Sunday, December 23, 2012

27 Weeks

Actually, it's 26 weeks and 6 days if you want to get technical, but my BBC app always starts the new count on Sunday and I have come to do the same.  It's my cheat day, if you will.

Yesterday morning, I was just coming to the surface of consciousness.  The baby always starts kicking away right when I am waking up.  I wait for him before I get out of bed.  When I was pregnant with Roo I waited for her too.  This time he didn't start kicking.  I laid in bed for another hour with my eyes closed, getting more and more frantic. Finally, just as I was about to dive for the Doppler, he fluttered around a bit.  Enough to satisfy me for the moment, but not enough to alleviate my worries about his altered movement pattern.

So...I guess I have some mixed emotions about making it to 27 weeks.  I'm so glad.  For me, 27 weeks is a huge landmark to hit.  I can't believe that those two little lines back in July have made it this far, but I'm so excited.  There is a rational area of my brain that knows the odds are getting pretty good for this little guy.  We are well past the age of viability.  So far so good.  Next week marks the beginning of the third trimester, and that's even better. 

Yet I can't help but be somewhat transported back to that time in 2006 when I was 27 weeks pregnant.  I had no idea what could go wrong.  I had no idea what a 2 pound 3 ounce baby looked like.  I didn't know what a placental abruption was.  It is so hard to look back on the first time I was 27 weeks pregnant and know what we were in for, and know I can't do anything to stop it or change it.

I am trying really hard to just chill out and have a Merry Christmas here.  My little girl is all about the magic of Christmas this year and I am so excited to provide that magic.  I know I should be enjoying these days, that they won't stretch on forever.  I mean, the odds are I will get to bring a baby home and/or get to go to work eventually, and she'll be off to school.  The days where it is just she and I at home are numbered.   I wish I could bottle them all up now when I know I am under-appreciating them.  I could dole them out one at a time on those days in the future when I am missing her as she is now. 

Particularly at 27 weeks, it is very easy for me to get sucked into the black hole of anxiety and grief.   It is my goal this week to stay busy and focus on the things in my life that are good.  Focusing on the good in my life is actually challenging for me every week, not just 27 weeks pregnant.  It's just extra-important that I don't let stress and anxiety get the best of me this week.  I'm trying to filter out all the outside stressors and just focus on my little family.  I hope you and your family are able to do the same for the Holidays.

Saturday, December 22, 2012

Just Give Me the Drugs

I like controlled environments (and I cannot lie).  

I'm not afraid to say it.  I enjoy a good scheduled c-section.  Not that I've ever had one that was exactly scheduled. 

You know those moms that are all, "I want to push this baby out myself with no drugs to numb the pain?"  Yeah, that's not me at all.  I really admire those women, but I admire them in the way I admire adrenaline junkies.  I think it's awesome that you like to go hangliding from the tops of snowy mountains.  But me?  I'm a bit afraid of heights and I think I'll just stay here on the ground, thank you very much.  During my nursing school rotations through L & D I became even more admiring of these women.  They rock. 

It's just that I feel like I always have to defend myself when I say I've had c-sections.  I'm really not a wimp.  I feel an obligation to tell inquiring people that I was fully dilated and pushing with no drugs on board with Matthew, but when they started squawking about bleeding and placental abruption?   Hell yeah I let them give me general anesthesia.  I wanted my kid out.  Alive.  And they pulled that off.  Mission fricking accomplished.  

When I found myself pregnant with Roo, I didn't even really consider a VBAC.  I was pregnant 6 months after Matthew's death, and I wasn't in the mood to test the strength of my uterine incision.  AT ALL.  Dr M (the exalted first perinatologist who died the year after my daughter was born and is thus unavailable to me during this pregnancy) did suggest one, but he seemed ok when I declined.  Until one hot July day when I wandered casually into L & D and asked to be checked for dilation as I was feeling a bit "off."  The nurses and Dr M were shocked to find I was at a 7.5 and could feel absolutely nothing.  Dr M couldn't help himself and told me I had a great shot at a VBAC.  Perhaps if Matthew had survived past his NICU stay I could've considered it.  Under the circumstances, I went with the original plan.  I didn't want to labor and wonder if it felt like last time and if that was a bad sign.  Or if my daughter was still okay in there.  Or if my uterine incision was going to hold up.  It was a decision made out of fear but I don't regret it.

