

Johnson’s pregnancy was classified as high-risk because of the high possibility of premature labour and delivery that is associated with multiple births. So despite the fact there were other hospitals closer to home in Drumbo, Ont., she was referred to obstetrician, Dr. Saima Akhtar at LHSC, the region’s only obstetrical care facility equipped to support high-risk pregnancy and delivery.

Johnson also began to experience extreme pregnancy symptoms such as hyperemesis gravidarum, a condition that involves nausea and vomiting more severe than the typical morning sickness many women suffer during early pregnancy.

October 2012
Johnson and Cartmill found out that the twins are boys. Johnson continued to experience extreme pregnancy symptoms and was put on bed rest.
 
November 2012
Family and friends celebrated mom and the babies-to-be at a baby shower. Two days later Johnson went into labour.

“At first I didn’t think it was labour,” recalls Johnson. “It originally felt like the usual growing pains and cramping that I had been experiencing throughout my pregnancy.”

Later that afternoon, with the pain getting stronger, Johnson and Cartmill decided to go to a hospital to have things checked out. With a couple of options in their area, they decided to head to Woodstock knowing it would be on the way to London should something be wrong.

During her examination at the hospital, it was confirmed that Johnson was in labour. Heartbeats for both babies were heard. The on-call physician decided to send Johnson to LHSC by ambulance.

At LHSC, Johnson was admitted to the birthing unit, the contractions became very strong and the team attempted to stop Johnson’s labour.

Wednesday, Nov. 28
The attempts to stop Johnson’s labour were successful as the contractions slowed down and eventually stopped. Johnson’s health-care team decided it would be best for Johnson to remain on bed rest in the hospital for continued monitoring. She was moved to the high-risk antenatal unit.

Thursday, Nov. 29
Johnson was taken for an ultrasound and later underwent an internal exam which confirmed that she was once again in the early stages of labour. She was moved back to the birthing unit where they tried to slow down and stop the labour.

Friday, Nov. 30
Johnson awoke and couldn’t breathe. She remembered an entire team of people rushing into her room and hearing that she might not make it. She quickly texted her sister and told her to send her mom to the hospital ASAP. When her mom arrived, Cartmill had to give the news that no parent ever wants to receive.

Johnson was rushed for a CT scan with concerns she could have a blood clot; instead they found fluid in her lungs, one of which had partially collapsed. Johnson was placed on oxygen and taken to LHSC’s critical care trauma unit (CCTC), where the team planned to take measures to remove the fluid from her lungs.

Unfortunately that intervention would have to wait as they discovered that Johnson was now fully dilated and ready to deliver the babies who were both in the breach position. She was rushed back to delivery for an emergency caesarean section. Due to the stress of the situation and the medical issues with her lungs, Johnson was placed under anaesthetic and not awake for the procedure.

“Before I fell asleep I remember there were people standing side-by-side around the entire length of the operating table and each person took the time to tell me who they were and what they were going to do. I just remember how reassuring everyone was, which made me feel comfortable at a time where I could have easily lost it,” says Johnson.

Jaxson and Jacob were welcomed into the world at 12:30 p.m. weighing just 2 lbs 11 oz and 2 lbs 2 oz respectively. The boys were whisked off to LHSC’s neonatal intensive care unit (NICU) and Johnson was taken back to CCTC.

Saturday, Dec. 1
Johnson woke up very early in the morning and her lungs still required the help of an oxygen tank. With tubes in her throat, she was unable to talk, but could hear her family talking to her.

“When I woke up I could feel Chris holding my hand,” recalls Johnson. “Because they weren’t sure yet if it was a virus that was affecting my lungs I had been placed on special precautions to stop the spread of any germs to me or from me to staff and visitors. Everyone visiting me had to wear masks and I wasn’t able to go and see my babies, which was really difficult. I was only able to look at the photos that my family had.”

Later in the afternoon, the tubes were removed from Johnson’s throat, but she remained on oxygen. She stayed in CCTC overnight for monitoring.

“It was very tough to see Courtney go through everything – it’s not something you ever want to see your spouse experience,” says Cartmill.

Sunday, Dec. 2
Johnson made great progress through the night and was no longer in need of critical care. She was moved to the postpartum mother baby care unit, but was still on the special contact precautions to prevent transmission of a potential virus and unable to see her babies.

Monday, Dec. 3
While the exact cause of Johnson’s lung problems remained unknown, her team determined it was not a virus and contact precautions were lifted. Johnson was able, for the first time, to go and meet her baby boys.

“They were really, really small,” says Johnson. “They were both on ventilators, IVs and were hooked up to all kinds of monitors. At one point when I was sitting there a team of respiratory therapists and doctors had to rush in and work on them. It was a lot to take in.”

