Amniocentesis FAIL (36w2d)

So my fluid was at an all-time low of 4.5 today, and even with Dr. Schwartz’s Jedi-like skills, the amniocentesis couldn’t be completed today. There was one tiny (1.2cm) pocket he was aiming for, but the kid kept putting his arm there when Dr. Schwartz got close with the needle. Paul watched on the monitor as they tried and tried to get into the pocket they were aiming at.

I got jabbed twice though. Not as bad as I thought it would be at all. The pressure was the worst part – until the contractions started. (It’s two hours later and they’re still happening…) It wasn’t pleasant by any means, but I’m not shaking in my boots at the prospect of another one.

So the plan is to wait another week. Since we can’t absolutely confirm that the little guy’s lungs are mature enough to be on the outside, we hang out. I’m still doing OK enough (surprisingly) that we have time before things get to a crisis point. So we’ll continue monitoring me this week, and on Friday I’ll be checked by one of the other doctors in the office. If he sees a big pocket of fluid, they’ll probably go ahead and attempt an amnio – but if not, it’s not a problem. I’m scheduled to arrive at the hospital at 7:30 on Sunday evening to start the induction. Dr. Schwartz will come straight from the airport on Monday morning to check on me, and we’ll take it from there. (Friday’s potential amnio would only be to tell us something wasn’t right – not to give us the go-ahead to induce. The default now has been flipped to induce, as opposed to waiting for confirmation.)

We were pretty disappointed. Paul and I had worked this weekend to get ourselves to a good head space for having the kid today. We felt ready. (well, as ready as one can feel…) So it was a pretty big let down today, and Dr. Schwartz recognized that. But we agree with him that discretion is the better part of valor and to err on the side of caution is a much better way to go right now. Paul is concerned for me having to stick it out another week, but I’m fine. Letting the little man have an extra week is all to the good for him, and I can put up with basically anything for another 6 days.

I’ll be going in to start the induction process at 7:30 on Sunday June 27. It’s entirely possible that the whole process will take 2-3 days. Paul’s birthday is Wednesday the 30th. Could be fun if his son shares his birthday. (Considering Paul was born on his parent’s 3rd anniversary.)

For now though, we’re finally back home. The appointment today was over three hours long with 30 minutes of monitoring before and after the amnio. We know what a contraction looks like on the monitor now! I’m dead on my feet and in a fair amount of pain in my upper-mid back and from the continuing contractions, so I’m gonna lay down for a nap. I’ll be working the rest of this week, so I will be staying busy between monitoring appointments on Wednesday and Friday afternoons.

Sorry for the big build up to nothing, folks.

Possible change in plans… (35w2d)

Today’s appointment for monitoring was pretty darned good. I walked in feeling better than I have in a while. Excellent blood pressure again (147/90) and after some not-so-gentle prodding, good numbers from the kid on the monitoring strip. (He did not appreciate me chugging half a bottle of ice water to get him to move and getting my whole belly woggled by the nurse.) Trace amounts of protein in the urine (up from zero) but not OMG either.

The bad part comes during the ultrasound where they’re measuring the amniotic fluid around the boy. The levels should be around 14 on average, with 5-25 being the extreme low and high ends of the scale. Anything at or below 5 is cause for major concern. I’ve been sliding down that scale and was at a 6 on Wednesday and Friday last week. I forced fluids this weekend, making sure I was taking in well over 100 ounces a day in the hopes of bumping up that number.

Today all the head nurse could get was 4.8 – and that was after 20 minutes of looking and looking all over. So the oligohydramnios is very much in affect. What exactly this means, we’re not sure. We know it ain’t good, but the fact that this is happening towards the end of the pregnancy as opposed to towards the beginning is good. If it were at the beginning, it would be because of some abnormality with the baby. Now it’s just a culmination of my pre-existing medical conditions: hypothyroidism, hypertension & diabetes.

Dr. Schwartz is in his other office across town today and tomorrow, so they called him while we were at the office to see what he wanted to do. We were sure he was gonna send me over to the hospital. But he asked to see me in his other office tomorrow instead. So we’re taking that as a sign that there’s no need to totally freak out just yet. Mostly what oligohydramnios means at this point is that delivery is gonna be a bit more complicated and the chances of a cesarean are probably higher. There isn’t anything they can really do to reverse it – like putting me on a saline IV to pump me full of fluids or something. (There are some therapies that involve pumping fluid directly into the placenta, but those are mostly for use *during* labor.) There isn’t enough amniotic fluid around the baby to *do* an amniocentesis – so we don’t know how much that will blow out next week’s plans. With such decreased levels of fluid/cushioning around the baby right now, the chances of him laying on his umbilical cord and squashing his blood/oxygen/nutrient flow increase. This is where I am SO GLAD that I completely trust Dr. Schwartz and his knowledge/experience in treating high risk women like me. Whatever he says tomorrow is OK with us. If he still wants me to try for a regular birth, I’m all for it – but if this situation necessitates a cesarean from the get-go, we’re OK with that too. Whatever gets our little man out safely.

