Saturday, July 31, 2010

Bump Check- 27 weeks

This week has been all about the heartburn. Seriously. All day, all night. I get heartburn no matter what I eat or when I eat it. I get heartburn from drinking water! Sometimes, in the rare moments that I don't have heartburn, I worry that if I eat or drink anything, it will come back- so despite being thirsty, I don't drink anything.

It always comes back, no matter what I do, though. And nothing really helps. I've tried it all.

I will not miss the heartburn one bit.

Other than that, things are going well. I did my GluCola challenge on Monday afternoon, and we will find out the results at my appointment on Thursday. I also talked to Abigail about being in the delivery room; she wants to be there. We were torn at first, worrying that it is too graphic for a child, but then it occurred to me that I think one of the main things wrong with the way young girls are taught to view childbirth and even their own sexuality is that very little of it is based in reality. In other areas of the world, it is totally natural to have your children present at the birth of their younger sibling, especially your female children. I think this helps girls learn a healthier view of childbirth and sexuality than what they learn from popular culture.

In addition, Abigail is really fearful about me being in the hospital, so much so that if we didn't have contraindications for a home birth, we would strongly consider it. I am not sure why she is scared of the hospital, but my guess is that it has something to do with the fact that John and I talk about people dying at the hospital (it's a reality of our work.) The girls go for a "big sibling orientation" at the hospital in a few weeks, which will give the kids a tour of the L&D/post-partum area and talk about what to expect when I am in labor. I am sure this will help Abigail a little bit, but mostly, I think she will feel better knowing that she can keep an eye on me.

We also have set realistic expectations for Abigail being at the hospital. We plan to bring a laptop and headphones so that she can watch movies while I am in labor. In fact, she will pack a bag, too- a "fun pack" of stuff to do, change of clothes, PJs, toothbrush, etc. We believe it's best if she is present but not necessarily "engaged" in the situation more than she is comfortable with... for instance, I don't think she needs to have the "doctor's view" of the delivery, although if she wants to, I don't care if she does (John and I call this the "natural sex deterrent.") We also have a plan so that if she decides she doesn't want to be in the room, she can leave. The idea is not to force anything. I think it will work well for Abigail- that's just the kind of kid she is. I don't think it would work well for Anna, even if she was older. That's just the kind of kid Anna is.

Recent name ideas from the girls include Hope (for either a boy or girl), and Christmas (for a boy, according to Anna.)

Monday, July 26, 2010

26 Weeks Bump Check

First, I need to clean our bathroom mirror.

Second, we hit the 26 week mark on Saturday, July 24. If I can make it another 10 weeks, I will be "term." If I can make it another 8 weeks, I will have exceeded expectations:) If I go another 6 weeks, I will be pretty satisfied that our baby will be healthy and have a relatively short NICU stay.  (If I go another 12 weeks, I will basically have to try all those home remedies for self-induction!) The idea of going to term suddenly seems much more realistic and reachable.

Depending on who you talk to, the third trimester has started, is starting, or will start at the end of this week... it really feels like an accomplishment, while at the same time bringing with it a bit of urgency to make sure I have the basics ready (ie, crib, car seat, diapers, breast pump, clothes.) The baby is going nuts and actually woke me up this morning with some ferocious karate (Ross-style.) Nugget is approximately 14" long and weighs 1.5-2 lbs. I continue to sound more and more like a bowl of Rice Krispies with all the joints loosening and popping, although since I have not been working a ton, my back is not feeling too bad. My fundal height is still right on target:)

Big plans this week include work, and the wonderful GluCola challenge/3rd trimester blood work! I plan to do that this afternoon, as long as my stomach calms down a little. That stuff totally made me want to barf when I was pregnant with Abigail. Then again, everything made me want to barf when I was pregnant with Abigail, so I guess that is not a reliable predictor.

Saturday, July 24, 2010

Bumpdate- 25 weeks

On Thursday we had our 25 week doctor's visit. There's not too much to be said about that- more of the same with the whole "we can't predict what is going to happen so monitor for any changes or anything you feel is not normal."

I really hate that word: normal.

Maybe it's because I think at the core, we all have worried that we were not "normal" at some point. I mean, isn't that what junior high school, and even part of high school, and heck, maybe even a good part of your early 20s  is kind of about... that fear that maybe you aren't going to find your place in this world because you are just not normal?

Maybe I speak only for myself, but even so, the frequent reminders to call with anything that doesn't seem "normal" has me so on edge. Because I am not sure if I know what normal is... or if I even know what "normal for me" is. It's just so freaking subjective!

