When Adoption Involves a NICU

Adoption is not an easy path to walk, but when adoption involves a neonatal intensive care unit and you start the adoptive parent/child relationship in the hospital, life can become more complicated. Our son Caleb’s adoption story started in the NICU (or Special Care Unit, as some have called it) of a hospital in a town 45 minutes away from where we lived. The journey involved me leaving our older son in the care of friends to travel through traffic to the hospital. It involved the belief that God would heal that tiny baby boy. For us, it involved a deep knowing that he was our son and that nothing could keep us from our boy.

Our NICU Story

When we first met our son, he was a preemie who was born at 35 weeks gestation weighing a little over 5 pounds. I can still see the NICU room after we had scrubbed our hands for what seemed like forever. The square room had three rows of little incubators across the middle and the perimeter was lined with little isolation units and tiny beds the size of large shoeboxes. There were wires everywhere…and bells and machines. It was pretty overwhelming.

My husband saw our son Caleb first. He was so teeny tiny in the big incubator. There were wires attached to little sticky pads that were attached to his tiny chest. Another wire adhered to a stretchy Band-Aid that was wrapped around his big toe. A feeding tube, held in place by a piece of easy-release tape, ran from the machine feeding him the formula, into his nose, where it ran down the back of his throat to his little tummy.  All those tubes and wires kept a constant stream of data on his heart rate, blood pressure, oxygen level, and formula feeding. The constant stream of data from those monitoring devices was recorded and displayed on a monitor on the wall above where he lay. Each baby’s information was transmitted to a master display over the nurses’ station. At any given moment, none, some, or all of the alarms could go off. The nurses were in seemingly perpetual motion taking care of the myriad of details that the care of their tiny patients required.

The large room that Caleb was in contained 13 to 15 preemie babies. I would later learn that some of the babies in this unit were preemies, mostly born at 28-35 weeks. Some were in withdrawal from some form of opioid as a result of the opioid crisis that is plaguing the United States. As a result, those babies were in various stages of detoxing which was causing them to shake violently and set off all of their alarms. Some babies were severely jaundiced and had tiny little blindfolds placed over their eyes as they lay under blue lights.

In addition to Caleb’s unit, there were three more units, each containing around 15 preemie babies, all needing varying levels of care. It was awe-inspiring and mind-boggling. Because he was born so early, his little brain had not fully developed to be able to perform some essential functions that a human needs to survive— like sucking, breathing, and swallowing at the same time. The lack of ability to do those basic tasks sent his little body into bradycardia and tachycardia every time he tried to do more than one at a time. It was so scary when those bells went off because he had stopped breathing. Eventually, he would learn to do these things, but his brain had to develop the memory processing center to do so.

He remained in the NICU until he was about 3 ½ weeks old. This teeny baby had captured our hearts from the very moment we opened the email that told us about a baby for whom we were being considered to be his adoptive parents. When we finally got to meet him and were introduced to his parents, we cried as the nurses and doctors rejoiced that he finally had a family to hold him and love him.

He was no longer just “Baby Boy” but Caleb. He had a name, and he had a forever family. And once he realized that he was loved and belonged, he began to thrive. His body began to grow and develop as he basked in the love of a mommy and daddy who had jumped hurdles to meet him. He started to eat on his own…and still has not stopped. It took about two more weeks for him to stop having attacks of bradycardia and tachycardia. Several times we were almost released to go home when he would have another attack and have to remain. Eventually, he came home to an adoring big brother and parents.

As adoptive parents, there were a few idiosyncrasies of this placement. I cannot speak for all placement situations, but I can tell you ours was so very different than Caleb’s brother’s placement. Because Caleb’s birth mother was not able to stay in the hospital with him and we were not yet identified as his adoptive parents, Caleb was placed under the agency’s guardianship. Within a day of us meeting Caleb, we were identified as his adoptive parents and had decision-making ability, but any big decisions had to be made through the agency. The agency agreed to whatever decision we made, but we had to contact them to receive approval first.

For this adoption, there were two revocation periods. The birth father’s rights were terminated before the birth mother’s due to circumstances. Once those periods expired, we were determined that neither “hell nor high water” was going to keep us from making our son legally ours. There is a caveat in the placement terminology that says something to the effect of “at the end of the 10-day revocation period or upon placement.” Because Caleb was still technically under the guardianship of the adoption agency AND still in the NICU, we had to sign “at-risk placement” papers. These pages made us the legal parents of Caleb, but the official placement would take place when Caleb was discharged from the hospital. So, for over a week, it was a weird “shared custody” of our son with our agency.

