Update from the Land of High Risk Pregnancy (36w4d)

Well, the Boy still looks good.  Cooperated on the NST.  Dopplers and fluid level holding steady.

But you know you're headed for a bad day when you find an ultrasound annoying.  Just the general concept of having an ultrasound.  The transducer.  The goo.  The discomfort.  You know, it felt a whole lot like the millionth follicle check during an IVF cycle.

Then I met one of the other OBs in the practice.  There are 6; I think I've met 5.  Started crying during the whole repeat repeat c-section vs. VBAC discussion.  As she said, the issue isn't really c-section vs. VBAC but delivering a baby who's not growing well at the right time.  She's all for VBAC if I actually go into labor prior to whenever it's decided that he needs to be cut out.

So I came home, and I was crabby.  And went to the library and picked up a couple DVDs and books and set up shop in my bed.  And fretted some more.  I think it comes down to the fact that I'm a girl who likes a plan, and this wait-and-see is making me rather nutty.  I'm not wishing this pregnancy were over in that way that uncomfortable pregnant women whine about wanting it to be over, but I'm also, at this point, not really capable of enjoying the experience much either.  And, as I've said, that really makes me mad.  I like pregnancy as a general state of being; I find humor in its bodily awkwardnesses, I think that I look (and feel) good as a pregnant woman.  But I'm tired of the monitoring.  I'm tired of being "high risk."  I'm tired of living in uncertainty and anxiety.  I'm tired of being unproductive because I'm worried about The Boy and because I don't have a sense of how much time I actually have to work on a project.  I'd plan differently if I knew I had almost four weeks and not just one.  Or less than one.

So that's where I'm at.  All-in-all, incredibly grateful that I'm not where I was a year ago, in the land of not-pregnant.  But still...crabby.  And waiting.

On High Risk Pregnancy, Preterm Delivery, VBAC, and the "S Word"

LG was delivered at 38w5d, which was the latest day my OB gave me in a week's window of possible induction dates.  Although neither LG nor I appeared to be in any immediate danger (at least at the time this choice was made...things did indeed get scary when I hit 38 weeks), the logic was (a) I was high risk, (b) I was on heparin, which is more easily managed in induction and (c) due to the aforementioned, there was an increased risk of stillbirth.  While I still resent that OB and the early/failed-induction-c-section that resulted from this proclamation, if I had to do it over I'm not sure I would have chosen differently.  It's really hard to have a doctor start talking about dead babies and not take it seriously, you know?

So, at my last OB visit, we had an eerily similar conversation, the major difference being this time I've got a baby who has the intrauterine equivalent of failure to thrive.  The question thus becomes at what point is he better off outside my body than inside.  And that's what people--and by people I mean friends and acquaintances who ask me about this situation--don't seem to get.  That is, because many people understand the problems caused by prematurity, they assume the closer to full term you get the better off the baby is.  When I say I've had steroids to mature his lungs, they assume it's because I'm at risk of preterm labor, not that my OB will decide to cut him out of my body prematurely because my body is failing him.

I am not, at this point (knock wood and all that hocus pocus), completely freaked out about the possibility of stillbirth; because I'm being monitored twice weekly, chances are really low that my doctor won't catch things going down hill.  But it is a real factor in my/her decision-making process; what I didn't know is that even in normal pregnancies (which I am certainly not having), rates of stillbirth go up once you hit 37 weeks (yes, precisely the time that risks associated with prematurity go down).  That said, I'm completely on board with a mandated c-section at 37ish weeks because I know she would only recommend that if she really believes he's better off in a crib than in my body.  And, honestly, I fully expect that will happen. 

But...if I get to 39 weeks, do I schedule the c-section or hold out for the possibility of VBAC?  Her preference, obviously, is the repeat c-section.  And while mine was VBAC, I'm not sure it makes a lot of sense anymore.  Even though the risks to me go up exponentially with a c-section, I can't see pushing my luck for what amounts to a few more days of intrauterine bonding for the possibility of VBAC and natural delivery.  Even Dr. Gorgeous advised me--before all this stuff went down--not to go much past 39 weeks.  Not worth the risk, she said, to either me or The Boy.  And I'm sure she wasn't really thinking about her DE live birth rate stats when she told me that!

