Wednesday, March 27, 2013

Seven days, six appointments

Getting ready to head to Georgetown for appointment number 2 of 6 in one week's time. The good news is that I really, really liked the OB I'm switching to at Georgetown. I think one of the nice things about dealing with a practice that handles lots of high risk cases is that they are more laid back. Which was a nice change from the anxiety inducing appointments with my previous OB. (Don't get me wrong - I love my normal OB, she's smart, and kind, and always ready with a hug when I need it. But she's very stressed about my pregnancy, which made me very stressed about my pregnancy!)

He's all for my plan of letting the baby stay in utero for as long as possible, as long as everything looks good in terms of growth progress, BPP, etc. He actually also thinks I'd be OK going into natural labor and trying a VBAC (not sure how I feel about that yet....)

So I decided to take his advice and also see the MFM team at Georgetown. The downside of that is they want to repeat all of the testing. Which means that in addition to the weekly OB appointments, I've got an MFM consult, U/S for growth and anatomy, NST, and BPP all scheduled over the course of a week.

Did I mentioned I really don't live anywhere near Georgetown?

This is in addition to our regularly scheduled appointment with the fetal cardiologist and tour at Children's Hospital.

My life is starting to feel like an endless series of medical appointments... But I guess it could be worse - I could be on bedrest or monitored full time in the hospital.

And I'm very curious to see whether the measurements with the new MFM are any different than with the previous. My fundal height is at 34 cm at 35 w+4 d, which isn't nearly as far behind as the measurements have been showing. Maybe some good news for a change??

ADDENDUM: Make that 7, 7 appointments in 7 days!! Ha,ha,ha,ha... (as the Count on Sesame Street would say). We've added a NICU consult to the list.

Friday, March 22, 2013

Oh, the difference a doctor makes...

Went in for another BPP today. As usual, overachieving bean scored 8 out of 8. And got to see lots of fuzzy adorable baby hair on the U/S!

Actually saw a different MFM today - the same one who did my amnio, and who I found very reassuring. Well, I again found him incredibly reassuring. Unlike the MFM I normally see - who, don't get me wrong, I like very much - he was way less concerned about the baby's size. Basically he said, "Yes, the baby's a little small, but is progressing. And it's the progress we care about."

Right on.

Tuesday, March 19, 2013

Missed the happy window

Should have posted yesterday. Was happy yesterday. Fundal height had increased. "You would never know the baby's small," said my OB. Got my hopes up...

Bad scan today. Only gained 5 oz in two weeks and baby is falling further behind on the curve. Have to go in for twice weekly checks now.

So sad I can't even type about it. 

Saturday, March 16, 2013

Oh, the drama...

Things always seem worse at night, don't they?

Yesterday was a rough day.

First, some background. In an odd coincidence, in my small office of about 2 dozen people there are four of us expecting in a three week period. Weird, huh? So the first of my colleague's wives had their baby girl a couple of days ago, a little more than two weeks early.

I found this to be a stressful reminder of how much I have to finish up, work wise, before bean arrival. So between that stress and this unshakable, hacking night cough, I ended up coming down at 4 AM yesterday morning, wide awake, and getting some work done. Not such a bad thing, really, since it made me feel much better to be productive.

At work, I learned that another co-worker thought his wife had gone into labor the night before - turned out to be a false alarm, but another reminder that babies come when babies come. It didn't help that all day I was plagued with contractions. Not regular, so not worrisome, but intense.

Fast forward to the end of the day. As the evening wears on, the Hacking Night Cough (or HNC, as it shall now be known), got worse and worse. So I settle down to do my evening kick count.

Nothing. Not a peep from the bean.

At first I don't worry. Honestly, the HNC was so intense and it was driving up my own heart rate so much, it was hard to even tell what was going on inside.

But hours begin to go by. I try all the old standbys - juice, belly wiggling, shower. A couple of minor twitches and that's it.

I begin to fall apart around 11 PM. Mostly, I think, because I just really don't feel well. The HNC is getting more and more intense, coughing to the point of retching, white lightning bolts across my eyes, searing pain in the chest. And still no movement from the bean.