So this afternoon and this evening are final prep, just in case. All bags are being packed (we were doing laundry this morning already) and final arrangements are being made. I’m gonna try to go get my nails done. Gonna get the Ragu Bolognese made and in the freezer, along with the Creamy Italian Chicken. (There’s a lot of simmering involved there – I’m not gonna be slaving over a stove.) We’re hoping that Murphy’s Law will kick in if we get all this stuff done tonight. Paul is pretty anxious, but I’m doing pretty OK. I am keenly aware that I need to stay calm, and having tasks to focus on helps me greatly with that.

We’ll update tomorrow after the appointment here and on Facebook. (Facebook will probably get updated faster because it’s easier to do from our phones.) We’re halfway expecting to be told to go to the hospital from our 9:00am appointment. I’m all the more glad that we have a 7:45am appointment to meet the pediatrician tomorrow. Gonna be a busy day. Prayers would be appreciated.

Pre-Eclampsia (33w4d)

We knew this was a possibility. Just didn’t think it would actually happen so dang fast. (But to put it in perspective, Dr. Schwartz expected to see symptoms of pre-eclampsia in me by 28 weeks or so. It usually shows up in non-hypertensive, non-diabetic, non-obese, non-thyroid-challenged women between 32-37 weeks. So the fact that I got to nearly 34 weeks with my medical history is astounding.)

Fetal Monitoring appointment today went well. Baby was head down (again) and cooperating with holding still for the monitor. It wasn’t strapped so tightly to me this time, so he wasn’t kicking at it. I actually fell asleep for a little bit while being monitored.

But when they took my blood pressure, things got a little scary. 157/110, up from 138/83 two weeks ago. (It was ~150/97 last week) And that’s with hella medication. The results of my 24-hour urine test came back in the mid 300’s, which indicates mild/moderate (as opposed to severe) pre-eclampsia.

None of this is a surprise. What Dr. Schwartz told us about at the beginning of this 3rd trimester is coming true. The hope is that the creeping up of my blood pressure stays slow/moderate, and that the protein count doesn’t skyrocket. More labs were taken today and the results will be in tomorrow – which will give a more exact look at what the situation is. I’m not showing many other symptoms – and especially none of the symptoms of HELLP syndrome. But I’m up 2 pounds this week, so that’s a tad worrisome.

If things are getting worse quickly, Dr. Schwartz will have to hospitalize me for more intensive monitoring (BP readings every 15 minutes, IV therapy, fetal monitoring, etc.) Nobody wants that – cuz it would stress me right the hell out. Being in the hospital (by definition, uncomfortable) wasting paid leave with no baby, strapped to a bed would just suck SO bad. And it’s possible that I could be monitored for up to a week before things reach a critical point where the baby has to come out. So that would be a TON of paid leave down the drain. If I’m allowed to be at home, at least I can still do *some* work, and Paul is here to keep a close eye on me. We live like 7 minutes from the hospital if that becomes necessary.

In preparation of the baby coming much sooner than anticipated, I got the first of two steroid shots today. (Supposedly they burn like crazy, but I didn’t feel it at all!) For those who know or care, I’m being given Betamethasone.

So here we are. I’ve been told I can’t go into the office any longer. Dr. Schwartz didn’t get into specifics right yet, but basically I need to be off my feet as much as humanly possible, with feet elevated. And most importantly, I need to be in a calm environment, away from stress. I need to go into the office tomorrow to collect some things and wrap up some stuff, but I’ll be leaving at noon for my 1:00pm appointment. I might go in for a couple hours on Friday too. Cuz seriously, I wasn’t ready to not be in the office quite yet.

Dr. Schwartz is back at home in Denver until Monday, so he’ll call me during my appointment tomorrow to go over my lab results and answer whatever questions we come up with by then. He’ll be back in the office for a 9-day stretch starting on Monday, so I have a strong suspicion that he’ll deliver me during that time, assuming I don’t need to be delivered this weekend for some reason.