When I asked LG when she thought her brother would be born, she said February 19.  When I said pick a date in November, she said November 10.  Which is, coincidentally, the date of my next growth ultrasound.  Personally, I think 11/11/11 might be a nice consolation prize for the low-risk pregnancy that wasn't.  Stay tuned...

Update from the Land of High Risk Pregnancy (35w4d)

Well, the good news is I will *not* be having a baby today.  That means (a) I can go to a campus event tonight, (b) I can see LG in her Halloween costume, and (c) unless I go into labor spontaneously in the next two days, I will have made it to 36 weeks (yahoo!).

The other good news is that The Boy is still growing, albeit sl-o-w-ly (about 11 ounces in the past 2 weeks), bringing him to a slightly more respectable 4 lbs 8 oz.  But...that places him at exactly the 10th percentile, which is the official cutoff for IUGR and the point at which my doctor uses the word concerned.

So...it seems pretty likely I'll have a ~ 5 lb baby at 37 weeks.  Maybe it's time to get the crib out of the basement and pack a bag...

The Gray Zone

It's been raining for a couple days now.  I like rain, but this is the kind of gloomy gray day that leaves me feeling melancholy and not wanting to do anything but stay in bed and read a novel.  Perhaps I should give myself permission to do that, but I feel guilty, as I am not technically on medical leave.

Gray seems to be the theme of the week.

In obstetric news:  The Boy passed his NST (he was a crazy man in there!), fluid level and dopplers still look good, and he actually doesn't have his legs over his head today (not that that last one is a big deal, but I was starting to wonder if he EVER moves his legs).  The OB I saw today said I'm in the gray zone.  No reason to deliver him today, but, yeah, go ahead and switch from Lovenox to old-fashioned heparin.  If he shows minimal growth next week, chances are he'll be delivered.  So basically I could end up with a c-section at any time...or a vaginal delivery around 40 weeks if he continues to grow, fluid and dopplers look fine, and I go into labor on my own.  I could have a baby who comes home with me from the hospital or who could stay a couple weeks in the NICU.  It all depends. 

I have to say, all this gray uncertainty is making me a bit crazy.

34 weeks!

A. threatened to take away my computer and cut off my internet access.  Look up pictures of frank breech babies (yes, I know he isn't anymore, but he's still got his legs over his little head instead of in the "fetal position") or google "breech head" and you'll see why.  Oh, yes, the crazy is back.

Then again, I'm also having moments in which I think this just might work out.  And he just might be healthy.  And not deformed.  And even if he were born tomorrow, which he probably won't be, he'd likely still be bigger than I was at birth (last estimated weight was 3 lbs 11 oz), and he's had the benefits of steroid shots, which I did not, back in 1972.  And given that I'm being monitored twice weekly, the chance that my doctor misses something going awry is really small; from what I've gathered, a reactive NST seems to be a pretty decent guarantee that the baby will be okay at least for the next few days.  Placental insufficiency, be damned.

*

LG and I went back to BRU yesterday and got a crib mattress and mattress pad and all that kind of stuff.  And A. dropped off an old bouncy seat, which LG has been playing with, despite the fact that she loathed such contraptions as an infant (which is why I no longer have any baby containment apparatuses).  That is, I'm getting prepared for the (likely?) reality that there will be a baby at Chez Gwinne sometime in the next 2-6 weeks, and probably no later than 4.  Imagine that:  we might just have a baby before Thanksgiving and my 39th birthday.  And that will be something to celebrate, indeed.

Dread

Two weeks ago, when I started down this IUGR path, I thought the earliest they'd make a decision about early delivery would be today.  He's been doing great on NSTs.  Fluid level was within normal limits, but lower than it had been last week. 

But on top of all my usual monitoring, I've got a growth ultrasound today.

I cleaned my kitchen.  I did the cat litter.  I straightened up the living room, just in case one of the random grown-ups on my emergency list needs to accompany LG into the house today.

I'm petrified.  I am not ready to not be pregnant.  I am not ready to have a baby in the NICU.  But I know if my OB suggests a c-section today, at 33w4d, there's a real risk of stillbirth if I don't do it.

Send us good wishes, please.  I'd really like to make it to at least 34 weeks.  36 would be even better.  Spontaneous labor and VBAC at 39-40 I'd be over the moon...


