Paul & Sarah

Where has the time gone? I can’t believe Kieran is already two months old. And yet, it seems like so long ago that I was pregnant…. WAY more than 2 months.

Today we went to the pediatrician for Kieran’s Well-Baby visit and his first vaccinations.

Length: 22″ (10-25%) [up from 20" at his 1mo appt]
Weight: 10lb 3oz (10-25%) [up from 9lb8oz 13 days ago: a better, slower rate of gain]
Head Circumference: 40cm (50%) [up from 37.5cm at his 1mo appt]
Vaccines: Hep B, Polio, DTaP (Diphtheria, Tetanus, & Pertussis/Whooping Cough), Hib (Meningitis), PVC13 (Pneumococcal disease), and Rotovirus

We discussed a couple of things with Dr. Hodapp –

• Constipation: We were thinking about this as an acute condition, when we need to be thinking about it (and treating it) as a chronic condition. So it’s diluted prune juice twice a day for the foreseeable future. Dr. Hodapp assures us that it’s not hurting Kieran to have the juice, even though he understands our concern about him having that much sugar at this young age. Juice is what fixes normal baby constipation, so that’s what we’ll stick with. Dr. Hodapp says that it’s more than likely not any of Keiran’s formulas that are causing the constipation, as we’ve continued to have a stopped-up baby across three difference formulas now. (And HALLELUJAH, we don’t need to be sticking with a formula for 2 weeks to see if it helps. Dr. Hodapp said if we don’t see a big change within 2-3 days, we’re not gonna see one.) Apparently like gassiness, constipation just happens, and as long as the usual remedies work there’s nothing to be concerned about. So this means we can dump the soy formula and it’s horrible toots, poots, and possible hormonal side effects. Hooray!
• Gas: Nothing we can do. DANGIT. All the home remedies we want to try are fine. But all infants are gassy for the first three months at least, and ours just seems to be particularly so. Again, formula doesn’t really make that big of a difference according to Dr. Hodapp. So we’re welcome to try whatever we want in that regard.
• Reflux: Got a new prescription for the Zantac which has worked wonders for our little guy. Dr. Hodapp confirmed that we were correct to up his dose on our own 10 days ago because Kieran had put on so much weight. Our new prescription is written at a better dosage, and Dr. Hodapp predicted that Kieran would outgrow the reflux before the prescription needed to be re-written again.

Dr. Hodapp assures us that we’re doing fine, and Kieran is thriving like crazy – so whatever we’re doing at home is working and to keep it up. He was pleased to hear that Kieran is smiling, following objects with his eyes and reaching for things in front of his face. Developmentally, he’s right on target for his actual age, and physically he’s doing just great. He’s surprisingly strong and able to hold his head up to look around for longer than expected at this age.

Kieran is sleeping longer at night, but certainly not through the night yet. We usually get a 4-hour stretch starting around 7:00pm, and a couple of 3-hour stretches after that if we’re lucky. Unfortunately, he’s taken to waking up for the day around 5:00am and cannot be persuaded to take a nap much before 10:00am. Paul is suffering greatly with this, because he gets stuck with this early-morning shift. It doesn’t help that Kieran’s natural fussy time seems to be first thing in the morning (as opposed to around dinner time for most babies.) We’re hoping that as we get a better handle on the constipation that Kieran won’t wake up so fussy.

Kieran is learning to love the swing and bouncer. He just this week noticed the mobile above the swing for the first time. His slack-jawed amazement was too cute for words. Having somewhere we can put him where he can be entertained and soothed by the motion is very nice when we just can’t pace and bounce him anymore. This week we’ll set up his IKEA baby gym with it’s plushy play mat and overhead crossbeams with dangling toys. We’re transitioning into more of an ‘entertain the baby’ household as Kieran’s attention span has grown and he’s now able to engage with us for longer periods of time.

I’ll be returning to work full time on September 13th. I’ll be in the office from 8:30-2:00 four days a week, working from home the balance of the day and all day on Wednesdays. I’m grateful to my supervisors for having such an open mind to a flexible schedule. Of course, this arrangement will be reviewed regularly to make sure it’s working for everybody, but if nothing else it will help us transition into a different schedule. Currently I’m working part-time from home with occasional office days. It’s been a good way to ease into Paul having charge of Kieran for longer periods of time while I’m working. I’m not looking forward to leaving my boys, but this is what’s necessary for our family. I have 1000% confidence in Paul though, which makes it a little easier. And it sure beats daycare, that’s for sure.

