October 29, 2007

Admitted

quick update from the hospital - I was sent over for monitoring by the peri this morning after an especially high BP (160/110). They have decided to admit me overnight to do another 24 hour urine collection to check for protein. A full panel of bloodwork came back completely normal, so if there's no protein I'll probably be discharged tomorrow afternoon. My blood pressure has remained pretty high all day despite the medication I started last week though, so an induction sometime next week (37 weeks) is still likely.

It was very weird going home and getting our stuff together to come over here. We knew there was a chance of induction. The peri told the on call to check everything and if she had any concerns to just go ahead and deliver. I am so not ready for that. I know i'm taking the whole pregnant infertile disbelief thing to extremes given that i know an induction in the next two weeks is likely, but I just still can't believe I (me!) might actually have a baby. I'm still working on buying inyo this whole pregnancy notion. Luckily it sounds like I've got at least a few more days to get used to the idea.

And I can't wait to go home. Its so uncomfortable in this bed, not to mention boring. I didn't get to eat or drink anything all day until around 3pm in case I had to be induced or anesthetized. Now I have these weird inflatable cast things on my calves which are plugged in and puff up and down to prevent clots. The only upside is maybe now I'll have some time to catch up on your blogs.

October 25, 2007

I Suppose Its Not a Good Sign When the High Risk Doc Says Come Back in Two Days

But that's what he said this morning. Then he said "Tell them to double book me if they have to," so he's rather serious about it. He says the placenta is looking a bit "old." The report he sent to my OB says "indications of early placental dysfunction." Apparently when it begins to look like things may be headed downhill placenta-wise, it can happen fast, thus the speedy recheck. It was such a bummer compared to last week, when we found out the baby is growing at an okay pace, as it continues to hug the 18th percentile curve. They can't check that again until next Thursday, since it takes two weeks to grow enough to outweigh the standard error in the measurements.

I have my first pelvic exam with the OB tomorrow. With things seeming more urgent at the Peri, I'm eager to hear how things "down there" might be progressing, if at all. I've had occassional Braxton Hicks for months but they have gotten stronger and I sometimes wonder if some of the adjustment I'm feeling is dilation. Mainly I think it's the baby head butting my cervix though--not too comfortable.

Bed rest pretty much blows. It's been over three weeks now, but sure feels like months. We all have enough whining and complaining in our lives so I won't go on and on about it, but the thing I didn't really anticipate is the fact that lying around all day saps all your energy without ever getting you tired enough to sleep. In a way it's a good thing that I've been so swamped at work I haven't had much opportunity to notice I'm not going anywhere. Since I already worked from home, it took minor adjusting to get me lounging a bit mopre at my desk with my feet up, but I have been working at reducing my workload. Instead of the routine 10-12 hour days with a few 14 hour days per week, I'm now down to regular days of 8 hours or less with a few 10 hour days here and there. In two weeks, I'll have everything wrapped up. If Imake it that far.

So I'm very sorry I'm behind on all your blogs. I've missed them and been thinking of you all, but between the race to get work done and the need to rest as often as I can, I feel so trapped irtyng to balance it all that I haven't dedicated much computer time to non-work activity. I'm going to try to catch up a bit later today, and hoping to find lots of good news out there!

October 12, 2007

Looking Good, Just Not All That Photogenic

The scan yesterday went well. It is too soon to measure growth again since the the margin of error for the measurements is greater than how much the baby might have grown in a week, so we'll have to wait until next week before we have an idea of how well the baby is growing. This time they checked all the organ functioning, breathing motions, and blood flow.

The main problem with hypertension is that it constricts the blood vessels, so the baby gets less blood and nutrients through the cord than it should. This is what causes the growth restriction. The baby compensates by reducing blood flow to the abdomen so it can direct enough to the brain, and this is happening properly. They've talked about putting me on blood pressure medication, but apparently the baby becomes accustomed to a certain level of blood pressure, and as long as the baby is handling it well, it's not a great idea to suddenly change my blood pressure. It appears that so far the baby is handling it well, we just have to keep monitoring it closely.

The other major problem which I'm still being evaluated regularly for is preeclampsia, but there are no further indications that I'm headed in that direction. That would be much more dangerous to me and the baby, and even the chance of it is one reason why I may be induced early (it tends to spike suddenly late in pregnancy). The Peri said we'd know more after next week's growth check, but that he thinks I'm going to make it to 37 weeks. If the growth looks really good, he said maybe 38.5, but I might as well give up on my 40 week due date.