During my postpartum visits, Dr M and I specifically discussed the possibility of a future VBAC.  He felt very strongly that I should not have one after 2 c-sections.  Because the issue was a moot point at that time, I didn't press him on the matter.  

Imagine my surprise when 6 years later the new perinatologist tells me he'd be "willing to try a VBAC" for this pregnancy if I so desired.  I was actually kind of annoyed.  I've seen the current research.  I know the chance of uterine rupture does not increase drastically between the second and third c-section.  I believe it's something like a 3% rate of uterine rupture for VBACs (correct me if you know different).  I quickly informed him that while he might be willing to take that risk, I was not so willing. 

It angered me because 3% might seem like nothing to him.  But percentages and statistics?  They don't comfort me at all.  Anyone know what the chance of a 22 year old pregnant non-drug abusing female having a placental abruption during the course of a normal pregnancy is?  Around 1 in 200.  Significantly less than 3%.  How about this one.  What are the odds of survival to hospital discharge for an infant born at 27 weeks gestation? Somewhere around 90% of these infants will survive to hospital discharge.  At 28 weeks those numbers increase to 95%.  You would think my son and I would fall on the favorable side of one or both of those statistics, right?  Yet we did not. 

The first thing I said to him was, "Dr. M felt very strongly that I was not a good candidate for a VBAC after he performed a c-section for my daughter.  I can't ask him why he felt that way.  Why do you think I would be a candidate?"  He quickly backtracked and said he wouldn't consider me a prime candidate, but that he'd be willing to let me try if I desired.  Right.

He also then mentioned that I would have to come camp out in his city from 36 weeks on.  And obviously pitocin is a contraindicated wonder in my case.  Pitocin increases the strength of uterine contractions, which is not a desired effect in VBAC patients due to the extra strain on the incision scar.  This means that if by some chance I did not go into labor on my own by 41 weeks, I could not be induced and would have to have the c-section anyway.  No thanks.  

It is my true heart's desire that doctors seriously quit asking me if I'm interested in a VBAC.  Ever again.  I am not. I have no desire to risk my life, my child's life, and my uterus.  I like the idea of holding my baby son in my arms an hour or two after checking into the hospital. The goals here are:  baby out alive, mama out alive, with as few shenanigans as possible. 

My second wish is for other women to not hassle me for my obstetric history and desire to continue with the form of birthing that works best for me.  I'm seriously happy and respectful of your desire to "feel everything" during labor.  Me?  I'm hoping to feel nothing but joy.  Hopefully I'll be seeing you natural birth ladies on the other side.  With both our healthy babies in our arms.

Friday, December 21, 2012

The Hardest Days to get Through

I am now 26 weeks pregnant.  It is not possible for me to birth a 24-weeker.  I can’t have a 25-weeker.  I can no longer be caught in a nightmare scenario where I am 23 weeks pregnant, in labor, and having to argue with Small Town MD about whether interventions to prevent delivery should be attempted.  Those nightmares, at least, have passed.  We are down to less than 100 days of pregnancy remaining.  Something to celebrate.  

I’m not going to lie, 27 weeks is looming.  Matthew was born at 27 weeks and I can’t help but be horrified as we get closer to that gestational age.  This baby is still so little.  In both of my subsequent pregnancies, I have been just emotionally raw around this time.  I expect it.  You know, like flu season.  Yet the brutality of it all is something I can’t prepare myself for in advance, even though I live it every single day, not just at 27 weeks pregnant. I mean, how could it have gone down like that?  What if it happens again?  I have just been a wreck.  Can’t focus on anything.  Irritable.  Restless.  People call to talk to me and I can barely tune in at all.  I nod along and inside I am just thinking, “I can’t listen to this right now.  I can’t believe this na├»ve person is calling and expecting me to participate in this conversation when I have a pregnancy to get myself and a fetus through.”  Don’t get me wrong.  These are people that I love with all of my heart, and I care about their problems.  I’m just in my own little isolated world right now.  It really sucks in here, actually.  It will all be worth it if I get to walk away with my little guy in the end, but I guess I know that it doesn’t always work out that way.

