30 weeks 4.5 days: And then just like that things change

January 22, 2014 § 53 Comments

This will be erratic and full of typos. Forgive me. It’s the middle of the night and I’m not so concerned with writing style right now.

My plan was to follow up yesterday’s post with one later this week about the pregnancy itself.

I was going to talk about how the movement is the most amazing thing I’ve ever experienced. I was going to tell you about the weight gain and the roundness and loving my less angular body. About how I’ve somehow miraculously managed to get by with no stretch marks yet. I was going to tell you that we picked out names that we love and that feel right. I was going to comment on all the weird things about being pregnant, like the leaky boobs starting at 20 weeks and the dizziness and low blood pressure and the inability to walk more than a mile during the second trimester (these last two have improved), and the multitude of Braxton Hicks contractions that started around 16 weeks, sent me in for monitoring around 24 weeks, and have since subsided to a “normal” rate. I was going to tell you about all of the things I love about being pregnant. In fact, on Sunday, someone posted a question to a due date group I’m in asking the women what they like about pregnancy. I said the following:

honestly, i am kind of loving almost everything about it. i love the movement. i love thinking of food as baby fuel and trying to squeeze as much of it as humanly possible into my body during the day for them. i am even fine with the insomnia, because i get to lay in bed and feel them move and think of how excited i am to meet them. i’d be lying if i didn’t mention loving all of the positive attention. attention from others usually makes me feel squirmy and uncomfortable, but for some reason now i’m basking in it. i work in a couple of different hospital settings with a lot of women (many of whom are in the child-wanting stage but who are currently focusing on academics and careers) who make me feel like a rockstar and ask me 100000 questions a day. i love the knowing and warm smiles i get from strangers. i love how my coat won’t close in the bottom and my belly sticks out and i’ve overheard two women over the course of the last month stop mid-conversation to comment to whomever they’re talking to on how “cute” i am. i mean, really. talk about making a lady feel special!! i love how peaceful the nursery makes me feel. i love that it has turned my already sweet husband into an even sweeter father over the last couple of months, even though they aren’t here yet. in the evenings, he often sits in the rocker in the nursery with a soft light on and plays his guitar because he “just likes it in there.” ha, oh yeah. and while i do miss working out, i love having the excuse not to, since you really can’t do much besides walk and stretch and squat with a twin pregnancy at this stage of the game.

But then.

Today (yesterday? I don’t know. It’s 3 AM and I slept for an hour between 11 and 12 and then woke and sobbed into the Artsy Engineer’s chest for 2 hours before deciding to get up and make myself a cup of tea to relieve the pressure in my head and to write these words). Today things went not so well all of the sudden.

I went in to maternal fetal medicine for my monthly growth scan. During the growth scan, they measure the femur length, the head circumference, and the abdominal circumference, and they use these measurements to estimate the weight of the baby. She measured Baby A first. Our dear girl looked good. She was right around average for gestational age for twins at 3 lbs 4oz. We weren’t able to get a good image of her face, because she was wedged in and sleeping most of the time, but the sonographer commented that she had really chubby cheeks. And I was able to see that she has quite a bit of hair already.

Then she moved on to Baby B, our boy. And his report is not glowing. Baby B’s growth has fallen off. His estimated weight is 2 lbs 11oz. I didn’t think to ask for his percentile at the time, but from my own Dr. Googling, this puts him below the 10th percentile. This represents only a 450 gram growth over the past 4.5 weeks. They then came back in the room to do all sorts of other measurements, including using the doppler to look at blood flow in the cord as a measure of placental functioning. This was also less than good. 

It is evidently not an emergency situation yet but it could quickly turn into one. The MFM doc has increased the frequency of my appointments. I’ll be going in every Tuesday and Friday for further monitoring. He also said that I will not be making it to 36/37 weeks, as was our goal, but might be able to “coast along” like this for another couple of weeks. Honestly, I didn’t hear many of the details from here on out. I heard the buzz words. Placental insufficiency, poor environment, lack of nutrients, preterm delivery, if we can get there babies born at 32 weeks generally do pretty well, get him out where we can get him what he needs to grow

And this was the first appointment the Artsy Engineer missed, because everything has been going so well and because he’d been out so much around the holidays and to drive me to all of these interviews.

As soon as I left, The MFM called my OB (who I lovelovelove) and my OB called me immediately. He said some additional things, including that he was “a little surprised” that I was not admitted today and that, while I don’t need to have my bags packed before each of these appointments, I should start mentally preparing for the possibility of admission for closer fetal monitoring and eventual preterm delivery.

They were also both careful to say that there is nothing I have done or can do. It’s not the little bit of caffeine I’ve been drinking (one half caff a day). It’s not my vegetarianism or my recent travel. It is most likely due to placement of the placentas and what this placement means for their growth and functioning. I have to believe them right now, because my focus is mostly on my babies alone, but there is a nagging voice of fear somewhere in there that wonders if this is something I have done or (worse, maybe?) my womb is just not good enough to make or carry babies.

Now we wait and we watch. They are weighing the risk of leaving him in an environment where he is clearly not getting what he needs versus the risk of taking them both out at this level of prematurity. The MFM doc said that had I been 34 weeks today as opposed to 30.5, he would have suggested that we deliver now. But I guess it’s all about balancing risk. The OB told me that he asked the MFM whether I should come in for the steroid shot to help develop their lungs in preparation for delivery, but that the MFM said that he thought that was still premature. So we wait.

Needless to say, I’m not doing super well at the moment. It was shocking. Everything had been going so smoothly. I was just thinking last night that I was pretty sure I could ride this out for another 6+ weeks. In fact, when I laid down on the exam table for the ultrasound today, I remarked to the technician that I felt WAY BETTER than I had expected to feel at this stage in the game. I had started thinking I was going to be one of those to make it to the safe zone.