And since full time bed rest is pretty much definite until delivery, three or four more weeks is sounding a lot better than six.

In this picture from last week's scan, you can clearly see two evil eyes glaring at me, displeased with this whole blood pressure situation, I presume:
Is it just me or does anyone else see a resemblance to Dr. Finklestein from The Nightmare Before Christmas?
Although I go back and forth, sometimes I see a very clear "Whatchoo talkin' 'bout, Willis?" face in the scan.

Actually we did get to see some cool stuff yesterday. At one point when we were looking at the profile view, we saw the mouth open and swallow amniotic fluid. Later, we saw it holding it's foot. Maybe there really is a baby in there afterall.

October 8, 2007

And Definitely Restricted

Last week I met with the OB to follow up on the scan. Actually it was a series of confusing visits with different people and different interpretations. My regular appointment was already scheduled with the physician's assistant. She explained to me it's not just a matter of the baby being small as I had hoped; it is considered growth restriction because of the hypertension, since we know that hypertension definitely restricts fetal growth, especially in mom's over 30. She showed me a chart with our 17 week anatomy scan on a grid and you could see that it has dropped from just above 20th percentile then to just below (18th). It was a little frightening to see that, although it is still not in the teensy tiny dangerous less-than-10th percentile range.

I left that appointment feeling a bit more concerned and thinking this situation was a bit more serious than I had thought. I had flashbacks to my tiny neice born 3 pounds 15 ounces at 34 weeks, which sounds like about the pace of growth we are on. I remember visiting her in the nicu and her head was smaller than my fist, about the size of a tangerine. It was amazing to see her but scary too, and I remember what a horrifying time it was for her mom, who was driving more than an hour a day after a C section (not advised) so she could go visit her baby in the hospital. She was there about two weeks and is now a thriving 5 year old, but we'd certainly prefer not to repeat that scary nicu stay.

The next day I came back to see an OB since the physician's assistant thought I should follow up with one of them. The first thing she said when she walked in the room was "Your scan looks fine to me." Irritating. I didn't even know what to say. What does that mean? We've just readjusted our entire lives around strict bed rest. I even missed a family funeral that was important to me, and she's telling me everything's fine?! I may have just stared at her blankly for a while, blinking. Eventually we got around to the part where she said "Look at it this way, you're 33 weeks. If we have to deliver your baby tomorrow, it will be just fine." That's when I realized she wasn't telling me I'd had a perfect scan and there was no growth restriction and bed rest was totally unecessary, she just had a very different definition "fine."

And now mine is somewhere in the middle. I'm aware that bedrest is important because we need to keep my blood pressure under control as much as possible and try to keep the fluid levels as high as possible, but the baby seems pretty healthy and there's nothing to do but wait for the next scan before we start guessing about whether I'm going to be induced early. Every week I'll be going back to the Peri for another check, and every week they'll be evaluating whether the baby is better off inside or out. Kind of familiar, the old weekly wait for the next check. I thought I'd graduated from that class already.

So the inevitable question everyone's asking us now is if we're ready. In the most basic sense, all we need is an infant car seat, a place for the baby to sleep, and a pair of stocked boobs. We've got the car seat, a bassinet loaned to us by a friend is next to our bed, and I've been leaking colostrum for two months now, so I guess we're ready. It doesn't even matter that we've got a pretty well stocked nursery ready to go, but it will be nice not having to worry about that until we're ready to use it. We've got some basic diapering essentials, but we'd have to buy preemie size diapers. Basically, we're ready.

There are a number of things that aren't as completely ready as I'd like. We still have one last baby class and a lactaction class I'm hoping we'll attend. I've got loads of work to wrap up before going on maternity leave but it's getting there. I haven't packed a hospital bag but I may get to that after the scan on Thursday depending on how that goes. I haven't pre-addressed birth announcement envelopes and other things like that but we'll see what I get around to.

From the time I had a due date, I've been trying to prepare myself for being late. It seems like everyone I know has been at least a week late and they go crazy waiting for those last few weeks to go by. I decided to be excited about the idea of being 10 days late (12/3) so the baby could be born on the third of it's month like me and J. This was my silver lining if it started to drag on forever. Now this whole thing has me thinking about delivering by 11/3 (37 weeks). If we are lucky enough not to have a preemie, the flipside is that it WILL drag on forever, so I guess there's no perfect answer to mentally preparing yourself. Of course the key thing will be hoping for a healthy baby, but the other thing I'll be checking the tea leaves for at each scan is some clue to just how much longer we have to go. Patience has never been my thing.