Update at 3:48:  No c-section today!  Although The Boy flunked his NST, he passed the BPP with 8/8.  And he's just slightly more off his growth curve (25th to 18th to 16th).  So barring funky fluid levels or doppler, I've got another two weeks.  Of course, now my OB is saying it might be worth delivering 37-38 weeks even if he's growing...because why rock the boat.  Golly...I think that's why I was induced at 38 weeks with LG.  Sigh.

But I'm still pregnant and no emergency calls will be made.  At least not today.

Small Good Things (32w4d)

1. The Boy passed his nonstress test, AFI and doppler check.  Repeat visit on Monday.  So it looks like I'll make it to at least 33 weeks... (When I asked her my OB said she was pretty sure he'd be delivered early...how early, she wouldn't venture a guess but said it's possible but unlikely I'll go all the way to 39 weeks.)
2. My OB said that bed rest is useless.  The Boy's going to do what he's going to do.  So I'll rest as I want to but not get crazy about it. 
3. Sometime yesterday I became aware that the Boy's head bulge wasn't jammed up in my right ribs but was somewhere closer to my side.  And then it seemed my belly had taken a different shape, and felt much heavier and there are movements in weird places from small baby parts.  Guess what?  Apparently he decided that ~3 months of being frank breech was enough, and he flipped over.  The ultrasound tech thinks he'll stay that way...but I'm not counting on it.
4. I took The Boy out for ice cream, because the university ice cream place has the BEST strawberry ice cream in the whole world, and it's suddenly 79 degrees again.  Seriously.
5. I had a productive morning, which makes up for the absolutely sluggish afternoon I've had.  But really how much can you accomplish when you're at the doctor's office for almost two hours?  Thankfully I have a fridge full of potential leftovers to feed LG, because I really don't feel like undertaking a large cooking project.

Sometimes it really is the small things that get you through the day, you know?

Just In Case I Deliver in the Next Week

I am, as they say, getting my ducks in a row.

It sort of feels like those days I have to scramble and cancel everything but the most critical because LG is home sick. 

In case you were wondering, here's what's made it to the top of the list:

1. Taking care of my will--online. [mostly done]
2. Reading submissions for a student program I run.
3. Writing three letters of rec.
4. Cleaning my desk.
5. Paying bills.
6. Making a (private) baby registry at Amazon.
7. Misc phone calls and emails, mostly of the setting up and cancelling appt's variety. [neverending, but caught up]

What will be ignored, unless I am granted a few more weeks, or have a sudden burst of energy:

1. My own writing deadlines.
2. All home repair projects.
3. Actual purchasing and/or setting up of baby stuff.

And I think this weekend will consist of playdates and/or "pajama and a movie day" for LG.  Because this leaving the comfort of my bed stuff?  Not so fun anymore.

*

In other news, things look more agreeable in terms of my chair's plan for me for next semester.  All the "service" work I'm supposed to can really be done from late March through the end of the semester, and I should be able to avoid daycare to do it (just need willing friends or babysitters to watch The Boy for a couple hrs here and there).  And he's still thinking I will be (knock wood) on a legitimate post-tenure sabbatical sometime next year as well, during which time I can finish this book project.  Final word on that should come in on or before Dec 15.  Don't you just love how the tenure clock and the bio clock coincide?  (Snort)

Update, Insomnia Edition (32w2d)

1. We--all lifeforms at Chez Gwinne--survived the weekend.  While you were wrong about me overdoing it on Friday, you should have warned me about the festivities that followed:  errands, applepicking, walks in the woods with friends...  Yes, settling down now...
2. The Boy passed his first of hopefully many NSTs.  I survived my betamethasone injection, which, if you want to know, sucks as much as PIO.  And I have to go back tomorrow for round #2, as I refuse to do an IM injection in my thigh, and there's no way for me to reach my own ass with my left hand anymore (ahem).  I've been warned that my thursday appointments (NST, ultrasound, office visit) will take roughly 2 hours.  At least there's not the 2 hrs in the car anymore...
3. Big Cat, who had another "episode" just before my NST, passed her cardio evaluation.  That is, while cardiac problems do exist, they have largely been ruled out as the cause for whatever is going on.  So, potentially more testing of other bodily systems...  As my other two cats died in such a way that there was no possibility to intervene, it would be great to treat whatever is going on with Big Cat...but at what (literal) cost?  Philosophical vs. financial quandary about the value of animal companions.  Subject for another time, I suppose.
4. Despite everything, I did not have a massive freakout episode in YFPP.  The pregnant masses seemed less whiny, and I just said I was sore from a steroid injection and left it at that.  Did tell the teacher I might not be back, depending on how all this falls out...
5. I have a meeting with my department chair tomorrow (well, I suppose today at this point) that I am absolutely dreading.  Subjects include:  crap with student organization, my "maternity" leave, and, inevitably, the tenure drama.  I think I will need to stop at the neighbors' teahouse and get me some of that anti-stress tea, minus the chamomile...