Thursday, Dec. 6
Johnson was released from the hospital, with orders to continue physiotherapy to exercise and strengthen her lungs.

“It was really awful to have to leave the hospital without the boys. It was emotionally draining to say the least,” Johnson says.

Friday, Dec. 7
Johnson arrived at the NICU at 6 a.m. and began what would become a daily ritual where she started her day by sleeping in a chair beside her babies’ incubators, just to be close to them.

“There would be days where I’d fall asleep again in the afternoon and wake up with a blanket and pillow and the lights off. I felt like the nurses weren’t just taking care of my boys, they were also taking care of me.”

Over the following weeks, the boys continued to develop and grow, little by little, getting stronger. Johnson and Cartmill were encouraged to be active partners in their health care.

“In a weird way it’s kind of been a blessing to have the boys in the NICU,” says Johnson. “Everyone from the nurses to the lactation consultants to the physicians take the time to really talk to you and answer your questions. They focus on teaching you and sharing their expert guidance on how to care for your babies and I don’t think that is something you normally get with an average delivery.”

Friday, Dec. 21
The boys were now three-weeks-old and Johnson and Cartmill could hold them for the first time through “kangaroo care.” This meant removing clothing to allow skin-to-skin contact between the baby and the parent’s chest and placing a blanket over the baby to simulate a womb-like environment.

“Even though it felt like I had waited an eternity to get to hold them, I was very scared at first,” says Johnson. “I didn’t want to hold them the wrong way – they were so small and there were so many tubes and wires. The nurses were so helpful with positioning the babies and ensuring that we felt comfortable holding them.”

“And it felt really good to hold them for the first time,” adds Cartmill.

Tuesday, Dec. 25
The family celebrated Christmas in the hospital. In lieu of gifts, they asked loved ones to join them in a donation to Children’s Hospital.

“We wanted to start a Christmas tradition of giving back to the place that has been such an important part of our babies’ lives,” says Johnson. “It’s something we hope to be able to do each year and something we plan to teach our sons about as they get older.”

Their philanthropic spirit didn’t preclude the boys from having presents though. The family was surprised to find that their primary care nurse had gifted the boys with beautiful frame ornaments containing the pictures of the boys wearing tiny custom Santa hats that had been taken earlier in the month. Each family in the NICU also received generous gift bags from Children's Health Foundation that contained bibs and onesie pajamas among other fun little things.

Tuesday, Jan. 1
Jaxson graduated from his incubator to a crib. Mom and dad were now able to hold him in a regular cradle position for the first time.

“It felt like a New Year’s gift and was such a wonderful way to mark the fresh start that a new year brings. Even though there’s still a lot of growing to do, this was a significant milestone for Jaxson and we knew that Jacob wouldn’t be too far behind,” says Johnson.

Tuesday, Jan. 8
Just one week later, Jacob graduated from his incubator to a crib. Mom and dad were now also able to hold him in a regular cradle position for the first time.

As January stretched on, the boys continued to gain weight, Jaxson was up to 5 lbs and able to feed on his own and Jacob was 4 lbs 6 oz.

At press-time in early February, the family continues to look forward to Johnson’s original due date of Feb. 22, the estimated date of when the boys will be going home. To be discharged from the NICU, babies have to be feeding on their own for at least 48 hours, breathing on their own and off all monitors for an entire week without incident.

“It’s certainly been a roller coaster of an experience and very tough at times, but I’ve always felt very fortunate to have received the care that we have,” says Johnson. “I don’t think I’ve ever seen such a good medical team – I’ve always felt included in my care and the care of the boys and supported at every turn. We’re getting excited now that Feb. 22 is within reach. We’ve started to introduce the babies to our dog by bringing baby blankets that have the boys’ scents on them home, and we just brought the boys’ car seats to the hospital so we’ll be ready to go whenever we get the 48-hours-to-discharge countdown notice. In the meantime I’m really grateful to continue to have the option of staying at the Ronald McDonald House so I can be close to the boys.”

Cartmill adds, “We’ve also been thankful for the support we’ve received from our family and friends who have been there for us every step of the way, especially our immediate family on both sides who constantly came to stay with Courtney while she was in the hospital. I’m also particularly grateful that I have a workplace, River Side Brass in New Hamburg, which has been very understanding and has allowed me to modify my work schedule so I could be here with Courtney and our sons. Having that kind of external support network has helped make things a little easier for us.”

When asked what Johnson’s hopes for the future are, she was quick to reply, “I’m just looking forward to starting our life as a regular family at home. I want the boys to grow to be big, healthy and strong, and hope they’ll be without any medical complications that would require extended care throughout their lives.”

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 Fraternal twins Jaxson and Jacob Cartmill are pictured in the NICU at Children’s Hospital