March 25, 2009

And The Complications Begin

As many of you know, my pregnancy with Piper was not entirely smooth. I developed gestational hypertension at 27 weeks which resulted in IUGR (in my case, growth restriction caused by inadequate placenta due to hypertension). I was induced three weeks early to hopefully mitigate potential grave outcomes for both me and baby.

It was an incredibly stressful time. My OB constantly assessed me for pre-eclampsia, which never became an issue, so they were mostly unconcerned. But then I'd see the MFM who was jumping out of his skin over the situation. He talked about things like a stroke in either me or the baby, the quick decline a baby with mild IUGR can take, and the potential risks when severe IUGR develops (which include long term growth problems or stillbirth). The MFM talked very excitedly about early induction while my OB kept saying things like "We'll see, things look fine..." They come from such different perspectives, the OB seeing thousands of perfectly normal deliveries and just a handful of serious complications, while the high risk MFM may see the inverse.

In addition to complete confusion over the extent of the problem between the two practices, seeing a different one of 15 docs at my OB further complicated things. For one thing, I had to explain the situation at each new appointment and there was no one person keeping tabs on the reports from the MFM. In addition, I got conflicting advice each time; one would prescribe medication and the next week another doc would say it can be dangerous to suddenly drop the baby's blood pressure - don't take it. And on and on like this for 10 weeks. In between there were visits to the hospital for monitoring when my BP spiked, off and on bed rest recommendations (depending on the doc), and a general sense that no one was managing my situation - that was left to me.

So my main goal for the first OB appointment was to review this and talk about seeing just one doctor this time. Based on the conversation I would consider whether to stay with them or move to a new practice. That part went really well, I saw the guy I have the best relationship with and he completely agreed I should see just him. He also has a good relationship with the MFM so I feel like we will stay on top of things. I have an appointment in two weeks for the first trimester screening with the MFM, including a hypertension/IUGR consult. Since we know in advance this time, we should be much more prepared to manage the situation.

But the bad news is the hypertension has already returned. Last time at the 8 week appointment my BP was 112 over 60 (normal for me). This time it was 138 over 80. That's not in the danger zone (150/100) but it's approaching it much more quickly than last time. The MFM will probably recommend medication but I remember him saying medication is not likely to bring my BP down, but rather to keep it from elevating further. I don't know if this means we're already screwed and I guess you never know how you'll respond to medication until you try it anyway.

In other news, I just got the worst haircut of my life. Between the too-long side fringe and the too-short bangs that pouf straight out, I look like I could join Spinal Tap. All things considered, that one seems like an easy problem to solve. Taking off for a few days, look forward to catching up with you all soon.

March 16, 2009

This Time

Thursday was my graduation scan. A little heart still beats away in there so off I went to meet with a nurse who unceremoniously shoved some papers at me in the hall and sent me on my way.

Last time my nurse sat me down in an office. She pulled out the mysterious OB wheel and gave me a due date, in came the sonographer with a picture in a silly paper frame congratulating me. She had written on the image "Here I am, the littlest (Last name)." The picture terrified me last time. I was afraid we'd made way too big a deal of something that wasn't yet real. Surely when I miscarried this picture would become the symbol of terrible heartbreak. I didn't mind at all the lack of ceremony this time. It was all very second-timer. The main thing was that J couldn't be there with me.

Last time I was terrified also by graduation to the OB. The idea of not being able to see what was going on in there on a regular basis was so unnerving. I couldn't wait for the OB appointment and scan, but I wasn't ready to leave my little comfort zone at the clinic where I'd learned my way around so well in the previous two years. I hated to leave my beloved sonographer and the nurses who had been so kind over the years.

This time I'm thrilled to be done with the clinic, and in no hurry to get to the OB either. I couldn't be happier to have no regular monitoring on the horizon. I'm ready to have a normal life. I'm sick of waiting rooms and lab coats and paper-covered tables. I don't want to spend my every moment wondering what's happening in there, if it's sticking around, or where the roller coaster goes from here. I want to be off the roller coaster.

