Cherita Parrish's niece April put a small hand on her aunt's stomach last fall and said, "Baby."
The 1-year-old girl had barely begun to talk, and her family had never heard her say the word before, but "baby" was exactly what her Aunt Cherita had been whispering in prayers, after eight years of trying to have a second child.
A few weeks later, Parrish found out she was pregnant.
"We were ecstatic," said Parrish, 40, who lives with her husband, Alvin, and a 12-year-old son in Ashburn Farm.
Twenty-four weeks later, their joy turned to fear when Alyssa Renee Parrish was delivered by an emergency Caesarean section. Alyssa had stopped growing inside the womb because of complications from Cherita's high blood pressure, a condition that can restrict the flow of oxygen and nutrients to the fetus.
Alyssa weighed 379 grams, less than 1 pound or barely more than a can of soda. Twenty-four weeks and 500 grams are the minimums at which babies are statistically more likely than not to survive, said Raul Lazarte, a neonatologist at the Inova Fairfax Hospital for Children, where Alyssa was born April 9.
Alyssa was testing the odds of survival.
"I'll never forget the look on that doctor's face when the baby was born," Cherita Parrish said. "It was a look of true concern."
But after four months in the neonatal intensive care unit, Alyssa went home on Aug. 11. She was the smallest baby born at Inova Fairfax to go on to leave without significant medical handicaps, Lazarte said.
Alyssa's long-term prognosis is unclear, and she will have to rely on an oxygen tank for another six months to two years while her lungs mature, Lazarte said. But she escaped other common problems with vision, hearing or sleep apnea that afflict many of the more than 470,000 babies born prematurely every year in the United States.
Cherita Parrish has a long and difficult history of conception and pregnancy. At 22, she developed hypertension during her first pregnancy, a condition that would have a serious impact on that and three subsequent pregnancies. Doctors told her that her high blood pressure probably led to the stillbirth of her first daughter, Britney Richards, after six months of pregnancy.
Her second pregnancy, six years later, was unproblematic until the third trimester, when she developed preeclampsia, another condition that can cause a sharp rise in blood pressure. Justen Richards was born via C-section at 34 weeks, at 3 pounds 8 ounces. He was on a ventilator for a few days and had to stay in the hospital for three weeks.
Cherita raised Justen, now a 135-pound football player who is going into seventh grade at Belmont Ridge Middle School, as a single mother until he was 3, when she married Alvin, now 36.
The couple wanted to have a child together, but it took four years for Cherita to become pregnant. High blood pressure sent her to the emergency room twice during that pregnancy and blood tests indicated that the baby might be at risk for Down syndrome. During a sonogram in the 26th week of the pregnancy, the doctor could not find a heartbeat. Alvin Renaud Parrish III -- "Trey" -- had died.
Four years later, the couple was considering visiting a fertility clinic when Cherita became pregnant with Alyssa. Four months into the pregnancy, on Valentine's Day weekend, Cherita's blood pressure spiked, "near stroke level," her husband said. Doctors kept her in intensive care for a week and increased her medication to the point that she was taking 22 pills a day, she said.
A few weeks later, at 20 weeks, she had her first sonogram. The doctor said the fetus looked small for its age. A second sonogram two weeks later had similar results. After a third sonogram, at 24 weeks, the doctor was sure that the fetus wasn't growing and that there was a serious problem.
"It looks like we might have the same outcome as the last pregnancy," Cherita remembered him saying.
Things happened quickly after that.
A team of doctors examined her and confirmed that the baby was in critical condition. The doctors scheduled another emergency Caesarean section, holding off long enough to give Cherita a shot of steroids and 12 more hours to induce growth in the baby's lungs.
After the delivery, Cherita was allowed to look at Alyssa for only a few seconds before the baby was whisked away to an incubator. Cherita, recovering from the major abdominal surgery, did not see her daughter again for several days.
"The first time I went in there, I was overwhelmed" by all the machines, she said. "I didn't know if I was going to be able to go through this with her."
For her first 33 days, Alyssa relied on a ventilator to breathe. She had patches on her chest with tubes leading to heart and oxygen monitors, so that nurses could track her vital signs. She had an intravenous line for nutrients and another tube from which blood was drawn. Her small veins collapsed easily, and the nurses had to keep moving the IVs to different parts of her body.
At 30 days, Alyssa had a heart operation because a valve that usually closes at birth was open, a common problem with premature babies that could cause improper blood flow into the lungs. Her skin was "paper thin," Cherita said, and she couldn't be touched.
For the first couple weeks Alyssa's parents couldn't even go close to her. Later, they could put their hands through two holes in the incubator and place them softly on her head or her diaper.
"For a father who hadn't even touched his baby yet, it was hard to be there during the day shift to see other parents picking up their babies," Alvin Parrish said.
So he started visiting at night instead, when everything was quiet. He worked the late shift as a cable installer until 1:30 a.m. and then drove to the hospital, where he would sit close to his baby, listening to the sound of the machines.
"It was a moment of prayer, to reflect and be grateful that she's here," he said.
Alvin used humor sometimes to offset the stress. He joked that the plastic oxygen tube that replaced Alyssa's ventilator made her appear to be snorkeling, and he teased that the baby steroids were giving her big muscles.
The nurses called her "little diva," or "little sistah" -- because she showed signs of being a fighter -- such as grabbing her oxygen tube and trying to pull it off.
Slowly the machines were taken away, one at a time.
On July 11, Alyssa was moved out of the incubator and into another room in the intensive care unit where she could gain more weight and her lungs could mature.
Now after a week at home, in her little pink pinafore dress and lacy white ankle socks, she looked like a regular newborn, all of 6 pounds 4 ounces, with creases in her chubby arms, tiny fingers in fists and her face screwed into dozens of funny expressions.
But she still has a tube leading oxygen into her nose and the long cords patched to her chest and attached to monitors that will sound if her heart rate or oxygen level drop out of a safe range while she's sleeping or eating.
The family is getting used to the strain of making sure Alyssa is breathing. On Thursday, Cherita fed her daughter a bottle of high-calorie formula for premature babies, which she drank until it was gone. Then her dad picked her up, so she could curl up on his chest and fall asleep.
"That's her favorite place," Cherita said.
"And I don't mind," her dad said, smiling broadly.
Alvin and Cherita Parrish's daughter, Alyssa, was born four months premature, weighing less than 1 pound and critically ill.
Alvin Parrish's daughter, Alyssa, has overcome the worst complications of being born four months early but must use supplemental oxygen for at least six months.