Tomorrow my dad has arranged for himself a quick phone call with the medical director of the NICU in the hospital where I currently receive obstetric care and where I’ll be delivering (the same hospital my dad recently left for a new position in a new state as resident Bigwig of Pediatrics at Bigwig Hospital). It helps to have family in medicine.

And me. I’m going to go drink my tea (which is now cold and as such will relieve no head pressure after all) and try to put myself to bed.

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30 weeks 4 daysareyoukiddingme?!!

January 21, 2014 § 18 Comments

When I was trying to get pregnant and failing miserably and then again during the early months after that miraculous last minute positive beta, I would look at those of you who were 30+ weeks and think of you as already done. Cooked. Finished. Baby is as good as birthed.

I cannot believe I am at this point. I have no clue how I got here. It’s like I hit 20 weeks and blinked and found myself in this space. No joke. I lost time.

In an effort to not sound absolutely ridiculous by updating you on all aspects of my life in the last however many weeks, I decided to break it up. In this particular post, I’m going to try to give you an overview of my work/school life over the past 10 weeks or so. Because, honestly, it has been MAJOR.

After I proposed my dissertation back in mid-October, I had to scramble to get my applications submitted for the next stage in my training. I started thinking about wrapping up my patients. I started climbing out of the cave I’d been living in while preparing for the November 1st application deadline to come around. Then the holidays happened. We traveled to visit the Artsy Engineer’s family for Thanksgiving and then my computer (our one and only computer) broke and then I started getting interviews coming in for said training programs. Lots and lots of interviews (this is good, but maybe less good when you will be 7.5 months pregnant with twins during interview season). Then the holidays kept happening and we drove to visit my family. And then my computer was still broken. And then I came home for three days and then left again to start the interview extravaganza. In the past two and a half weeks, I have attended 10 day-long interview sessions. The Artsy Engineer took time off to drive me around the country. We opted to limit my application to programs east of the Mississippi River in order to remain a reasonable distance from family, but even so, we’ve been in many states and put thousands of miles on the car.

And as an aside. This man deserves a medal. He has taken care of all of the details – driving me around, arranging accommodations, feeding me. He even got up with me each morning and pressed my suit while I was in the shower. He’d help me put on my shoes, grab some breakfast for the road either from the continental breakfast (if we splurged on accommodations for the night) or, more likely, from the shoddy Dunkin Donuts across from the motel (if we didn’t). Then he would drive me to the main entrance of the hospital where I was interviewing and drop me off in front of the main entrance. Hand me my coffee and my fancy portfolio thingy and send me on my way. After kicking around all day in whatever city we were in, either parking and exploring the city on foot (the man visited countless museums and music stores throughout the eastern half of the country) or finding a library or coffee shop where he could eek out a couple of hours of work, he’d pack up the hotel where we stayed the night before and pick me up at the same entrance where he dropped me off. The car would be warmed and ready to go and he’d have the route out of the current city planned so we could start making our way toward the next. We’d get in late, he’d unpack the car, I’d prep for the next interview, we’d go to sleep. Then we’d do it all over again.

I would not have made it through this time without him.

Now it is now and we are finally home. I have been gone for 7 of the last 9 weekends and nearly 4 of the last 8 weeks. I have interviews this week, too, but they will take place in phone or Skype-land. These are ones that would not fit on our route earlier on. And I cannot travel by plane or alone because of low blood pressure issues and dizziness.

What is the point of all of this torture, you ask?

Well.

If you have been around awhile, you may remember that the final step in my doctoral program is to spend a year focusing on clinical training alone. It’s kind of like residency, but it happens before the degree rather than after. For my specialty, there is one of these positions in my entire state. In addition, placement is based on a match system (much like medical school here in the US). I rank sites that asked me to interview, sites rank applicants they asked for an interview, and a computer system spits out our future.

The actual placement will start between July 1 and the end of August, depending on the training site. The inmates will be 3-5 months old when we will likely be moving across the country. The Artsy Engineer will have to leave his wonderful job. We will have to leave the house that we love in the location we love. I will work long hours and get paid pennies that will not be enough to support my family. Thankfully, I’ll still be technically a “student” so we can take out student loans to cover living expenses if the Artsy Engineer does not immediately find work or if we decide it is best for him to stay home with the babies to save on childcare.

So yes. Babies are about to change our lives. But there are all kinds of things up in the air for us right now.

I have to submit site rankings in the next 2.5 weeks and then it is out of our hands entirely. It’s tough, because there are several things pulling us in several different directions. A couple of the sites are close to family, but these may not necessarily be our favorites in terms of program of training. So we have the get-close-to-family pull. And the stay-close-to-AE’s-job pull. And the best-program-to-keep-the-most-doors-open-for-you-in-the-future pull. And the best-fit pull. Taking all of those influences and trying to come up with one final list is really daunting.

In fact, the whole thing is incredibly overwhelming. Two infants. A move. A new job for me. A loss of employment for The Artsy Engineer. A (fingers crossed) new job for him (or a new job as a stay-at-home-dad). Finishing a dissertation. Financial stress.

But.

But. It’s also really exciting.

I love love love what I do. Love. It. I’m really excited to move on to the next step. And I actually like to move around and experience different parts of the country. The US is full of varied cultural experiences by region. And we are people who like varied cultural experiences.

Is it ideal that it’s all happening at once? Ehhh, perhaps not. As every single one of us knows, the luxury of timing is not always on your side. But I think we’ll thrive survive.

There will certainly be plenty to write about.

Where Am I?

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