Having Piper around surely helps redirect my attention, and strangely enough, so does the "morning" sickness. Graduation day was also the day my innards sought their revenge against all that's been foisted upon them. I was never this sick last time. Just getting through the day takes all my energy lately; I have very little left to spend thinking about the cause of all the queasiness. However I do manage to waste at least an hour or two a day googling vacation ideas. OB appointment is Thursday.

March 10, 2009

Undecided

I've been cripplingly unable to decide what to do for months now. The problem is that what I want and what I want are two different things. No that's not a typo. I want to be able to do a good job at work and continue to provide the best I can for our little family, to make the most of the incredible opportunity I have with my job, and to not feel like I'm losing my mind or failing at everything because Piper is at home with me. But I also want to continue to enjoy my days with her, playing outside when it's nice, reading books, taking her out and seeing her smile and say Hi to everyone, enjoying her hearty giggle all throughout the day.

Piper had a stay at home day until she was 10 months old and it was great. I work from home and my hours vary enormously so there were days when I could spend the whole day with them and days when daddy was on duty (and pulling his hair out) all day. At 14 months I took her out of day care when she got on the one-nap/day schedule. With the economy tanking I wasn't sure how busy I'd be and I could easily get my then-current workload done during her 2-3 hour nap, with a little catching up after bedtime. J is often able to "work from home" if I've got really important meetings.

But lately life has been crazy. Not being available in the office all morning is taking a toll with my boss. I'm getting busier and I'm soon going to need to be much more available for phone calls for an upcoming project. I'm also hitting the super-tired stage of early pregnancy when I'd rather be napping through Piper's naptime than working. I also think she would benefit from some time with other kids. And a big concern I have is that when (fingers crossed, can you believe I'm talking this way?) the next baby arrives, I want Piper to already be well established in her own routine so she's not being sent off someplace at the same time her little sibling arrives. I also assume this sibling will have to go right to daycare, at least part time, since he/she won't have the luxury of a stay at home dad. Heartbreaking.

I think I've decided against having a part time sitter/nanny because I really do think time with other kids would be great for her, and also because of her penchant for banging on my office door whenever she can't have my attention. I've talked to a center nearby and really like them. Piper is going for a trial day on Thursday. I had thought I'd send her part time, just mornings, then pick her up for lunch and a nap at home. But now I'm thinking maybe instead of five half days, we'll do three full days (I really only need help Monday-Wednesday). That will give me some flexibility if I have work commitments later in the day but I can always pick her up after lunch if I want to. I just don't know. I feel like we can make it work keeping her at home, but at a certain cost to my business and my sanity. On the other hand, I absolutely hate the idea of spending money to not have her here.

The problem is that my assessment of the trade-off fluctuates every day with my fluctuating workload. Today I'm all caught up in the office and had the best giggle fit I can remember so it seems like a no-brainer to just keep her at home. Someday very soon I'll be drowning in lapsed commitments and kicking myself for not finding a solution.

March 2, 2009

Three Three: Updated

The ultrasound is tomorrow morning, March 3rd. The anniversary of the Piper's ER. We had the first u/s with her on what would be today of that cycle and we saw a heartbeat. I know that was early, so I'm trying to prepare myself not to be too alarmed if we don't see it this time, since we seem to be just behind on everything else this time around. Hopefully 3/3 will continue to be a lucky day. I could really use some good luck.

Updated to add: we saw an egg sac, a yolk sac, and a healthy little 120 bpm heartbeat. Instead of a grain of rice, this time it looked like a tiny lentil bean. At some point I'm going to have to believe this is really happening. The RE who came in to monitor the scan said "So you're batting two for two, pretty great odds." Indeed. I know there will be bloggers out there who, even if they hoped for the best, figured I was due for a turn at failure. Let me put your mind at ease: so did I.

Next step: another scan next week then graduation to the OB.