My husband tries to reassure me. I cry, I try to go to bed. I toss and turn. No baby movement.

At 1 AM, I decide to call the doctor, because everything in me was screaming something is not right. On a tangential note, I feel like this pregnancy has wreaked havoc on my gut instincts. Every time I feel everything is great, I get bad news. Just when I'm feeling the sense of doom, everything looks fine. So it's become very hard to trust myself.

As it turns out, it was my actual OB (it's a medium sized practice) who was on call at the hospital last night, and she basically said she wasn't too worried, and I should drink some more juice and give it a little time, but I was welcome to come into L&D and get hooked up anytime I needed reassurance. She virtually held my hand, patted me on the back, and told me I wasn't going crazy for being paranoid. And she casually mentioned that steroid injections can change a baby's activity levels.

A little reassured, I drank some more juice, felt a small flurry of movement at 2 AM, and that was enough to relax me to go to sleep, as well as I was able with the plague of HNC.

This morning, I got up early, as the house was quiet and sleeping. Crept downstairs for a big glass of juice - orange juice, which I happen to hate - and lay on the couch to do another kick count during one of bean's normally most active times.

Nothing. A tiny little flutter and then nothing more.

As I lay there trying to decide if I really want to go to the hospital, it resurfaces in my brain that my OB had said something about steroids changing fetal movement.

As it turns out, this is a documented thing - described in the peer reviewed literature and everything: http://www.nature.com/pr/journal/v57/n5-1/full/pr2005107a.html

This study, for example, notes that at older gestational age (34 weeks in that study, which is exactly where I am), steroid injections were more likely to cause a transient decrease in fetal movement. No big deal, returns to normal 1-3 days later.

If only someone had bothered to mention that.

Thursday, March 14, 2013

A bemused rant about the healthcare system

So after chatting with my army of doctors, I decided to go ahead and get the steroid injection.
For reasons I completely do not understand but expect has something to do with Medicare billing,  these shots must be done at the hospital,  in labor and delivery. My doctor made it sound so simple: I'll tell them you're coming,  just pop in this afternoon,  get the shot, come back tomorrow at the same time, get shot two all done.

I figured I was taking sick time from work anyways and in a unprecedented move had cancelled the class I was supposed to teach that night. Plus there had to be worse places to feel dreadfully sick than in a hospital. So I dragged myself out of bed, put on some clothes, and head up to the labor and delivery department of the hospital where my son, Shea, was born.

The friendly staff there immediately send me back downstairs. Turns out you have to be admitted to the hospital. To get a shot. Sigh, of course you do.

Much paperwork later, I am back in L&D, where they tell me the first step is to do a 20 minute non stress test. To get shot. Sigh, of course you do.

If I had known this, I would have chugged some juice before coming in, to give the bean a bean a little jolt. Because bean slept through the entire NST. And because we failed the test miserably, I needed to be sent for a BPP. My last one, you may recall, was the day before. Perfect score and all. Sigh again.

So they leave me hooked up to the monitor while waiting for the ultrasound and of course bean chooses that time to begin the cha cha. Good news, NST results now look great. Bad news, they've already ordered the BPP, and now can't back away from it. To get a shot. Sigh.

So I wait for my official transport because heaven forbid I walk down the hall and get my BPP. In which the ultrasound technician asks, puzzled, why are you here for decreased fetal movement? The baby is moving all over then place! Yeah, tell me about it, lady. Second perfect BPP score in two days.

Finally, the shot is given. After two hours of hospital testing, it takes all of 2 seconds. Sigh, of course it did.
I am assured the next day I will need no monitoring and can just get the shot. This, of course, was an enormousn lie. Next day, right back to the NST. Bean was apparently also fed up at this point, and decided to put on quite a show. Kicked the ass of the NST. Good bean.

All of this to get two injections with allegedly no side effects that I probably could have administered myself. And we wonder why healthcare is so expensive!