The PlacentaCrisis of 2012 certainly hasn’t improved my psychological state.  Thank God for my Doppler.  This little guy is pretty cooperative when it comes to moving in a reassuringly regular pattern, but if he dares to oversleep?  I whip out that Doppler.  So far it has done nothing but provide reassurance.  I was a bit cautious about purchasing one because I wanted to avoid any can’t-find-the-heartbeat crises that a Doppler might cause, but I think waiting until I was a bit into my second trimester took away much of that risk.

Due to my history of placental abruption, I like to think of my subsequent placentas as being indestructible.  Learning that this placenta has the potential to be less than anatomically perfect is of concern to me, even if Small Town MD doesn’t seem to be appropriately alarmed.  When an innocent friend suggested that I should be reassured by the doctor’s lack of concern, she was treated to a 5 minute theory of mine wherein I propose that Small Town MD may not be intelligent enough to be concerned.  It may be that Small Town MD does not fear for his license.  It may be that Small Town MD believes his usual laid back, good ole boy style will see him through having me as a patient.  But it will not, my friends.  If ever this man should fear for his medical license, it is now, when he has me as a patient.  Because, one misstep with me….Nevermind.  I’m obviously coping well.  I just think it would be unwise of him to not take my care VERY seriously.  He knows I delivered a 27 weeker in his tiny rural hospital after an uneventful pregnancy, so he should know to be vigilant.  I honestly don’t harbor much resentment towards the doctor that delivered Matthew.  She would be overseeing my care in this pregnancy because I know she’d do a great job and be hyper-vigilant, but she is no longer practicing in this area.  But this guy?  He has a huge warning flag in the form of a 500-plus page medical record,  and I think he should heed that warning.  There.  Tirade over.  

In my years of experience with grief since Matthew died, I’ve learned that there are times when it’s best not to fight against my instincts.  Right now, I really just feel like hunkering down and not leaving the house much.  I like being close to home so that I can best control my stress levels and blood pressure.  I do feel alone and isolated.  Living on the frontier certainly adds to that feeling.  In past years I’ve tried to force myself to interact and live a life with a full social schedule during times like these, but it never really worked.  His birthday, the anniversary of his death, and anytime I feel pregnant and emotionally vulnerable are now all completely acceptable reasons to hide out a bit.  Maybe it’s not the healthiest way to get through, but it does get me through.  

So here I am at 26, almost 27 weeks along.  Go team.  I swear I get a bit more relaxed after 27 weeks, and even more cheerful after 30.  One day at a time, right?

Thursday, December 20, 2012

After the 14th

About the tragedy at Sandy Hook….what do I say about this disaster?  I’ve started several posts about it, but they all sound completely egocentric.  Ironically, I think a person has to be just a smidge egocentric to have a blog in the first place, but still.  It’s not what I’m aiming for when speaking of this subject.  Looking at pictures of those beautiful babies….I don’t know how anyone can see them and NOT hug their children a bit tighter.  I’ve spent so much time staring at pictures of their little faces, so similar to my own little girl’s face.  I pray their families can get through this.  I pray our nation can find a way to get through this crisis united together. 