To Do List Triage

M, whom you may recall drove me to transfer back in March, showed up last night in her pj's as I was putting LG to bed.  We sat on my porch and we both cried, and she said do you remember when Dr. G told you to eat all those avocadoes?

She's volunteered her services to clean my house, assemble a crib, and generally do what needs doing.  She brought me banana bread and her company and really, it turns out that's exactly what I needed last night.
One thing I know for sure:  I have good friends, online and off.

I feel like everything I wanted to get done before my due date needs to be done now because I'm operating on borrowed time.  I need to figure what to prioritize, and what my plans are if I show up to any OB appointment only to be told I'm being delivered that day.  Basic stuff, like who will pick up LG from school and feed the cats and all that.  And I wonder if I should go ahead and take that trip to Babies R Us and pick up the odds and ends that I'll need, assuming I get to keep this baby, because if he is born early, I'm certainly not going to want to be running errands when I need to be recovering from major surgery and taking care of a baby in the NICU.

What I'm surprised by is that my OB hasn't put me on bedrest, which I know is often used when IUGR seems to be an issue (the theory being that it improves blood flow to the placenta/uterus and therefore nutrition/oxygen to the baby).  I think my plan is probably to do the kind of modified activity Dr. G had me on at the beginning of the pregnancy, for the same reason.  (On that note, does anyone know if something as obvious as me eating more could help fatten this little guy up?  I highly doubt it, but I thought I'd put it out there.)

And maybe when A. comes over tonight to appease our daughters with matzoh ball soup, she'll help me figure out what needs to be on my to do list at this point and what can potentially fall by the wayside.  Because I'm too overwhelmed to tell.

So here's my plan for today:

1. spend the remainder of the morning on writing-related tasks
2. go to my scheduled prenatal massage
3. pick up steroid injections from the hospital
4. buy assorted groceries for matzoh ball fest 2011
5. cook and clean
6. make a to-do list for the next 1-8 weeks
7. hope nothing else unexpected happens today

And Now I Have a Real Reason to be Anxious

The Boy has officially fallen off his growth curve (down to 18th percentile, from 25th), mostly in his abdomen.  And if one does even a small amount of reading, it seems this is the major tip that the growth problem is related to uterine environment, not genetics (though my OB didn't put it in exactly those terms).

What this means:  I'm getting steroids (because I've missed intramuscular injections so much).  I'm starting NSTs twice weekly, with weekly checks of amniotic fluid level and a doppler ultrasound of umbilical cord, growth ultrasound in two weeks.  And I could be delivered by c-section any time. 

Oh, yeah, on top of everything, he's still frank breech.

Gwinne Is a Freak #4,000,822

Yeah, so what I didn't say in my last post is that I pretty much haven't stopped crying--except when I was sleeping and getting LG ready for school--since last night.  I don't think I've been this spazzy since around 12 weeks.

I contemplated calling my old therapist and asking her for a rec for someone who might just take Crappy New Insurance.  I contemplated calling acupuncturist #1 so she could stick a needle in the top of my head.  I contemplated calling a friend but decided really no one I know IRL gets this, as sympathetic as they might be.

I settled for calling my OB's office.  And they brought me in for a fetal heartrate/maternal blood pressure/mental health check because, as the nurse said, a week is too long.  Agreed.

So I had a nice chat with one of my OB's partners.  And got to listen to the boy's heart thundering away.  And I was told that what I'm feeling is completely normal given my history and if I'm ever just filled with dread to call them and they'll bring me in and stick me on the monitor for a while.