But for now, we are enjoying our little boy every moment. He is the light of our lives. Our little miracle.



2 Comments | Tags: development, Doctor Appts, formula, work

I really need to find the time to write out the whole birth story and our experience in the hospital… Paul kept good notes for me of what went on so I can construct it from memory and notes, but there just doesn’t seem to be time to sit down and write it out! (I’m writing this while pumping, thanks to my hands-free bustier thingie.)

As some of you may know, I was born with a birth defect in my heart. (A Ventricular Septal Defect, or VSD to be precise.) Because of this, and the fact that I was on an ACE inhibitor when I got pregnant, Dr. Schwartz ordered that a fetal echocardiogram be done while I was pregnant (remember? I talked about it.) which necessitated a follow up echo before we left the hospital.

The echo was done on day 2, I think. A tech came to the room with the machines and did the tests on Kieran there in the room. She didn’t tell us anything, but said that the cardiologist would come talk to us the next day after he reviewed the results. The cardiologist did come chat with us and explained that while Kieran definitely doesn’t have the birth defect that I was born with (WHEW!) that there was a murmur and a thing or two that wasn’t 100% on the echo. Basically it’s nothing to be worried about, just little flaps inside his heart that hadn’t closed all the way when his heart and lungs kicked into gear, and a “bypass” that hadn’t closed itself off as expected.

So today was the 1 month follow-up to the hospital echo to see if things had healed up like they should. The answer is a qualified “yes” on all accounts. Things are healing, but they’re not *healed* yet. The murmur is still there. The holes and latent byways are still there, but smaller. The cardiologist says there’s nothing to worry about at this point, that this is all very common and that things *are* healing up, so there’s no reason to think that they won’t continue to heal. The Pulmonary Artery is a little narrower than he’d like to see, but he says that he sees it all the time and usually they strengthen and widen out on their own. (I don’t have my notes at hand while I’m pumping here… otherwise I’d give the technical terms.)

We have an appointment to return in three months (Nov 16) to make sure everything has healed up the way it should. Until then, we’re not worrying about anything. Kieran isn’t showing any signs that these little issues are bothering him, he’s gaining weight like a champ and is cute as hell: so life is good.

On a side note: it was nifty to see ultrasounds of Kieran from the OUTSIDE. :)

Today was my last prenatal appointment. Short and sweet.

• BP: 154/97 both times
• Fluid: 5.7 in only two pockets (dunno if that’s good that they were big, or bad that there were only two.)
• Monitoring: Little man seemed content to kick at the monitors, so he didn’t need to be buzzed.
• Group B Strep test was positive, so I’ll need 2-3 doses of antibiotics during the course of labor. No big deal, just one more thing going into the IV.

We chatted for a bit with our favorite nurse, Paula. She’s a neat lady. Hugs all around when we left.

So we’re cleared to arrive at the hospital at 7:30 on Sunday. This is getting very real all of the sudden.

9 Comments | Tags: BP, Doctor Appts, induction, kicks, oligo, pre-eclampsia

Quick & Dirty update:

• BP was 155/99, so in the unhappy-ish range and up from Monday.
• Monitoring went well (no buzzer needed)
• Fluid is back up a bit to 5.7 (although Dr. Schwartz told us on Monday that he has a sneaking suspicion my fluid has always been a little higher than AFI readings are saying – just because on someone of my shape and size there’s more ‘nooks and crannies’ for fluid to hide in. Doesn’t make visualizing them or getting to them for an amnio any easier – but it does explain why he hasn’t been all Chicken Little like the nurses for the last two weeks.)
• Gave blood and pee to re-check stuff and was sent home (as opposed to the hospital.)

If I wasn’t scheduled for induction on Sunday, they’d be having me do a 24-hour urine starting tomorrow. So thank God for small favors.

Worrisome upper belly pains + increasing headache + vision changes are making Dr. Schwartz look at me funny, but he let me go home today, so I consider that a victory. It’s possible the lab results will change that tomorrow, but we’re thinking positive. In the meantime, I’m trying to lay low – which is fairly easy today cuz I kinda feel like crap between an upset tummy, headache and the upper belly pains.