October 2, 2007

Restricted

It's been interesting around here since my last post. I did go to Boston and had a great visit. When we got back, the dog took another turn for the worse, had to go back to the vet, and we were asked to decide between putting him down and another expensive surgery. We decided to go forward with the surgery because there is one last treatment option that hasn't been tried, and it didn't seem right to give up without trying everything. If this last option (steroid drug therapy) has no affect of his intestines' habit of attacking themselves and dying off, it's the end of the line for my pup. So far, so good post surgery, but it will be some time before we know if the drugs are working.

Next I went in for my regular OB visit and high-strung newbie doctor freaked out about my blood pressure, decided strict bed rest was in order, and instructed me to come back a few days later for a recheck. When I went back last Friday, the OB I saw agreed with all the other docs who had previously said basically that my BP is worth keeping an eye on, I should take it easy and continue regular monitoring, but bed rest wasn't indicated since everything else looks good and the baby always does great on the monitors. Phew. Minor freak out over.

Until Monday, when I went to the Perinatologist for my "final" ultrasound. Now I don't know if being in the business of dealing with high-risk pregnancies makes the Peri's naturally more inclined to be cautious and nervous, but this guy was much more concerned about my BP. Then again, he was the first to have real evidence of a potential problem: even though the baby looks very healthy, it's measuring about a week and a half behind. He looked at the blood flow through the umbilical cord and it looks perfect, as well as the blood flow in the heart and brain, so that's very reassuring. Also reassuring that the stomach is displaying breathing motions. But since this was the first scan since week 17, we don't yet know if we've got a smallish but healthy baby, or if we're seeing the onset of growth restriction caused by my hypertension (a top reason for small for gestational age babies).

So I have to go back to the Peri weekly now so we get an idea of the pace of growth as well as to continue to check the blood flow to the baby. And I get to be on strict bed rest. Maybe I'm in denial or maybe I'm an idiot, but I am honestly not very worried at this point. A week and a half behind just doesn't sound that horrible to me, and everything else about the baby is very, very healthy. There's a family history of small babies (I was 5lbs something, my sister was 6). I don't mean I'm not taking it seriously, I have done plenty of googling on the potential risks to small for gestational age babies. I certainly don't want a tiny little preemie to have to fight for her life and spend weeks in the NICU, but it also seems like there's reason to believe things are still going pretty well.

The Peri is talking in terms of "hopefully making it to 37 weeks if nothing worse develops." Something worse would be:
- further signs of preeclampsia (my giant jug of 24-hours worth of refrigerated urine remains LOST at the lab but so far no other problems detected)
- next week's scan shows baby is not just small but growth has significantly slowed
- doppler indicates abnormal blood flow to baby
- no doubt there are other unimaginably awful things I have neglected to google

If any of these things happen, they will weigh the risks of preterm delivery against the risks the baby faces in utero. They may do an amnio to determine lung maturity, though it bodes well that the belly appears to be making breathing motions. If none of these things happen, it sounds like the Peri would still make a case for inducing me at 37 weeks once the baby is considered term. Incidentally, 37 weeks would be 11/3. J and I both have birthdays on the 3rds and the egg retrieval was on 3/3, so that seems somehow fitting. My birthday is actually tomorrow, I guess I'll spend it working from bed. Yay me.

I'm weirdly unphased by all this other than being highly irritated with bedrest one day into it. Partly I think I do have good reasons to feel okay about things. I could have left the Peri with way worse news than she's just a little small. But partly I think I'm so accustomed to things not going as planned after all the years of infertility that it just seems like par for the course. And throughout the process, I've gotten pretty confident in what can be accomplished with a combination of frequent monitoring and medical intervention. We'll just take it one step at a time and see what makes sense as we get more information. Bed rest on the other hand, is just damn aggravating.

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Further googling tells me that if we're a week and a half behind, we're in about the 25th percentile for 32 weeks. Clinically small for gestational age babies are below the 10th percentile. If we stay in the 25th percentile, that would be just under 6 pounds at 37 weeks or just under 7 pounds at 40 weeks. This all seems pretty good as long as growth continues at a normal rate. We'll find out next Thursday at the next appt. with the Peri. Meanwhile baby is kicking me in the ribs and pelvis at the same time with a vigor that feels pretty healthy to me.