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Preparing for Cade Before Day One

For Angela Hartwig, a surgery nurse at Lakewood Health System in Staples, Minnesota, her coworkers are like family. So when she discovers she’s expecting her second child—a baby boy she plans to name Cade—she’s excited to welcome him at her community hospital where her colleagues will ensure her delivery goes smoothly.  

But 18 weeks into her pregnancy, Hartwig’s plans change unexpectedly. An ultrasound reveals Cade has a cleft lip and palate. “It was heartbreaking,” says Hartwig. “I experienced the stages of grief—the initial shock, then grieving, then fear of the unknown. And I prayed a lot.”

collage of cade as baby

Another fear creeps into Hartwig’s mind: the possibility she won’t be able to deliver Cade at Lakewood due to his complex condition. Her dream of welcoming Cade into the world surrounded by people she knows and trusts starts to fade.

Transforming uncertainty into opportunity

Hartwig’s nurse training kicks in and she begins to research online. “I needed a focus,” she explains. “I’m a nurse. I like to ‘do’ and help people.” Research leads her to YouTube, journal articles and websites about her unborn baby’s condition. It also leads her to Gillette Children’s. “Multiple sources told us how great the Gillette team was,” says Hartwig. 

Two months later, Hartwig and her husband sit in a clinic room in St. Paul, Minnesota, for a prenatal consultation with the craniofacial team. Nurse practitioners Martha McGrory and Katie Bucka explain the customized bottles and other special equipment that they’ll need. They are asked to make another appointment when Cade is born. “We walked away feeling very well taken care of,” Hartwig says. But she still worries about where she’ll deliver. 

Her worries are soon alleviated when Sarah Baumgartner, Lakewood’s OBGYN manager, approaches her with an idea. “What if we use Cade’s situation as an educational opportunity for our nurses on how to care for infants with clefts?” Baumgartner asks. “That would be wonderful!” Hartwig replies.

Webinar reassures mom, providers

Baumgartner jumps into action, collaborating with McGrory to arrange an instructional webinar for the Lakewood OBGYN nurses who’ll care for Cade after his arrival. The webinar walks the nurses through the special bottles and other unique needs of cleft infants. The training reassures Hartwig that she can safely deliver Cade at Lakewood, as she had originally planned.

Just five days after the webinar, Cade is born on February 23, 2016. Hartwig is overjoyed to see that, other than his cleft, he is healthy—a typical baby. “He’s different but that doesn’t really register,” she says. “This is Cade, my little miracle.”

One week later, Cade has his first appointment in St. Paul. “They looked at Cade, talked to us about the treatments and surgeries, then said ‘this will be a piece of cake,’” says Hartwig. “We were reassured by their confidence and expertise.”

The family also meets with Cheryl Anderson-Cermin, an orthodontist who specializes in caring for patients who have cleft lip and palate. Anderson-Cermin fits Cade with an OrthoCleft® retainer, a presurgical orthopedic device that he’ll wear until his first cleft repair surgery.

Cade post repair surgery

“It isn’t always easy,” admits Hartwig of using the retainer and taping Cade’s lip to prepare him for his initial surgery. Once again, she draws on her nursing background. “He doesn’t always like it. I have to approach those things as a nurse doing what’s best for him, and not as his mother.”

Confidence, competence and compassion 

When he’s four months old, Cade undergoes surgery to correct his cleft lip. Although Hartwig has confidence in the Gillette craniofacial team, she breaks down when the time comes to send him into the operating room. After the three-hour long time period without Cade, she’s reunited with her baby. Happy and relieved to see Cade, his repaired cleft lip initially doesn’t register."I was so focused on my baby, who is finally in my arms. He looks perfect. I never would have guessed he had that cleft lip.”

With Cade’s first surgery behind him, Hartwig enjoys watching his personality emerge. She describes him as an interactive, expressive and observant baby who brings immeasurable joy to her family. 

Hartwig knows Cade will need an additional surgery to correct his cleft palate when he’s 9 months old, potentially another at age 3, and  a final surgery between the ages of 7 and 8.

“I’m a huge advocate for Cade’s Gillette team,” says Hartwig, “not only as a mom, but as a nurse. As a care provider, you can be confident and competent. But you also need compassion. At Gillette, it’s obvious that every member of the team is truly passionate about helping the patient and their family.”