I guess I should clarify that the induction on Sunday isn’t something we’re expecting to go especially quickly. At not quite 37 weeks, I’m high and tight (not dilated or effaced at all) so I’m assuming it’s gonna take at least the full 12-hour cycle of the Cervidil to get things moving, if not a second round. (Our prepared childbirth instructors warned that it’s not at all uncommon for two rounds of Cervidil to be needed for induction before 38 weeks.) I’m not contracting anymore though, thank goodness. If the contractions from the amniocentesis had continued more than 8 hours or so, that would have been a problem. So while a shared birthday with Daddy is possible for June 30th, I’m not aiming for it. Personally, I think the little guy is gonna arrive on the 29th – but the 28th would be even better! As always – safe and healthy baby and Mama is all we’re after, however that comes about.

I’m back at Dr. Schwartz’s office on Friday for monitoring and possibly an amniocentesis if there’s a big fluid pocket that the doc of the day (not Dr. Schwartz) feels like trying to stab at. (Uug, that sounds gross, doesn’t it?) I’ll say goodbye to the girls in the office who we’ve gotten friendly with (I swear, it’s like Cheers when we come in now: a chorus of “Hi, Sarah” wafts out of the back.) If I end up with a Cesarean, I’ll be in the office for a follow-up at two weeks. If I manage to do a vaginal birth, I won’t see anyone in Dr. Schwartz’s office (including Dr. Schwartz) for six weeks. (He’ll still manage my insulin and meds during that time, but we’ll do that via email only.)

So, in the meantime I plug away at work stuff and Paul tries to keep me from working too hard. :)

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.

Wow. Possibly our last kid-free weekend. EVER. This is kinda hitting me all right now.

Today’s monitoring was pretty routine. The office was INSANE busy, but they were kind enough to squeeze me in early as Paul’s cousin Mike came in for a surprise visit this morning. (My 2:30 appointment wouldn’t have worked so well today.) My fluid was up to 7.4 – which is still crappy, but better than it has been in over a week; so maybe forcing fluids is helping the teeniest bit? Baby showed off his breathing skills and happily kicked at the monitor, so he didn’t have to get buzzed today. (He was doing some serious headspins on my bladder while I was on the monitor though – I actually thought I was gonna wet my pants at one point!!) My BP was not so hot though, 147/97 and 165/103. They took more blood to run my PIH levels, but since I’m scheduled for the amniocentesis on Monday they didn’t feel the need to get uppity about the BP.

So we’re in the clear for Monday morning. No change to the usual routine for this weekend – stay off my feet as much as I can (ha!) and force fluids. The better my fluid is on Monday, the easier it is for Dr. Schwartz to do the amnio. He says he likes a challenge, but I’d prefer that my son not get poked if possible. :)

This weekend…. I dunno. Paul and I still need to pack our hospital bags (I just *hate* packing for anything…) but other than that we’re pretty good. Oh, I need to prep/boil the premie-sized prefolds that Kelly sent us. I’ll boil the hell outta them and then throw them in the wash with the other infant-sized prefolds to make a full load. (At least the half-dozen premie PFs will easily fit into my regular stock pot!) I’m hoping Paul and I can spend some “quality” time together – not that we haven’t been enjoying our time together anyway. But maybe just spend some time together where we’re not running any errands or putting something together – no agenda. Gonna be a long time before we have the opportunity again, methinks.

Paul’s cousin Mike is out for a visit, so Sunday (Father’s Day) will be spent at Paul’s parent’s place. I’m writing this from their patio on Friday evening actually. Paul is on his laptop, Jeanne’s on her iPad and Mike is doing his insane-O workout routine for our comedy enjoyment. The dogs are happily racing around our feet and the breeze is blowing. Ya know, adding a baby to this mix isn’t gonna be a problem at all. :)

Fairly boring appointment today. Did the test for Group B Strep, the results of which should be back on Friday. (Most people carry Group B Strep on them with no worries, but if I’m currently carrying it, the baby can get REAL sick if exposed to it during a vaginal birth. Two doses of antibiotics via IV during labor will take care of it if I am positive.)

Amniotic fluid was back up to a 6 today, so that’s good. Little man was happy to show us how well he practices breathing, and had fun kicking the ultrasound transducer. Monitoring was the same as usual, requiring the buzzer to get things going. But once he woke up, he proceeded to kick the contraction monitor pad for about 5 minutes. His heartrate did a scary little deceleration thing a couple of times, but he bounced back quickly – so that’s OK.

Blood pressure was mixed: 164/97. So it was higher than it has been, but the diastolic was under 100, which is good. Dr. Schwartz said he was OK with my BP today, so yay.

Paul and I chatted with Dr. Schwartz about the plans for the rest of this week and next. (We also talked about developing an iPhone app vs a fee-for-service website…) But once we got home, Paul was explaining to his Dad what my status is and kinda had it all wrong. We talked, but Paul was still pretty convinced that he had it right and that the induction wasn’t happening unless it was an absolute emergency. So I e-mailed Dr. Schwartz. Below is the actual e-mail conversation (along with an explanation of what’s up for the next 5 days):

On Jun 16, 2010, at 8:10 PM, Sarah wrote:

Sorry to bug you, but Paul and I seem to have heard completely different things at today’s appointment and I’m hoping you can clear things up.

I’m under the impression that barring any significant change to my condition, you’ll do a Jedi-worthy amniocentesis on Monday morning which will confirm binary-style whether the little man’s lungs have matured enough to be on the outside. If the test comes back with a yes, you’ll have me report to the hospital Monday evening to start the induction. If the amnio comes back saying baby’s lungs aren’t mature yet, we’ll hang out and do another amnio a week later to check lung maturity then.

Paul is under the impression that I’m not being induced until the situation becomes an emergency, and that Monday’s scheduled amnio is just to give us an idea if the baby could handle being outside the womb when that crisis time comes, whenever that is.

So, who’s got it right?

Sarah
——-
Hi,

As is probably the case in any disagreements that you and Paul might have, YOU heard correctly and Paul is wrong. Please feel free to refer Paul to this email throughout the rest of your life.

JKS

Sent from my iPhone

I LOVE my OB so freaking much. So we’re just hanging out for monitoring on Friday and then the amniocentesis on Monday morning. We’ll have results that afternoon, and either we’ll be at the hospital that evening, or we won’t.

I was totally expecting to get sent to the hospital today, but I got sent back home! Yay!

Dr. Schwartz re-did the fluid check and is confident he saw 5.5-6 worth of fluid in there. Heck, he even thinks there’s enough that he could do the amnio on Monday. He says he likes a challenge. My BP was fantastic today, with the diastolic under 90!! (I forget, it was 140-something/80-something.)

So I’m home now, gonna go take a nap. Monitoring and Group B Strep test tomorrow. We’ll see how it goes. I’ve got a monitoring appointment on Friday and the amnio scheduled for Monday morning.

Oh, and Dr. Schwartz obliged Paul while he was hunting for fluid and took some measurements. The little man is weighing in at just a tad over 5 pounds right now. Not sure about his length cuz the measurements were kinda all over the place, but the weight is a good estimate at least. Our little bag of sugar! :)

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.

Shortest appointment in the last two weeks! We were in and out in barely an hour!

Little man cooperated with monitoring and kicked and rolled over a couple of times. I gained back a half pound. So that puts me at 13.5 pounds total gained this pregnancy. I find it fascinating how these numbers bounce, since they seem to have no correlation with my actual size. But hey, I’m just happy I’ve managed to stay in a happy, healthy range. My blood pressure was better than it’s been in like two weeks: 147/90!!

Apparently, I have oligohydramnios or too little amniotic fluid. I’m drinking more, I swear I am. My fluid score was 6.7 today, so a teeny bit higher than it was on Wednesday, but still well under the 14 they wanna see at this point.

We were concerned because I’m feeling like ass about half the time, and my right and left feet/ankles were not equally swollen – which is something the lists of pre-eclampsia symptoms always point out, when one foot is markedly more swollen than the other. But the nurse said that as long as the edema wasn’t pitting and I could still move my feet, we didn’t need to be worried. That was nice to hear!

So I’m cleared for the weekend. Next appointment is on Monday. A week from then and we’re done!