When a newborn needed surgery in his first hour of life, his medical team delivered

When Victoria Priest found out she was pregnant, like most expectant moms, she dreamed of what her first moments with her newborn son would be like: cradling him in her arms, savoring skin-to-skin contact, hearing his tiny cries and coos, then carrying her swaddled baby home.

But that’s not what happened. Lawson Gay arrived a month early and had a rare congenital abdominal wall defect called omphalocele. It’s a condition where there’s a larger-than-normal opening in the umbilical cord and the abdominal organs stick out through the belly button, covered in a transparent membrane called the omphalocele sac.

And there was a complicating factor that meant the newborn needed emergency surgery.

“What made Lawson more complex was that a portion of the intestine that was in that omphalocele sac had actually perforated and was leaking bowel contents,” said Dr. Jeff Dehmer, a pediatric surgeon at Novant Health New Hanover Regional Medical Center.

Lawson was hurried into emergency surgery just moments after he was born, where Dehmer repaired the bowel tear in his delicate newborn tissues. He spent the next 18 days recovering in the neonatal intensive care unit (NICU).

Priest said she’ll never forget seeing her tiny son whisked away into surgery just moments after birth, then later intubated in the NICU. It was terrifying. But today, she calmly recalls the experience with appreciation for the care and teamwork that got her infant son through all those scary moments.

‘I was very reassured’

Priest, a respiratory therapist who lives in Whiteville, about an hour west of Wilmington, began coming to the coast months before Lawson’s birth to receive care for her high-risk pregnancy caused by a thyroid condition. During her care at Novant Health Maternal-Fetal Medicine, an anatomy scan revealed that Lawson had an umbilical hernia, meaning his intestines were bulging through the umbilical cord opening in his abdominal muscles. It would need to be surgically repaired after his birth.

Priest met with Dehmer, who specializes in surgery for individuals under the age of 18, and they planned a surgery to take place three days after Lawson was born. This would give his heart a few days to strengthen and allow the spaces in the atrial chambers to close. (It is normal for babies to be born with spaces in the upper chambers of the heart, which then close over a few days.) Priest said the news her baby would need surgery just three days after birth was jarring, but Dehmer’s demeanor and expertise put her at ease.

“I was very reassured that he would do a great job,” she said. “He brought comfort because he knows what he's doing, he could handle it. Just trust him.”

The hidden blessing here, Priest said, was that because they had slated Lawson’s surgery, she had already planned to give birth at New Hanover Regional Medical Center. This, ultimately, put her and Lawson in a position to receive exemplary care when a planned hernia surgery turned into an emergency same-day procedure and 18-day NICU stay.

A surprise appearance

Lawson made his appearance earlier than expected. About a month before his Aug. 20 due date, Priest was spending an uneventful day at home, swimming, grocery shopping and cooking dinner, when she began to experience cramping and bleeding. She immediately drove to New Hanover Regional Medical Center, where she learned her cervix was one centimeter dilated.

Priest’s medical team closely monitored her over the next three days using an array of diagnostics. Once Priest had advanced to six centimeters dilation, her care team rushed her to delivery. And Lawson made his appearance quickly thereafter – really quickly.

“It was 8:07 a.m. when they broke my water and by 9:15, he was already out,” Priest said. He weighed only 5 pounds, 3 ounces.

Just moments after Lawson was born and placed on Priest’s chest, his delivery team quickly realized the pressing need for surgery. An omphalocele occurs in roughly 1 of every 4,200 babies born in the U.S., and it always requires surgery. Doctors typically wait a couple of days, while protecting the omphalocele sac with sterile dressing. But Lawson’s tear in his bowels required immediate intervention.

Lawson was hurried into the operating room with Dehmer, who successfully removed the damaged portion of the intestine, reconnected the healthy intestine and closed the omphalocele. Dehmer wore 3.5x magnifying loupes to enlarge the image of Lawson’s tiny tissues. Fortunately, Dehmer said, babies heal fast, and Lawson was in a position to make a full recovery.

On the healing path

And heal he did. At first, Lawson’s intestines weren’t ready for food, so he received nourishment through an intravenous tube called a central line.

In time, he was ready to start with very small amounts of breastmilk, just a few milliliters, which he received through the breastmilk donation program at New Hanover Regional Medical Center. (Priest decided ahead of time she would formula-feed to help ease her transition back to work and avoid pumping. Lactation consultants worked with her to find the best option when Lawson’s delicate system required breastmilk.) As Lawson’s healing digestive system adjusted, his NICU care team helped him through issues like vomiting and constipation. But he continued to exceed expectations, and his appetite grew.

Lawson gradually received more breastmilk and began physical therapy to help his body adjust to movement. Little Lawson’s body grew stronger with his daily routine. Priest participated in kangaroo care, holding her baby close to her chest. She was grateful for the NICU team making it easy for her to get as much contact as possible.

Novant Health New Hanover Regional Medical Center is among just 17 North Carolina hospitals to receive the coveted U.S. News and World Report High-Performing Hospitals designation for maternity care.

When Priest would drive home to Whiteville at the end of each day, Lawson’s care team reassured her he was in good hands, and helped her deal with what she described as the “mom guilt” and separation anxiety that can often be a struggle for parents of children in the NICU.

“Dr. Dehmer had told me: ‘Go home, get some rest, get a hot shower, a nice meal.’ He was very reassuring,” Priest said. And after nearly three weeks, Lawson was cleared to go home.

Support from the NICU team

Priest is open about how hard it was for her – and many NICU parents – to have the dream of a picture-perfect childbirth and aftermath shattered by frightening complications.

“It takes a toll emotionally,” she said. “You have a lot of emotions that run after you give birth; the baby blues are a real thing. And then the hardest part was having to then leave my child in the NICU and, not getting that whole ‘going-home’ feeling.”

Still, she weathered those tough days with support from her family and friends and is now back to work after eight weeks of maternity leave. She also gained a new perspective.

“There were a lot of good, positive outcomes,” Priest said. “I gained a lot of confidence and the nurses taught me a lot. … When I got home, I wasn't feeling that same emotion that other people feel having a newborn: ‘I don't know what I'm doing.’ It helped me a lot being a first-time parent because they taught me things like changing a diaper, feeding, all this is stuff I had no knowledge about. I didn't have that thrown-out-to-the-wolves feeling. It ended up being a really good, positive thing in so many different ways.”