32 weeks, 3 days: On becoming an inmate
February 3, 2014 § 37 Comments
I’ve written update posts several times, but before I’ve been able to finish any of them and press GO, something changes and makes it no longer relevant.
Let me try to give you all a bit of a timeline. Last Tuesday, when I was 30+4, our baby boy’s growth had majorly slowed. He was sitting somewhere around the 10th percentile after measuring solidly in the average range on previous scans. To try to figure out what was going on, the MFM performed an umbilical artery doppler assessment. The purpose of this is to look at the blood flow through the umbilical artery during peak diastole (when the heart is at its’ most relaxed). Flow in the umbilical arteries ought be in the forward direction. If the placental resistance increased for some reason, the diastolic flow may reduce, then become absent and finally go into reverse. Below is what you might see on the ultrasound screen when there is “healthy” flow. See how the tops of the valleys between the peaks are well above the line? This is essentially what our girl’s looks like.
My understanding is that toward the end of all of all pregnancies, the placenta matures and doesn’t function as efficiently. This is supposed to happen slowly over time and to not cause problems (and is also one of the reasons they talk of induction post-due date). But our boy’s placenta seems to be deciding to quit early. I grew it wonky, and it’s making its’ displeasure known. The image below will help explain.
The top line is normal. A week and a half ago, when we discovered that there was a problem, there was reduced end diastolic flow that was also intermittently absent. So, the space between the valley and the line was small, and every once in awhile, there would be a big gap where there was no valley showing at all. This got me on schedule of biophysical profiles (BPPs) and umbilical artery dopplers twice a week with MFM. Three days later it looked the same. No change was good.
The following Tuesday when I was 31+4, I saw my OB first thing in the morning. This was to be followed by a MFM appointment. I don’t think I had quite wrapped my head around the seriousness of the situation until my OB told me that he was going to do a quick ultrasound even though they were doing one down the hall at the MFM appointment in a couple of hours. I must’ve had a quizzical look on my face, because he then said, I’m doing this because if your baby has died, I want it to be me who tells you, not an ultrasound technician you have never met. I know this probably sounds incredibly insensitive. Heartless even. But I appreciated it. Immensely. He knew that there was no other reason to justify his looking, and he knew that I would know this. But he wanted to look anyway because it was important to him, and so he just decided to go ahead and tell me why instead of just making something up. Or saying nothing and leaving me wonderingknowing.
Incredibly, he later came to my MFM appointment. There we all learned that the flow had changed to continuously absent end diastolic flow (#3 in above image). The two doctors looked at each other, had a brief discussion right there in front of me, and I was admitted to the hospital in order to “tighten the safety net.” I was shocked. My OB had warned the week before that it could happen any time, but it still hit my like a truck. I cannot describe the fear we felt. Not only did it mean very likely early delivery of both babies and all of the risks and complications that come with that, but I also jumped to all of the worst case scenarios for our boy, like death. Or neurological and/or developmental problems from being deprived during such an important stage of growth.
I was allowed to go home and pack my bag and say goodbye to the dogs. And, guys, I cried the entire time.
I won’t be going home again until I am a mother.
I’ve been in the hospital for 7 days now. I was given the steroid shots on Tuesday and Wednesday to help speed fetal lung development, and I learned that the doctors thought it was likely that I would likely need to deliver within the week. In that picture included above, you deliver when you see #4. Reverse end diastolic flow. Now that I am in the hospital, my two a week BPPs and umbilical artery dopplers get increased to three a week. They also do fetal non-stress tests (NST) three times a day at 6 am, 2pm, and 10pm. For these I get monitors put on that are kind of like our home dopplers, and reactivity of heart rate to movement is measured for 20 minutes. You also deliver if there is a problem seen on one of these tests. So the level of monitoring is outrageous. But it’s allowing me to sleep at night.
It had been pretty quiet around labor and delivery the last few days, then last night and this morning things have really picked up. You could see the stress on the nurses faces. I am one of a number of “ante’s,” who are meant to be here long term. Everyone else rotates. They come in, labor, have their babies, and then move upstairs to the mother and baby unit. They try to stick the ante’s on one hallway so it’s quieter for us. I met one of them yesterday for the first time when we were both getting ourselves some orange juice. She said she’d been here two weeks already. She barely looked pregnant at all and I thought, I hope she has a long, long while left. When I woke up this morning to The Artsy Engineer bringing me blueberry pancakes and tea before heading to work (a variation of which he has done every day to prevent me from eating too much horrible hospital food), he told me that there was a labor bed outside of her door. All morning, doctors’ and nurses’ voices have floated past my door and into hers. And I can hear her crying. And tomorrow she’ll be gone. Hopefully with a small but healthy baby to visit in the NICU.
I’m also on strict bedrest, which is very interesting. I sit. ALL DAY I sit. I can get up for the bathroom and to take a shower. And every once in awhile to walk to the ice machine in the hall right outside my room to fill up my own water because dear god is it hard to let others do things as simple as this for you all day. The nurses come in once an hour to check on me during the day and every two hours at night.
But you know what guys? It’s helping.
I had been warned that this sort of issue doesn’t really improve. It just gets worse (slowly or not so slowly) and then you have to deliver. But something is seriously, really really helping. Since I got here, I’ve had two additional ultrasounds. Both have continued to show reduced end diastolic flow (but not continuously absent and not even intermittently absent). This is EXCELLENT. The babies both continue to pass their BPPs (which is where they look at movement and heart rate and attempts at practice breathing using ultrasound). And I’ve been told repeatedly that our babies look great (even for their gestational age!) on the 3x/day non-stress tests. That our boy “does not look like a baby with cord blood problems.” So they both seem to be healthy and doing developmentally appropriate things in there, and no one is distressed. No one is distressed. On Friday, my MFM said that if he were a betting man, all of these things would lead him to place his bet on our being table to talk in weeks until delivery rather than in days until delivery. It still seems doubtful that I will make it much past 34, which is about a week and a half away at this point.
But man. I’m so so close, sisterfriends.
So I will continue to relax my ass off in this hospital bed for as long as I can if it means these babies can use the incubator on the inside of me instead of the incubators on the outside of me.
I can’t wait to meet them, but my body will miss them when they come.