Anyway, the Nugget's heart rate was 162 beats per minute and my fundal height was measuring right at 26 cm. So, by all objective measures, thins look good. I feel pretty good, too- except for the worry that I am not "normal" and am thereby going to miss some important clue that something is going wrong.

Next week I get to do the lovely glucola challenge. Yum. Or not.

Friday, July 16, 2010

Bumpdate 24 Weeks- And a rant.

First of all, my belly looks smaller than last week. Smaller, but pointy-er. Like the baby is not up in my stomach so much as down in my gut. Either way, the Nugget is all up in my organs. Particularly my diaphragm, which I am sure has been injured resulting in a hiatal hernia... hence all the heartburn. Thanks, kid:)

So, the good news: cervix is 2.6cm! And maybe I don't have to be high risk- just intermediate!

The bad news: my appointment sucked. Not that the doctor didn't tell me all that they know about my situation and discuss options given the various outcomes. He did. The problem is that that there is simply not much known about my particular situation. To be honest, most women who experience pre-term labor/delivery do so based on a few particular circumstances: pre-eclampsia/eclampsia (dangerously high blood pressure), trauma (injury of some sort that induces labor or causes a woman to be unable to continue carrying a child safely), drug abuse, or women who have a history of pre-term labor with or without cervical incompetence.

I do not fit any of those categories. The reason I am at a higher risk is because of the history of surgery I have had, including a major surgery on my cervix in August, 2009. There is no category for me. The number of women of childbearing age who have had the surgery I had last year and then gone on to conceive a child are few... un-studyable. Certainly, if anyone in the OB/GYN department at my institution has dealt with a woman with my history, they haven't told me or any of the other doctors (I always knew I was special.)

Since we can't really compare me to a similar group of people, we  really are in the dark about what to expect. At this point, things could go very wrong, very quickly... or not. My cervix could drastically shorten and open unexpectedly... and just as equally I could experience a failure of the cervix to open when it is supposed to! Or, things could be absolutely perfect for the rest of my pregnancy, and I could avoid the problem I had when I was pregnant with Abigail (low amniotic fluid) and have no complications from my clotting disorder. We just don't know. Which is terribly frustrating.

And which is why I was referred to the experts. Because while they don't know things- while they can't predict the future any more than you or I, they can certainly give an opinion. As a nurse and a doctor, John and I are rarely interested in opinions of health care providers, but in a situation like this, where he and I are both out of our element and where there is no "fact" available, we are looking for an educated opinion. That's really all I wanted.

And that is the one thing I didn't get.

I asked specific, reasonable questions and got crap for answers. The doctor continually stated that I should make the team aware of any "concerns", but when I asked how I should know when I to be "concerned," he gave me nothing. Are there any signs of a shortening cervix other than bloody discharge that I can look for at home? No, not really. Is there any way for me to tell if my contractions (which I have been having for weeks) are causing cervical change? Nope, although they can check me out if I go into the Labor and Deliver department. So how do I know when to be "concerned?" Well, just be aware of changes was the response that I got. Repeatedly I asked what kind of changes or what kind of symptoms I should look out for, and I got not a single objective measure. The doctor continually told me that if I "felt" different, I should be concerned... if things didn't seem "normal," I should call them.

Let me just rant for a moment...

1. I am pregnant. I "feel" differently all the time- literally from moment to moment. My feelings are volatile. Do you really want me to call you every time I "feel" different?

2. I am not sure I know what a "normal" pregnancy is supposed to "feel" like. In many ways, Abigail's pregnancy was so much more difficult than this pregnancy- I was vomiting constantly, more exhausted than I am now, and never once had a painful contraction until I was in active labor. This pregnancy has had shortness of breath, chest pain, intense contractions, heartburn, and very little vomiting- as well as off-the-charts levels of stress. Are either of those a "normal" pregnancy?

3. Why is he putting everything on me, as if it's my job to know what is "normal" in pregnancy? And why can't he give me any objective rather than subjective measures to guide my decision-making? We don't tell diabetics to go to the ER if they "feel" abnormal, we tell them to check their blood sugar and come to the ER if it is above or below certain numbers. We don't tell people to avoid their blood pressure medication if their heart rate is below normal- we tell them to avoid it if their heart rate is less than 60 (or 55, or 50 or whatever) beats per minute. So why am I being given subjective terms like "normal" and "feel."

4. I am all about trusting my gut- as a nurse, I do it frequently. But when there is a baby in my gut, I don't think my gut is very reliable.

