September 30, 2009

Birth Day Eve

Or eve eve. After two weeks in the hospital and a very bad blood pressure day yesterday they've started me on Cervidil to get things going. I'm not dilated at all and cervix is still very long so cervidil stays in for 12 hours and Pitocin starts at 11pm tonight. If this is like my induction with Piper, I can expect a baby about 22 hours later, or sometime Thursday night. It wasn't a super long labor last time, just took a long time to get labor started, so this being the second time around won't necessarily go any faster as you so often hear about successive labors. Whatever happens we're on our way and she'll get here when she gets here.

Which presents a small dilemma: we have no idea what to name this girl! I seriously need help, throw everything you've got at me. I want another spunky, spirited name like Piper, but that doesn't sound new or made up. For example the old fashioned Sadie sounds just right to me but my husband hates it. Piper's middle name is Harlow, which means from the hilltown, chosen because J and I met when we were neighbors on Capitol Hill. For this baby we're considering the middle name Eve, a reference to the place where we married (called evelynton). We think Eve as a first name sounds weird with our last name. Anyway, that's what I've got for you to go on. Some of you will understandably not be in a place were thinking about baby names is even a remotely pleasant idea, but for those who are please send any and all suggestions my way! And a deep thank you to everyone who has been so supportive all this time, thank you so much.

September 24, 2009

Day 250: One Week In

I've been living in L&D room 19 for a week now. It's gone by surprisingly fast, which is not to say it's been easy. Yesterday was a bad day. I'd had some problems overnight after sort of falling through the cracks between the nurses shifts, and then when I finally got a nurse around 10am, she said "So the plan is still to keep you here until 37 weeks?" I burst into tears. It wasn't particularly shocking information but no one had specifically said that before and in that moment, the idea of being away from Piper for another week and a half after 6 days away already hit me hard. My nurse was upset about having upset me and became very defensive. I tried to swallow the tears but they kept sneaking out over the next few hours.

Eventually my OB came by to talk to me about the u/s I'd had the day before and a plan. I'm mainly here for low fluid and over the past week it is holding pretty steady. My mfm still feels the pregnancy is basically just done and wants me here monitored until delivery. My OB made a case with him for sending me to bedrest at home with bi-weekly monitoring but the mfm didn't go for it. I knew he wouldn't, he told me when I left his office last week that I would not be going home pregnant. I had accepted that, and set my sights on making it to 36 weeks in this miserable little room. That's two days from now. The idea of tacking another week on that was unbearable.

Both the OB and mfm had previously mentioned their comfort level with delivering at 36 weeks which was what put that number in my head. While 37 weeks is considered full term, babies' lungs are typically developed at some point between 35-37 weeks and it just varies by the individual baby. It's very encouraging that we've seen practice breathing on u/s for over six weeks now. Basically the expectation is that the baby would be fine if I had to be delivered today, but could face some significant NICU time based on it's lung development, weight (ability to maintain body temperature), and suck reflex (ability to feed itself whether bottle or breast), which is the last thing to develop. The longer we wait, the less likely NICU would be necessary, and as my OB said, the longer you stay stable and everything looks good, the greedier we get about wanting to give this more time.

So when my OB said we could plan an induction for his next hospital on-call day a week away (next Wednesday 9/30) I felt relieved. That's 36w4days, just a few days before full term. But a week away felt manageable too, having just made it through one week already. So it seemed like a reasonable balance of caution and expedience. I may be plotting my escape after a few more days, but right now it's just great to have an end point.

September 19, 2009

Greetings from Hospital Bedrest

Two weeks ago everything looked so good at the mfm. The next day at the ob I had my first major bp spike: 150/102. It came down and I got to go home but readings at home have been high ever since. I knew the mfm wasn't going to like the bp but I didn't expect to be sentenced to immediate hospital bedrest, where I have been since Thursday. Apparently when gestational hypertension causes deterioration of the placenta, things can begin to go downhill quickly. So while the cautious OBs continue to try to get to 36-37 weeks, they are on board with the mfm who wants me here, monitored, and ready for an induction at the first indication.