As far as baby goes: he’s doing OK at this point as far as we can tell. He was 4 pounds exactly two weeks ago, so we’re assuming he’s somewhere between 4.5-5lbs right now. Our concern for delivering him soon is his lung maturity. The steroids they gave me today (and tomorrow) are designed to kick his lungs into high gear to make surfactant to make it easier for him to breathe. He’ll have to spend some time in the NICU when he comes, but we don’t know how long – could be 2-4 days, could be 2 weeks or more. No way to know until he gets here. If we make it to 36 weeks (doubtful) they can use amniocentesis to check the development of his lungs, but prior to 36 weeks, there isn’t much they can do to check. If he comes sooner than that, it will be because my body just can’t take being pregnant anymore.

We’ll have a better idea of where we stand after tomorrow’s appointment. I already have appointments for Monday, Wednesday and Friday next week for fetal monitoring. Here’s hoping I can keep those.

I still need to pack my hospital bag. I need to wash some baby clothes and put things away in drawers and in his closet. I need to go out and buy some preemie-sized clothing and onesies. It never occurred to us that we could have a preemie. We knew the pregnancy would almost assuredly have a bumpy ending, but having a preemie never occurred to us. I can’t believe I’m typing that word.

I don’t know how to deal with this, really. I’m a planner, and I can’t plan anything right now. I don’t know how things are going to go or what my options are anymore. I don’t know how nursing/pumping gets dealt with in a NICU situation. What do we do with ourselves when we can’t be at the NICU? Does it make me a terrible parent that I’m still worrying about getting to work during all of this? I’m vacillating between abject terror and a preternatural calm, both stemming the knowledge that I am in control of absolutely none of this. I’m going with the flow, because I don’t have any other choice. I’m doing my best to stay calm because stress really doesn’t help the situation. Prayers would be appreciated though. An update will happen as soon as possible after the appointment tomorrow afternoon.

Limited Engagement (28w6d)

Great appointment today, and apparently Dr. Scarypants was only available for a limited engagement – cuz he was nowhere to be seen today.

Today was (once again) a short, boring, good appointment. Highlights:

  • Blood Pressure was 138/85 on the first attempt (granted, the machine pumped up twice) which was VERY happy-making for Dr. Schwartz. Usually we have to take it again at the end of my appointment to get it that low. So Dr. Schwartz was very happy to see that.
  • I lost a half a pound. I was expecting to show a gain of at least a pound. So that was surprising. None of it makes any sense to me, cuz I’m totally eating. A lot. My belly is getting bigger. But whatever, I’ll take it!
  • Holy Cats! My kid is getting big! Misty (my favorite nurse) took a minute to have a look around and I was SHOCKED at how big my little boy is getting! I was convinced that Misty had the ultrasound zoomed in, because he looked SO BIG, and I couldn’t see all of him on the screen. His spine looked huge, with easily visible vertebrae! And OMG, he has HAIR!! Misty got a picture for me – but there’s no doubt he’s got quite a bit of hair already! And honestly, I don’t want to think about how big his head is already.

A little bump in my insulin, but that’s the only change. It’s expected, really – just part of the insulin resistance that comes with pregnancy. Dr. Schwartz cautioned me that if I’m starving when I’m up in the middle of the night to pee, that I should probably be eating something. He asked me to take my blood sugar if I think about it – just to make sure that the middle-of-the-night cortisol boost isn’t making me dip too low. He’s OK with my current blood sugar readings – even though I think they’re trending too high still.

My next appointment was set for two weeks, but had to be bumped to three weeks because of a scheduling conflict. The next appointment will be for a fetal echocardiogram, with Dr. Schwartz and a cardiologist watching the ultrasound as they check out every little part of our little man’s heart. Should be a great appointment to get new measurements of our (not so) little guy.

I’ll be 31+ weeks by the next appointment, which means that the non-stress tests will probably start the next week. Twice a week, at an hour or so each. Here’s hoping I can get them scheduled first thing in the morning so I won’t miss much work.

All in all, it was a great appointment. Dr. Schwartz said he hoped he didn’t scare me too much at my last appointment, and that the way things are looking right now, maybe his dire predictions wouldn’t come true. I told him that I’d christened him Dr. Scarypants, and he requested I give him another name now that he wasn’t preaching fire and brimstone. I explained that Paul and I are aiming to have everything ready at home and at work by the 36 week mark (June 19th) so that whatever happens, we’re ready. Dr. Schwartz was very happy to hear that.