5. Do you have any idea how stressful it is for me to think that if something were to happen- if something were to go wrong, it would be because I had a messed up sense of how I was supposed to "feel" and whether the way I felt was "normal"? I HAVE ENOUGH MOTHER-GUILT. I DON'T NEED ANYONE ADDING CIRCUMSTANCES THAT WOULD ONLY SERVE TO INCREASE MY GUILT LEVEL!

End rant.

So, not the most fulfilling doctor's appointment. We will meet back with my intermediate risk doctors next week and hopefully get a better idea of what we should be doing/not doing/monitoring for, etc...

On the other hand, the high risk doctor thought it would be okay to return the the "honeymooning" that John and I were missing out on:) Now, if only my stress level wasn't through the roof, John might be a happy husband!

Monday, July 12, 2010

The V Word

Warning: This may be a controversial post for some. I am not trying to be offensive in any way- just sharing our thoughts about a sensitive subject. You don't have to agree with me by any means; as a matter of fact, I expect very few of you to agree with me. That is fine- in such a personal matter, we can only come to truly know our own beliefs through deep introspection, and this post is the result of such for John and I, which has been fueled by our own experiences as well as through examination of research. Please know that I post this with the utmost humility and sincerity, respecting the sanctity of human life.

The V Word. Kind of a dirty word, in a way... a word that makes me feel dirty, somehow. But not really "dirty" the way a cuss word is dirty, nor greasy the way it is when speaking the word "moist." More like unsettling- like the feeling the word "scabies" induces in me- minus the itching and grossness.


It's a clinical word- a word we don't use at home. Technically, our baby achieved the age of viability on Saturday, the 24 week mark of this pregnancy. However, viability at 24 weeks is only truly viable if the baby weighs more than 500 grams (a little over 1 pound.) Under 500 grams, the babies don't really live- or at least, don't live long, even with advanced medical interventions. My sister works in a NICU where they are well-known for pioneering interventions to keep tiny babies alive- they top the list of hospitals to have discharged the smallest babies. But even those tiny babies were gestationally older than our baby is... at this point- between the 24th and 28th week, our baby will go from needing a ventilator and extended NICU stay, to being able to breath fairly well without a ventilator and only needing a relatively short NICU stay. Even still, NICUs and Neonatologists around the world are trying to figure out how to keep babies that are not even at the 24 week mark alive, even if it means they live their entire lives hooked up to machines. And even if it means that many of them will not make it past the one month mark- let alone into childhood.

There are stories out there of babies who were 24 weeks- or even younger- and did amazingly well and had outcomes far greater than what could be expected of a baby of comparable gestational age. While I am not one to discount miracles, I often think that those babies were probably older gestationally than they were thought to be. I mean, how many women can pinpoint within 24-36 hours the time that their baby was conceived (besides me)? More than 50% of babies in this country are "surprise" babies, and women are often shockingly uncouth when it comes to the intricacies of their fertility cycle, not to mention that all women are assumed to have a 28 day cycle when determining gestational age, and many, if not most women who are not on birth control do NOT have a 28 day cycle.

But anyway, the V word came up at our last OB visit. The doctor said flat out that now that we were close to viability, we need to consider every decision that would remove me from immediate access to top-tier OB and NICU care (or at least the best of what is available in our area. Which isn't really too shabby- you know, my hospital delivered and cared for the Gosselin sextuplets. And I've been seen and examined by both of the OBs mentioned in that article:) While I agree with the doctor in some ways, it really did freak me out.

I guess, up until this point, I knew that if something were to happen, knowing that medically the baby did not meet the criteria for viability, John and I would be completely in control of the decision-making. We would get to choose to deliver or try to stop the baby from coming based on what was safest and best for both the baby and I. If we delivered, we would be in control of that situation, too, knowing we could choose to simply kick everyone out after the baby was born and just be alone with our angel.

But suddenly, knowing the baby is "viable" (and our little Nugget is estimated to weigh over 500 grams right now), we as the parents get fewer choices. Suddenly, if something were to happen, the decision-making would be skewed, and the power placed into the hands of the neonatologists that might have different priorities than we do. The OBs would almost certainly defer to the advice of the neonatologists, and this would no longer be about John and I and the life I am carrying, but about a baby whose parents are just trying to hang on during the crazy ride that is life in the NICU.

Don't get me wrong, I admire and respect neonatologists. I have a huge amount of respect for NICU nurses- it is a field of nursing I don't think I could ever pursue. But sometimes, I think that we as parents have different priorities than they as health care providers have.