On the bright side, everyone was very nice. And my cold seems to be improving. Plus, having been basically continuously monitored for three days, I am feeling pretty confident that bean is doing just fine. 

And ending on a wistful note, the whole experience made me a little sad I won't be delivering at this hospital again (because I need to switch to one with a tertiary care NICU). Everyone there really is fantastic, and the admissions clerk proudly told me on my way out she had gone ahead and done all the pre-registration paperwork for my delivery there so I wouldn't have to worry about coming back in to do that. I didn't have the heart to tell her I wouldn't be back. 

Wednesday, March 13, 2013

Sick and confused

So, I'm sick. Full out cold-turned-into-something-nastier sick. Cancelled a big time work commitment and cancelled my class tonight - which I've never ever done before - because I feel so awful.

The call from my OB didn't help. She wants me to go in to get steroid injections for the baby's lung development. She was very doom and gloom. Says it won't hurt and if I deliver early will be glad that I did it. Called my MFM for a second opinion. They seem to be delivering such conflicting messages.

Can't stop crying. And throwing up. Which is depressing because I'm working so hard to hydrate and eat lots for the baby. Totally wasted on tears and vomit.

Amazing how I can go from totally happy to total despair in 24 hours. Stupid doctors.

Tuesday, March 12, 2013

Water, water, everywhere...

"Waterwaterevery where,: And all the boards did shrink: Waterwaterevery where,: Nor any drop to drink."

Unlike the Ancient Mariner, it is not a lack of water currently plaguing me. After the last appointment where my amniotic fluid is low, I've been completely committed to drinking a huge amount of water per day. A gallon or more. I feel a little bit like I am waterboarding myself. Each glass of water is starting to feel like the next mile on the Inca Trail. 

However.... it may all be worth it!

Had our Biophysical Profile today and the bean scored an 8 out of 8! Hooray! Amniotic fluid is nice and high and everything else looks good. Definitely not delivering a baby this week! Next appointment is at 34 weeks plus - just have to keep going for five more weeks, bean!

Saturday, March 9, 2013

Good bean!

After an evening spent wallowing in stress and sadness, bean seemed determined to make me feel better. Spent the morning making big, healthy movements. Thank you, little one. I love you!

Friday, March 8, 2013

Plunging into despair

Kicking myself for not checking my cell messages earlier. Long, dark message from my OB. She didn't reveal anything that we hadn't already learned from the perinatologists, but somehow, she made it sound much more pessimistic. Wishing I didn't have to wait until Monday to talk with her.

Ugh, I do not want to deliver this baby early.

Thursday, March 7, 2013

Soooo sick of eating...

I realize this is a very whiny, first world problem to have. But I've been trying the Brewers diet to try to combat the growth restriction and get this bean growing.

It is So. Much. Food. Ugh.

This is an ironic statement from me, since my entire life, food has been my weakness. Weight gain, in my case, is generally not from lack of exercise, but because I have no willpower to back away from the hamburger and learn to embrace the cauliflower. But right now, I feel like I would give a lot for an all broth, raw veggie diet.

Only 6 more weeks to go. Thank goodness.

Tuesday, March 5, 2013

Still too small...

Another week, another round of medical appointments. Left the OB feeling happy and optimistic, albeit sore from my DTaP vaccination and sniffly from a cold.

And then we did our joint perinatologist/cardiologist appointment.

Let's start with the good news. No new news on the heart. Still need surgery, but all is looks good in terms of heart function. Hooray for the bean!

Bad news: the incredible shrinking fetus. Actually, that's not at all accurate. Our little one has grown since last we met, up to 3 lbs 1 oz. But we're going down, down, down in percentile on the growth chart. The dreaded "growth restricted" term has been officially invoked.

What does this mean? More protein. More water. Weekly, and maybe even twice weekly, biophysical profile checks. And, oh yeah, totally switching delivery hospitals.

Not really new news and switching hospitals is probably not much of a big deal - I won't have to switch OBSs. But the whole thing just has me down. Why can't anything be easy with this baby?