Hooray for short, mostly boring appointments. And seriously, I do love Dr. Schwartz. I totally trust him and his judgment as to what’s best for me and the baby. He gets that life goes on, and that as great as being pregnant is, life doesn’t revolve *entirely* around the pregnancy. I have every confidence that no matter how things shake out over the next several weeks that the little man and I are in the best possible hands.

Dr. Happy’s reality check (27w1d)

I had my regularly scheduled appointment on Wednesday morning, the last of my 3 week appointments. It was a simple appointment, no bloodwork, no ultrasound to speak of, nothing major – just checking in.

First the good news: I gained 3 pounds since my last appointment. I was TOTALLY expecting more, because I feel so much bigger. But Paul concurs with his mom that apparently I’m shrinking in other places. As he (ever so lovingly) put it, I’m “less flabby” than before. I get what he meant though – places that were flabbier are – well…. full of baby now, so they’re filled out. (I’ve got stretch marks to prove it!) I was THRILLED to hear that I’d only gained 3 pounds. I like to think that I’m making good choices with what I eat and portion control – but it’s so hard to tell when I’m SO farking hungry, and when I keep gaining weight, regardless of what I eat. So yay me. I’m up a total of 12 pounds so far. Everyone is happy about that. The little guy should start putting on an average of a half pound a week here soon – so steady continued weight gain is expected.

My blood pressure was a little on the high side when I first got into the exam room, but when taken again at the end of the appointment was down to a happy-making 128/83. So the meds are still working as they should, which is awesome.

We didn’t really get a look at the little guy. The nurse this time was all business and only even remembered to turn on the speakers so we could hear the heartbeat after she’d already found it. The stallions were galloping at 142 bpm.

Dr. Schwartz was pleased to see that my blood sugars were already coming back down now that my stress level has reduced quite a bit. Between finishing off the horrific, unending server install/migration at work (I worked 4 weekends in a row…. I’m still trying to catch up on rest) and Paul finding a contract programming gig – my stress has gone down a lot. My blood sugars are almost back into the happy range they were 5 weeks ago. Dr. Schwartz upped my evening regular insulin by 2 units, so nothing major. He and I are still expecting to see more insulin resistance as the pregnancy progresses, so I’m prepared for more insulin bumps.

But then Dr. Scarypants arrived and started preaching. Basically what Dr. Schwartz told us is that now that I’m in my 3rd trimester (which started either today or a week ago, depending on who you ask) that the gloves are off. Dr. Schwartz doesn’t want to scare me, but he felt the need to reinforce the fact that I *am* a very high risk pregnancy. And while I’ve done fantastic so far, the likelihood of me getting all the way through this pregnancy, let alone with no complications is slim to none. He believes I *will* get pre-eclampsia – it’s simply a question of when and how severely. He reminded me that there’s nothing I can do to prevent pre-eclampsia, and there’s nothing I’ve done wrong that will make it happen. But someone of my size, first pregnancy, diabetic and hypertensive just *will* get it. Nothing you can do but pray for a miracle.

So now we live with goals. The first goal is to get to 30 weeks. Then to get to 32 weeks. Then to get to 36 weeks. And after 36 weeks – he could deliver me anytime. Dr. Schwartz warned me that he expects to put me on modified bed rest at some point which means I’ll need to modify my work schedule – if I’m able to go to work at all anymore. I may be reduced to working from home, which severely limits what I can do. (It’s hard to do Accounts Payable when the invoices have to stay at the office, ya know?) He didn’t rule out the possibility of needing to hospitalize me towards the end. (That’s my idea of hell there, kids.)

So for now we keep doing what we’re doing. Taking it as easy as possible, treating myself and baby well, eating as well as I can manage, exercising moderately (although he strongly cautioned me against over-doing it even by a little bit) and trying to stay calm. Each day my blood pressure stays below scary levels is one more day my little man gets to cook in his first apartment.

I’ll be honest, the thing that freaks me out the most is being told I can’t work. We cannot afford to not have me working, especially for weeks before the baby comes. That will just eat into the meager paid leave reserves I have. (Yes, my work is willing to adjust my schedule as necessary – but seriously, I can’t do half my duties from home.) But stressing isn’t going to help anything, so I try not to dwell on it.

I’m back to two week appointments now, and will drop down to one week intervals after 30 weeks or so. So next appointment is April 28th. Then I’ll have one right before my shower – which is in less than a month!