John and I are big proponents of palliative and hospice care in the patient population that we serve. We feel that length of life is secondary to quality of life. Often, when patients are facing circumstances where they can prolong their life without having any quality of life- sometimes without even the capacity to think, feel, or engage in life, there is a group of care providers who want to keep fighting for prolonging life, and there is a group of providers who wants to focus on bringing as much meaning and fulfillment into the remainder of the patient's life. This is a discussion that is often made easier when the patient is of advanced age and deteriorating health- I mean, most people feel better about palliative and hospice care when you are talking about your 95 year old grandma who already has had dementia and 2 strokes. It's harder when you are talking about options with the 62 year old gentleman who is awaiting the birth of his first grandchild while his cancer wreaks havoc on his body despite all the chemo and radiation we can throw at him. But, John and I both strongly feel that despite the circumstances, our focus should be on helping patients achieve the quality of life they want. Which means, if what they want is to die knowing that every option was exhausted- even knowing that their chemo was killing them, then we should do that. But if what they want is to die surrounded by family and friends, pain-free and peaceful, then we have an obligation to make that happen to the best of our ability.

We feel this way because we believe that it is not the beating heart and the exchange of oxygen and carbon dioxide that make a life. Life is truly so much more than biochemical processes. Living is more than keeping cells alive and reproducing. And even thought we often have medical technologies that can keep those biochemical processes going- sometimes indefinitely- they should be used with discretion. Just because we can treat doesn't mean we should. As the providers, this is rarely, if ever, a decision that is left to us. This is a decision that the patient- if they are able- and the patient's family must make together. But we as the care providers are there with them as they make these decisions.

We believe that a baby, regardless of gestational age at birth, is a gift. The life of that child is precious, unique, and a great responsibility for us. It is our job as parents to foster our children's quality of life, not just length of life.

And at 24 weeks gestation, just because we can continue the biochemical processes through technology doesn't mean we necessarily should. As providers, we know this. As parents, we feel strongly about this. As a person of faith, I know that miracles can happen, but I also know that I am not the person choosing who is granted a miracle. I also know that miracles will happen without regard to the medical interventions we provide, and sometimes in spite of them. I choose to put my faith in God, not in man- not meaning that we discount the medical technologies, rather that we chose to use them with discretion.

But at the end of the day, neonatal care is one area where no decision-making is given to the patient (obviously) and very little is given to the parents. Options for palliative care- care that focuses on quality of life rather than length of life- are few. In fact, while I don't know the exact procedure at our facility, I do know that in some circumstances, parents have been stripped of their decision-making rights and children have been placed in protective custody over the choice to treat or palliate neonates. I mean, these doctors are neonatologists, not perinatal palliative specialists- their priorities are to treat and prolong life. And sometimes those who don't agree with their decisions get plowed down- even if it is the parents.

Again, I don't want to say this is true, necessarily, at our facility. But I do know that having reached the age of viability, there will be tremendous pressure on us as the parents to allow the neonatologists a free hand in determining the care our baby would receive. And we don't know that we would agree to using all of the interventions that medicine has to offer. We can't say now what we would  or would not do as so much of our decisions would be based on the baby and how he/she was doing as well as gestational age, but the point I am trying to make is that we want to be able to make the decisions that we feel are most respectful of our child's life and purpose in this world. And having reached a point where science and medicine become single-minded in goals of treatment, we want to keep our options open.

Viability means being capable of living. But the definition of living is what I question in the world of neonatology. Knowing that our definition and the definition of the doctors might be very different makes me nervous... and sad.... and in a way, it makes me feel a little bit dirty. Not because I think my definition of living is wrong, but rather because I think the doctor's definition of living is so removed from what life really is. I think medical technology has perverted the meaning of living and reduced it to a series of cellular processes. And I want our baby to have more than cellular processes, even if it means it is only for a few moments that our baby gets to truly live.

Sunday, July 11, 2010

Bumpdate 23 Weeks

Well, now we've gone and done it!

We had our 23 week OB visit on Monday, followed by a cervix check on Tuesday. At our OB visit, a few things were decided based on the "borderline" cervical measurement from last week.
1. I am not to be traveling- if something were to happen, I would have the best chance of getting the best and most appropriate care from our team at our hospital because they know me and have all the records (as well as a plan for what to do if something did go wrong.)
2. I have been "upgraded" from "intermediate" risk to "high" risk. Yippee! In some ways, this was a bummer (who wants to be told they are high risk?) but in other ways, it's totally cool. High risk was managing the cervical checks, but intermediate risk was managing ME, so it was a little difficult to know who was in charge or who my main "point person" was. This way, we are down to one service line, and since high risk will be following us the rest of the pregnancy, concerns about low amniotic fluid levels will be easily managed. Hopefully.
3. I freak out when people bring up the "V" word. Not in the doctor's office, but at home. And I am thankful I have a husband who knows what to do when I am on the verge of loosing it. (I will post about the V word later...)