Have you heard about Ann Curry’s 26 Acts of Kindness?  Elizabeth from E Tells Tales also wrote a beautiful post on the subject here

Tuesday, December 11, 2012

No Protection

Even before I embarked on this sorta-surprise pregnancy, I had no delusions of things going perfectly.  I knew I could lose another child.  Perhaps this sounds terrible, but I was hoping it would happen early on.  I figured I would be less attached, that I could "hold off" on becoming attached for awhile.  I don't think all women are this way; I think many are attached from the second they know of the baby's existence.  I already have a history of loss so I do my best not to get overly excited about an embryo or a baby who isn't here safely yet.  But I had no delusions.  There is no protection from that swell of hope and the terrorizing fear that comes along with it.  There is no way I can keep from loving the baby that kicks and flips constantly in my stomach and sucks his thumb during ultrasounds. 

I can do everything possible to try to hang onto my "wait and see" approach.  I can cut off every annoyingly well-intentioned person who starts to say, "When the baby gets here..."  I can avoid telling my daughter detailed stories of what a great big sister she is going to be. 

But I can't protect us.  I can 't save this baby.  I can't keep my daughter from remembering she was supposed to have a baby brother if one day there isn't one anymore.  I can't keep Jerry from feeling the pain of holding another dead child.  I can't save myself from any dangerous complications that might occur.  I can't protect us.

I wouldn't say I underestimated the feelings of helplessness that would come.  I know I'll start to feel a bit better after we get past 27 weeks, and even better when we are past 30.  I know that squashing all hopeful thoughts into oblivion won't spare me any pain in the end.  

It's just...damn I hope this all ends well.

Saturday, December 8, 2012

Placentas and I Just Don'tGet Along

Okay.  Another humdinger of a doctor's appointment to dissect here.  Not the overly-hormonal pregnant mommy rage this time, I promise. 

I am now 24 weeks and 5 days.  I am so grateful.  I had a celebratory post all planned out, but I got bogged down by schoolwork and had to focus for a few days to finish it up.  So here we are.

I have some pretty serious anxiety about discussing my pregnancy with people.  I hate going into maternity stores because the well-intentioned sales ladies are all "OMG, when are you due?  What are you having?  IS THIS YOUR FIRST?"  I can't take it.  What am I supposed to say?  Same goes for family members that I'm not extremely close with. 

That being said, I have tried in this pregnancy to be marginally closer to one of those "normal" pregnant women.  You know, the ones who can have an actual optimistic conversation about the practically guaranteed infant they will soon be blessed with.  It's just not working, though.  I fricking give up.

It started when I had an ultrasound with the perinatologist at 16 weeks.  Jerry was coming of course.  Because my mama and I are not used to living apart, we were pretty excited to meet in the city that lies partway between us for a weekend of good old gender-revealing ultrasound fun.  Then she broke her driving foot.  So we figured she should stay home, but suggested I invite my Grandma and Grandpa to come along.  I adore my grandparents, so I swallowed my anxiety and invited them.  They were so excited.  Then I wrecked my car and had to reschedule the appointment. At 18 weeks, I finally got to my appointment with Jerry, Kiddo, my mom, and my grandma in tow.

I hate that feeling in ultrasounds when you feel like the tech is spending too much time on a specific part of the baby.  Like something might be horribly wrong but the tech won't tell you because of the audience you drug along. 

Well, as you know that ultrasound went fine.  We found out we were having a boy and my grandparents were such a lovely addition to the day.  My Grandma has called at least three times since then just to jabber about how amazing she thought it was.  It brings tears to my eyes every time.  My grandparents rock. 

Fast forward 6 weeks to yesterday.  My dad has now heard about me bringing the grandparents along to the ultrasound and casually mentions that he has never seen one.  In the spirit of sharing my pregnancy joy, I indulge him.  Then he brings his new wife.  It's not that I truly dislike her.  It's just that my comfort level around her is about a 0. I've always had a bit of a difficult relationship with my father.  He conveniently waits until he has driven the two hours to Small Town MD's office before texting me to ask if I mind if she comes along.  Now, it seems to me if he truly wanted to be sensitive to my wishes, he would've asked yesterday before he left the house.  Whatever.  That's not what this post is about. 