I also got a reminder that I really do need to call them if I have regular contractions.

All that and a free flu shot.

You think I'll get any writing done today? 

It's Ba-ack

I had my follow-up with the hematologist yesterday.  She was quite happy with my lab results--the only thing that's unclear is if my homocysteine level is normal because it's normal or because I'm on massive B-vitamin supplements--but gave me a look when I told her The Boy is only ~25th percentile.  My OB has said she won't worry until/unless he hits the 10th.  The question, of course, is if he's small not because he's genetically programmed to be small but because of uterine environment; the concern with APA (which has haunted my medical history since 2003 but seems like it might not be an issue now?), at least from the fetal side of things, is IUGR.  Small blood clots in the placenta keep it from functioning adequately; therefore women with APA take aspirin and Lovenox to keep such clots from forming.  She said she'd talk with my OB--I guess they're friends--but is recommending I stay on Lovenox until 36ish weeks and then nothing (I was on heparin with LG until 6 weeks postpartum).  The logic is that there's really no evidence I'm at increased risk of stroke, based on my history, and by 36 weeks The Boy should be okay.  The fact that my blood work basically shows nothing to be concerned about and she'd still like me on anticoagulants for another 6-7 weeks has me a bit (okay, more than that) freaked out.

Of course it's about that time, right?

I'm not due for another OB visit for another two weeks, which will also be a growth ultrasound.  I don't know if I can handle that.  I mean, I wasn't keen on starting NSTs this early, but this baby is small (smaller than LG, who would have been close to the 50th percentile if actually full term) and he really doesn't move a lot.  Or at least not as much as I think he should (if I do kick counts as I was instructed, he does wiggle sufficiently in a 1 hr window).  And you know breech babies are more likely to have birth defects (yes, I know, step away from Dr. Google)?  And I'm still haunted by Dr. G's comment that the sac problem really could mean trouble later in pregnancy; granted, the perinatologist was not concerned, but it's still hard for me to accept that he's  fine after seeing the odds that there was a 90% (or higher) chance we wouldn't make it out of the first trimester.  Add all that to yet another person looking absolutely shocked to find out that I'm due in November because I'm so small and, well, here we are again.

Yes, folks, the reign of terror has returned.

Notes from the OB (27w3d)

1. That gestational diabetes screening test sucks.  Yes, I've done it before.  Yes, it still sucks.  And I am a terrible patient who took ~12 minutes to drink it instead of 5.  Oops.
2. The Boy is breech.  Actually, The Boy has been in *exactly* the same position for the last three ultrasounds I've had, face forward, with his legs over his head.  My OB said he's got until 34 weeks to change his mind, but I do not think he is going anywhere.  (I was paranoid enough to ask if he has enough space and the answer is yes.  He's just obstinate.)
3. Placenta, on the other hand, moved away from my c-section scar, so if he moves, I might be able to do the whole VBAC thing.  I am not counting on it.  I do not think this is actually a decision I will need to make.
4. The Boy is growing acceptably.  About a week small, roughly 25th percentile, about 2 pounds.  Because he looks good, my next app't has been pushed back until 31 weeks, along with repeat ultrasound.
5. I take it as a good sign that my OB (a) decided not to start NSTs until 34 weeks, unless The Boy falls off his growth curve, and (b) does not see bedrest in my future.

26 weeks

Just a quick pregnancy update.  Still feeling good--so much better than I remember with LG at this stage.  The only real annoyance is heartburn, and it's fine if I take 10 mg pepcid/day.  I've been thinking of this as my last week of "freedom" before all the high risk monitoring starts up, though there's a chance all the NSTs won't start until 30 or 32 weeks.  At the very least, I'll be seeing my OB every other week once we get back from NYC, which kicks things up a notch.

I'm getting a little paranoid because so many people have made comments about how "small" I am for ~6 months.  I've certainly gained enough weight (~22 lbs), and as of my last OB app't my fundal height was measuring appropriately.  But he's also up in my ribs already, which makes me wonder where he's going next...

But in short:  I'm happy.  We're healthy.  All good.  And a far cry from where I was this time last year or the year before.

Today LG and I have much cleaning and errand-running to do, as tomorrow we head to my mom's and then out to NJ/NY on Thursday.  In the meantime, I leave you with this: