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Pre-Eclampsia (33w4d)

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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.

Fetal Monitoring (32w4d)

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Today was my first experience with fetal monitoring. They did an ultrasound to see what position the baby was in and then took me to another room with a reclining chair for me to hang out in to be monitored. It took the nurse a minute or two to find his heart with the monitor, but once she got that thing strapped on, it was clear as a bell! (Actually, the baby started kicking the monitor which was funny to feel and hear!)

My blood sugar took a nosedive while we were there though. I’d had a super busy morning and a board meeting right before my appointment, so I just hadn’t eaten enough. I took my blood sugar and it was at 48, so I asked for and chugged some juice.

My blood pressure though… not good. It’s been 138/83 or lower this whole time. Today’s lowest was 155/96, and that was after I was done with the monitoring, so I’d been chilling out for a while. So they took some blood and another urine sample, and I’ve got the 24 hour urine collection to do tomorrow. (I did one when I was about 20 weeks or so as a baseline.) We’ll see. Dr. Schwartz says he’s not worrying about me yet so I’m not to worry either.

I feel the same though. Swelling hasn’t gotten any worse. No pain in my upper abdomen. I’ve had a twinge of a headache a time or two in the last week, but nothing severe or lasting at all. No weight gain since last week. (Shocking since I’ve been so dang hungry!) I’m trying to think positive and assume it was the busy/stressful day at work directly before the appointment or because my blood sugar was so low. We’ll see. If pre-eclampsia has started, we’ll figure out a way forward from there.

Unless something changes though, I’ve got an appointment for monitoring in a week, and then I go to twice weekly after that. FWIW, the baby monitored excellently today – Dr. Schwartz said he couldn’t be more pleased.

Tonight we went to our Baby Basics class, and were fairly disappointed. I didn’t learn anything at all. Paul at least got to change a diaper on a baby doll and we both burrito’d the doll and put a shirt on it. Some of the information presented directly contradicted what we’ve already learned in our Prepared Childbirth classes, and what we’ve read in books and online. So meh. Good to have the experience under our belts, but we’re both looking forward to the Breastfeeding class in two weeks much more. I figure between the couple of baby care books we have, my experience, and just fumbling along – we’ll be just fine.

Good appointment (20w6d)

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Great appointment today. Confirmed something important about our baby: it’s a little punk. Misty (Dr. Schwartz’s nurse) spent a good 15 minutes trying to coerce the little critter to show us the goods. We were looking up at it’s bum, like we were under the invisible little chair it was sitting on. But the baby just wasn’t about to open it’s legs and confirm what we thought we saw. The baby was flip flopping and bouncing around (maybe because of the two sips of OJ I had right before the ultrasound) but not about to show us what we wanted to see. DANGIT. Next time… (Misty and I both thought we saw something, but she wasn’t confident enough to call it.) It continues to seem odd to me to see the baby doing crazy acrobatics and I still can’t feel ANYTHING. Hopefully soon.

Dr. Schwartz was great about answering questions today, having been prepped by my e-mail last week. We covered a lot of things today:

  • I only gained half a pound!! Holy cats! I was totally shocked. I was honestly expecting a gain of 4-6 pounds because my clothes are totally fitting different (way tighter) and well…. I’ve been eating more than I ever have cuz I’m starving all the time!! Dr. Schwartz was happy to see the small gain, but cautioned me that I need to make sure that I actually am eating enough since the baby does need a fair amount of nutrition for all the growth it’s doing these days. He totally gets that my brainmeats are making it hard for me to eat as much as I apparently need to. At my next appointment he’ll be checking to make sure that the baby is growing and gaining weight as expected. But he was supportive (as always) that I must be doing things pretty well as far as nutrition and calories because my blood sugars are consistently improving, and my a1c results (like a 3-month diabetes report card) were down to 6.0 (from 6.5 and 6.3 the last two times it was checked.)
  • Speaking of proper nutrition, my Muscle Milks are TOTALLY FINE. Contrary to what the morons at GNC and Vitamin World yelled at me last week, there’s NOTHING of concern whatsoever for pregnant women to have protein shakes. The L-Arginine in the shakes (as a form of protein) is also found in most nuts. L-Arginine has been found to help with placental growth retardation, as well as preeclampsia: both of which I’m at risk for! (The lady at GNC was yelling at me that I was going to have a GIGANTIC, over-grown baby because of drinking protein shakes, and that my doctor was stupid for allowing them. Dr. Schwartz asked which GNC it was cuz he wants to have a word with them.) So I can happily keep drinking my yummy High-protein, Low-carb, vitamin-rich shakes. Hooray!!
  • The swelling in my ankles/feet is nothing to worry about yet. Dr. Schwartz thinks I’m just prone to swelling. (I’m getting a fair amount of swelling in my wrists too.) He encouraged me to continue to keep my feet up as often as possible. He agreed that striving for good hydration is a good idea, but that it won’t help this kind of swelling as much as it does for regular hot-weather swelling. He cautioned that it’s not gonna be fun towards the end of my pregnancy when it’s hot, cuz then I’ll have both types of swelling working together. Oy. (Oh, and apparently a restless legs / ants under the skin feeling in the evenings is normal too. Wheeeee.)
  • He also commented that towards the end of my pregnancy, he expects to see me twice a week for nonstress tests and whatnot. So I’m gonna have to work something out with him for scheduling, and work something out at work so that I burn as little of my paid leave as possible. (Maybe I can just not take a lunch EVER AGAIN.) I’m really concerned about my maternity leave. I’m taking as little leave as possible for my appointments, but any leave I take comes directly out of what I’ll be able to take when the baby is born. I have to take 8 weeks off because the daycare won’t take infants under 8 weeks – but there’s no way I’ll have that much paid leave saved up – especially if my appointments move to once a week or more. Unfortunately, we need both our salaries – so I’m not sure what we’re gonna do for several weeks that I’m gonna have to take off unpaid. I guess that’s what credit cards are for, right?
  • So, because I’m doing so well (blood pressure was lowest it’s ever been, blood sugars are consistently lower, weight gain is very small) I’m cleared for another 3 week appointment. No changes to my insulin or blood pressure meds for the 2nd appointment in a row! So I’m set for Wednesday March 24th at 3:00pm. (Dr. Schwartz is taking me as his last appt from now on so I can burn as little paid leave as possible – he just has to leave by 4:00 to catch his flight home.) Edit: I changed my appointment to the first of the day at 8:00am, because I actually lose less work time by going in the morning. Those first-thing appointments go fast tho, so I can’t always get them. There will be a full ultrasound at the next appointment to check growth and (hopefully) confirm sex for us.

Little Stinker… (17w6d)

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For those waiting with bated breath: WE DON’T REALLY KNOW. Sorry.

Our kid is a little stinker. The baby spent basically the entire time sitting on it’s butt, directly on top of my cervix. The tech tried and tried to jiggle it outta position, but nothing doing. (a couple of Andes mints didn’t help either.) She had a hard time even getting the measurements she needed for the anatomical ultrasound (femur, abdomen, head) because the little critter wouldn’t cooperate. And the couple of times it did move where we could get a look: it put it’s hand(s) between it’s legs.

But the good news is that Dr. Schwartz says everything looks fine. Some of the measurements are measuring “ahead” by nearly two weeks, but Dr. Schwartz says that’s because Paul and I are both tall, so we’re having a tall baby. It’s weight clocked in right at 8oz.

For those interested or who know what on earth this relates to:

  • Head Circumference: 16.25cm (6.4″)
  • Abdominal Circumference: 12.42cm (4.8″)
  • Femur Length: 2.5cm (1″)

The heartrate came in at 161, so according to old wives – it’s a girl. Dr Schwartz and the tech gave us a guess, but they both strongly cautioned us not to paint anything yet. I tried to explain to Dr. Schwartz that I’m a planner and I really need to know… he chuckled, told me to deal, and then listed his favorite neutral nursery colors.

Paul’s mom Jeanne came along today and seemed to really enjoy herself, especially when the tech turned up the sound and the WHOOSH-WHOOSH-WHOOSH of the baby’s little galloping heart stopped our chatter for a moment. I wish the kid would have cooperated a bit more so she could have seen it wave and face us like Paul and I have seen before. I invited her to come to the next appointment if she wanted to, since we’ll try again then to get/confirm the sex.

In the meantime, there’s new pictures that I screen grabbed from the DVD we got today. (I’ll get a DVD of the next appointment too.) They’re mostly body parts, but there’s a couple cool profiles – and an awesome 3/4 full face image from the heartrate image. It’s small, but if you’re good at all for looking at ultrasounds, I think you’ll see it. It’s kinda like the face on the moon… the baby is looking to the left. You can see the chin, lips, nose, cheeks, forehead and a dark hollow where the left eye is.

Blurry face
Labeled blurry face

The rest of the appointment was pretty ordinary. Insulin and one BP med were upped a tad. Weight is up .5lb for a total of 4.5lb in 18 weeks – just fine. My next appointment is in 3 weeks, which is great. The fewer appointments I have for a bit, the less paid leave I have to burn. (Last week’s illness cost me 3 days of maternity leave…) They drew blood for TSH, a1c, and the 2nd part of the quad screening. (Dr. Schwartz took a copy of a bill I got from the lab for $700 worth of “genetic” tests that my insurance is denying from my first visit in November… I LOVE that he’s willing to take on that kind of stuff for his patients.)

So for now I guess we’re looking at more gender neutral stuff, since we might not find out the sex of our little stinker until July!

No news on sex, but good info (13w6d)

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Quickest appointment yet today. But I guess I’ll be having more like this for the next couple of months.

Took a quick look at the baby, mostly to check the heart rate (160, just like it has been.) Didn’t get a measurement, but the critter obviously bigger than it was two weeks ago! (According to the intertubes, it’s 3-3.5″ or roughly lemon-sized.) It was just kicking back, with it’s arms up, like laying in a hammock. The tech got two pictures, but they’re pretty fuzzy. It was bobbing it’s little head, but not dancing like last time. (This appointment was at 3:00pm, whereas my others have all been before 10:00am… so maybe afternoon is siesta time?)

Dr. Schwartz went over my 1st trimester screening results with me and things are looking great.
Downs Syndrome result is 1:4800 (chances of the baby having DS are one in 4800 similar births.) The baseline chances for someone of my age with my health profile was 1:320, so the actual test results tell a MUCH better story.
Trisomy 18 result is 1:2350, which I guess is very good. Dr. Schwartz says anything over 1:100 is fabulous.
Based on these numbers and the great results on the nuchal fold screening, there’s no need to seek further testing (like a CVS or amnio) at this time.

My a1c is down to 6.3 from 6.5 when I first got pregnant. (The a1c is like a 3 month report card on my blood sugar control. Anything below 6 is non-diabetic territory, so I’m doing fabulous in this regard which basically negates any diabetes-related risks to the baby.) Thyroid is creeping up a little, which is expected. My thyroid meds will prolly get adjusted at my next visit, if for nothing else than to negate the fact that I’ve got 30% more blood volume now. My blood pressure was lower than it has ever been – which means the new med (Methyldopa) that was added to my regimen last time is working. Still on the high side, but Dr. Schwartz was happy to see some movement on that, finally.

I e-mailed Dr. Schwartz yesterday with a couple of questions, so he’d be ready to be interrogated. Got some surprising answers, not what I was expecting from the reading I’d been doing in books and online.

Delivery: Currently Dr. Schwartz is planning on letting me go to 39 weeks – so delivering around 7/10/10. (If I went to 7/11, this would be the 3rd kid in my family with that birthday, which includes my brother!) He wants to avoid a C-section if at all possible. Vaginal delivery has a lot of benefits to the baby, but mostly he doesn’t want me to have to deal with recovery from abdominal surgery. He feels that at my current weight and as a diabetic, recovery would be less than optimal and that I would be in a lot more pain & have a longer recovery than average. He’s totally open to a C-section if it becomes necessary, but has every intention of inducing me first and letting me at least attempt to labor. He said that actually he expects me to do well with a vaginal birth. So YAY for that. I’m not all crunchy granola and ‘needing’ to try to push the kid out – but I’m totally open to the experience. I am also totally open to the epidural as soon as they’ll let me have it. :)

OMG pains: Apparently mostly what I’ve been experiencing in the last two weeks has been “low pelvic pain” as opposed to “round ligament pain” My pelvis is splitting apart and it’s totally normal. Hurts like hell and scares the crap outta me when it takes my breath away or wakes me up in the middle of the night, but it’s normal. So whee and hooray for being pregnant.

Bedrest: Currently not a big concern. Dr. Schwartz says I’m doing fine and that he avoids complete bed rest if at all possible. Apparently high risk pregnant women are at higher risk for DVT (blood clots) when on complete bed rest. He didn’t rule out modified bed rest for the last month or two though – which would mean that if I’m not at work, I’m home with my feet up. (Honestly other than the fact that modified bed rest would mean baby/house prep has to be done sooner, being ordered to go home and put my feet up sounds pretty good actually.)

Next appointment is first thing in the morning on Wednesday the 27th. Dr. Schwartz says we’ll try to figure out the sex at that appointment, but if we don’t get an answer then we will for sure at the next appointment which will be the “big” anatomical ultrasound. So hopefully we’ll know soon!