On Tuesday, we had much better news:) My cervical length INCREASED from 2.3 cm to 2.7 cm!!!! This is, I am assuming, fairly rare (I don't know, because part of controlling the freak out is NOT consulting Google, much as I may want to:) This doesn't mean that we are out of the woods, it just means that we are good for now. We will have one more cervical length measurement next week, and again we will make decisions based on that measurement.

We won't be doing more cervical length measurements after the 24th week, because at that time it becomes a matter of "pre-term" labor rather than cervical incompetence (which, in this particular case, seems to me to be a matter of semantics, but whatever...) This is especially irritating because I have been having contractions, and we are not sure if they are related to the cervical changes or not... if they are, then it is considered "pre-term labor" after the 24th week, as "labor" is contractions that result in cervical change (which is why "false labor" is false... it's contractions that don't result in cervical change.) So I guess I will be asking a lot of questions at our next appointment. I mean, without routine cervical checks, how do I know when I should be concerned about my contractions? Some of them have been pretty intense (and that is saying a lot considering I KNOW what contractions feel like... what triple-peaking-never-ending-only-30-seconds-between-them-and-no-pain-meds-to-take-the-edge-off contractions feel like. How do I know when to call the doctor? Very frustrating. And definitely a semantic discussion far too detailed for me.

In other pregnancy news.... I am feeling, well, huge. And heartburny. I can feel the Nugget doing all sorts of yoga or Pilate's or something, and let me tell you, my diaphragm doesn't like it! As a matter of fact, the assaults on my diaphragm are probably why I am so heartburny- I probably have a hernia now! I also have some very beauteous swelling in my ankles when I work all day, despite my industrial strength lederhosen.

Anna things that if the Nugget is a girl, we should call her Abigail. So that both of her sisters are named Abigail. Easy enough to remember, I guess:)

Abigail took one look at me on Wednesday and said "Wow, your belly has gotten bigger!" Granted, she hadn't seen me since Sunday afternoon (spending time with her grandparents) and I was wearing a new maternity shirt that did increase the appearance of my bump, but still... it kind of made me feel, well, huger than I was already feeling.

One of the girls at work said she things I am having a boy, because I "still look the same." She as following the adage that girls steal your beauty and boys steal your energy. She said I looked good (thanks:) but was always saying how tired I am. And so it must be a boy. John is stoked and finally has an old wives' tale that he can put some stock into:)

My grandma is becoming a bit forgetful. Which, at nearly 90, is okay. My mom told her that I was pregnant at the end of my first trimester when we officially announced it to the world (or at least to the rest of our family, co-workers, and Facebook/Interneters.) When my mom told her I would not be coming out to Chicago at the end of the month, she acted as though that were Totally New Information (think: Phoebe on Friends) and claimed she didn't even know I was pregnant. Um, okay:)

Oh, hahahahah! The joke's on John! The doc said Monday that any unnecessary "wear and tear" on my cervix should be avoided. That means John has more than just a 6 week post-partum wait... he has the rest of the pregnancy (however long that is) PLUS the 6 weeks post-partum! He thinks that by accepting this and not fighting against this new edict, it will inevitably force nature to prolong the pregnancy as long as possible, just to test his resolve (reverse psychology, maybe?). Yeah, we'll see:) For now, he is getting an awful lot of teasing from his parents. His mom told him that this is what he gets for knocking me up so quickly. My mom thinks that this is what he gets for thinking that now that he's married he gets to do "it" ALL THE TIME. And at the risk of over-sharing, I will say that sometimes I think this is God having mercy on my poor, exhausted body... I feel way less guilty about going straight to bed every night since our options for evening entertainment have been limited to Netflixing the BBC version of Robin Hood, playing with the cats, and voting for Jose on So You Think You Can Dance.

In all honesty, though, this has really made me appreciate my hubby on a whole other level, because he has not made me feel bad about any of the restrictions (travel/vacation, work, sex, or anything else that might come up) the way some guys have been known to guilt their ladies. In fact, he is nothing but supportive of my and the Nugget's health and well-being, even if it means working harder and crazier hours to save up for a very unpredictable future, while knowing that all that waits for him at home is an ever-expanding wife who has managed to zap the "honeymoon phase" out of the first year of our marriage. I love that guy.