In addition to the high bp, growth dropped from 32nd percentile to 16th in two weeks, the placenta which was so healthy last time has rapidly matured, and the fluid is low. Low fluid is the main reason my OB is keeping me here. Apparently that can also be a rapidly worsening situation. A nurse told me about a woman who came in the day before me with low fluid at 34 weeks and by the time she got here the baby had died. So I'm okay, maybe this is the best place for me to be but it's still pretty miserable being stuck here.

It was just such a shock at first. The mfm practically pushed me out the door and across the street to the hospital saying it was time to get the baby out. This happened several times last time and each time all monitoring came back normal and the OBs sent me home until I was within a few days of 37 weeks. I was so sure I'd be here for just a couple hours Thursday, especially as they gave me all the lab results, all normal. But the low fluid was the kicker. Thursday night I was on heavy IV fluids to see if we could increase the fluid level, which would have bought me a ticket home. No dice; they told me when that amount of IV fluid doesn't help, you're not just dehydrated, it's a sign that things are not functioning properly.

So at any time they could decide it's time to induce, but for now I'm just living on a hospital bed, in my fancy gown, strapped to two monitors, a bp cuff, and an IV. Although I can't image another week in this bed, I'm still hoping we get another week in before baby (I'm 35 weeks today). The hardest part might be being away from Piper all this time. I left for my appt during her nap and expected to be home before she even woke up. She's been to visit each day but it's hard for her to be here and I think might make it even worse than missing me at home. I had all these things I had in mind that I was looking forward to enjoying with her in our last few weeks of her being my one and only. I'm done being sad about that now, it's clear I am not going to get to go home for even just the day or two I was hoping for. I've accepted it and moved on to being sick of being stuck on a hot vinyl bed, not getting any sleep, monitors that fall off and beep constantly causing me to feel like I can't move, so I'm constantly sore and uncomfortable. And I'm only a day and a half in! How will I ever make it another week?

September 4, 2009

Day 230

50 days to go according to my iphone, 82% through. This baby will be term in four weeks (37 weeks), the point at which I was was induced with Piper. Very hard to imagine. I'm tired and uncomfortable and I'm sure I'll be getting anxious to get on with it in another month but right now I can't imagine not being pregnant. I'm trying to savor this last bit of time with just one child. With #2 neatly packaged away and all its needs met. It sleeps, it wakes, I hardly notice. It's fed whether I'm asleep or awake and I'm only changing one set of diapers. My back is sore but my arms are free. And I never have to feel bad about dividing my attention between the two. Piper and I just returned from visiting my sister in San Diego. Traveling alone with a toddler will really make you appreciate not traveling with a toddler and an infant.

IUGR was diagnosed at week 32 last time so yesterday's MFM appointment was a big one. At this point I'd already been to the ER a number of times for high blood pressure and so far this time it's stayed just on the right side of the upper limit (132/88 yesterday). My OB sees this as a good number, safely below his danger level (140/90), but the MFM reminds me this is hypertension because it represents an increase of over 20/10 points from my normal pre-pregnancy levels (1-teens/70). So far though, it doesn't appear to be having a negative impact on the baby. At around 4 lbs. the baby measures in the 32nd percentile. The IUGR diagnosis means that Piper at this point was at or below the 10th percentile. Because this wasn't identified until 32 weeks, we really don't know at what point her growth began to slow and fall off the charts, but so far we don't seem to be on the same path. The baby was 36th percentile at the last visit so there may be a slight drop-off but I think it's within the margin of error and certainly still in the safe range.

Better yet, at 32 weeks last time the placenta already showed signs of deteriorating, caused by the hypertension and the cause of the growth restriction. It was smallish, thin, and heavily calcified. At delivery it turned out to be even smaller than expected and fragmented. This time he said it still looks fine. The MFM said his gut feeling is that I may be walking the line all the way to the end, but at this point last time he was already putting bets on early induction.

For all the good news, he did mention a few reasons to remain concerned. He clarified what my OB had told me about only 15% of gestational hypertension cases repeating in successive pregnancies: this statistic is related to pre-eclampsia, which I never had. In discrete hypertension cases, it's more like 90+%. And the main reason is because when the problem is only gestational hypertension, not related to kidney problems seen in pre-eclampsia, it is really the emergence of an unknown underlying problem causing the blood vessels not to expand properly. So, we stay on top of it. Back in two weeks for more monitoring.