So....there we all are.  The tech gets me all set up on the table.  It is only a minute or two in before I feel the vibe coming off her, and I don't like it.  She's spending too much time measuring things.  She seems to be trying hard to keep the mood light.  My ultrasounds-gone-wrong nightmare begins literally unfolding before my eyes.  All the while everyone is next to me jabbering and generally just raising my anxiety levels by being oblivious to the icky vibes in the room.  Worse, I can hear my dad and his wife talking to the Kiddo about "when Baby Brother gets here."  As though I'll actually get to keep him.  As though my amazing daughter will actually get to be a big sister. Just taking it all for granted like those people who've never had anything bad happen to them do.  I stare hard at the screen.  His brain looks good.  Spine has no huge chunks missing.  Two kidneys.  Four-chambered heart with no white spots.  Since this is about the limit of my ultrasound interpretation expertise, I couldn't figure out what she was looking for.  The tech starts asking all sorts of questions about his growth.  If this is my first.  I mention my placental abruption history, but consciously withhold Matthew's name from my lips.  And when was my last ultrasound.   When she finds out I had one at the other office 6 weeks ago, she can't get out of the room fast enough.  She says something vague about pulling up the images on her other computer to compare and bolts. 

There I am covered with ultrasound gel.  Stuck on that table knowing she has just bolted straight for the doctor.  With several obliviously excited family members in the room.  Jerry is also oblivious, simply beaming at the images on the monitor in a proud daddy sort of way that makes my heart feel like it's breaking.  Kiddo is happily chanting, "Baby brother, baby brother, baby brother"  over and over again.  I don't say a word.

The tech comes back and says something stupid about technology being slow.  She spends a lot of time making sure I get good pictures.  She measures some more.  At this point I am fairly certain it must be his growth she is concerned about so I am relieved when she estimates his weight at 1 lb 12 oz.  She measures him right at 25 weeks.  Perfect.

When the ultrasound wraps up, I dismiss my audience and head into the doctor's office.  My blood pressure is elevated.  Shocker.  Small Town MD enters.  I'll just paraphrase his little schpiel for the sake of brevity here:  "So....everything looks great with the baby.  His weight is great.  Your amniotic fluid level is great.  I almost wish I didn't have to mention this at all.  The umbilical cord insertion site on the placenta is a bit off-center.  I'm not concerned about it AT ALL.  The cord is actually situated about 2 centimeters in from the edge, and that's GOOD."

Um...he had me at placenta.  2 centimeters from the edge?  Me and my fricking placentas.  I ask if it is a velamentous cord insertion (I don't even really know what that means at the moment, but I've heard the term once or twice in relation to umbilical cord issues).  He says no.  I ask if it correlates to placental abruption. Nope.  

All I could think about was the way the baby was torquing on his umbilical cord for a large portion of the ultrasound.  I mean, he doesn't exactly have any toys in there, but still.  

Considering my general distrust of Small Town MD's abilities, he held up pretty well during the appointment. He recommended that we do the evidence-based thing and simply continue to monitor.  He feels the biggest indications of a well-functioning placenta are adequate growth and adequate amniotic fluid.  My cervix is closed up tight--a positive sign that I might not go into premature labor.  For now. 

I think to say that all this scares the shit out of me would be a huge understatement.   I mean, am I incapable of growing a decent placenta?  I certainly hope not, but with my body you never know.  I agree with Small Town MD's suggestion that we simply monitor his growth and hope for the best.  But one bad measurement and I want this baby out.  The last thing I would ever want is another NICU experience.  But even more than that?  I do not want my baby to be stillborn.  I am so afraid that we will lose another baby.  This baby.  

When we got home, I sorted the baby clothes and tucked them into a plastic tote, out of site and with their corresponding receipts.  You know, in case it all goes to hell.  

Having no other option besides continuing to take things one day at a time, I am trying hard to stay positive and just keep putting one foot in front of the other.  But the ultrasound-sharing portion of this pregnancy?  Is absolutely over. 

I am beginning to do some researching and consulting on the matter and will discuss what I learn and the implications after I sort things out a bit.  Until then, if you are the praying kind, please pray for us.