Finally, the day came for Caleb to discharge from the hospital and go home. Our sweet nurse had to carry him through the hospital and out the doors. Then she placed him in the arms of our social workers, who in turn, placed him in my arms. All this was to show the chain of guardianship. It felt weird to pass the tiny baby around a triangle, but the result was the same, we got to bring our forever boy home. Our NICU experience was scary because of just what it meant for our boy, but it was awesome as well.

Here Are Some Things I Learned When Adoption Involves a NICU.

1.) Medical advancements are cutting edge.

Babies shouldn’t come with wires. That being said, I am very grateful for those wires and tubes. Fifty years ago, my child would not have survived an early birth. In fact, most of the 40 or more babies in that NICU would never have survived early births and other birth/health complications. I am impressed and so grateful for modern technology and medical science. Despite all the bad in the world now, I am grateful to live in such an advanced age where all sorts of medicine, knowledge, and resources are available to the common people. I will not take that for granted ever again. Medical science created machines to monitor heart rates, blood oxygen levels, and a myriad of other things. Someone thought of making tiny tubes to enable an automatic feeding machine to feed babies when they are unable to eat orally. Sensors trigger alarms to go off when numbers drop or rise into certain ranges, reminders tell when the food or medicine has been completely administered, and fluid runs through IVs. The weight of urine and stool output can be measured to make sure the body is doing what it is supposed to. Medications, warmers, special lights, and devices for every facet of the medical world are truly amazing!

2.) NICU Trained Medical professionals are top-notch.

Let me give a shout-out to NICU nurses, doctors, and staff! It seems there is no limit to what they can learn to use to help these precious itty-bitties. What an amazing group of people! They are truly special in the way they care for the teeny tiny babies with gentleness and smiles. And they don’t get upset when a mama asks lots of questions or when the same mama asks for another pacifier since her son decided to throw his on the floor again today. They never rest until all the babies are cared for, and then they start over.

When Caleb was born, his name was “Baby Boy.” When the nurses found out that we were his family and that he had a real name, they were overjoyed.  Some may have had tears well up in their eyes. They had cared for tiny Caleb for nine days instead of his parent’s presence. They were invested.

3.) Your medical knowledge will grow very quickly as the information is thrown at you.

I had to learn quickly. Our son did not have as many special considerations as his tiny NICU neighbors, but I still had to learn the lingo to understand how my son was being cared for and what I needed to do. I had no idea that the different parts of the brain developed at different times. Nor was I aware of bradycardia, tachycardia, Gavage (guh-vary) feedings, and other terms, but I had to learn quickly. Don’t be afraid to ask questions. I was so thankful that the staff was patient enough to explain as they went. They want you to know how to care for your child. I promise.

4.) You may not get to carry your baby out of the hospital.

As I explained earlier when you leave the hospital the baby may not be in your arms. It all has to do with the chain of custody and legalities. Until that baby is placed in your arms, he/she is in the custody of either the adoption agency or the state. Then, there are hospital regulations. Just be aware that you will get your child eventually. Wait for it. The Bible tells us that “hope deferred makes the heart sick: but when the desire comes, it is a tree of life.” (Proverbs 13:12)

5.)  You have an opportunity to pray.

Sitting in that NICU with a bird’s-eye view of the master heart monitor and listening to the alarms go off all day, has reminded me how fragile life can be. And when I say fragile, I mean 2, 3, 4, 5 pounds of skin and bones fighting for breath and the right to live. I am appalled that people even think that life should be terminated, especially when I look around the NICU at the 29-34-week-old preemie babies the staff members are fighting to keep alive and who have the same needs as all the rest of us.

You can also choose to use this time to pray for the other little ones, their families, and the staff who care for them. You may not know their stories or what their little ones are facing. You can’t hear what the doctors are saying to the weary, anxious parents, but you know how they feel. They wear the love for their children the same way you wear the love for yours. You do not have to hide in the NICU room of “semi-commonality.”

Conclusion

When adoption involves a NICU, life can get very complicated. All members of the family are affected. Not only is your new little one very sick or small, but normal routines of life are disrupted as parents go to love on their new one. As hard as it was to leave my older child and drive to hold my younger child, the time spent in the NICU was worth it. I had a bird’s-eye and inside view to beauty and pain, hardship and victory, and the miraculous grace of God, who is the giver of all things. Somehow, I don’t think my life will ever be the same, and for that, I am grateful.