Thursday, February 26, 2009

37 Weeks, 6 Days

I ended up just going in to see Dr. Devine today. I needed an appointment this week anyway. I woke up feeling AWFUL this morning, just the same terrible stomach upsets I've had since day one of this pregnancy, and I was secretly hoping if she saw how miserable I was, she'd be compelled to move up my c-section date. (Assuming one was scheduled for me as hoped.)

Anyway, when I got there, the nurse who was supposed to schedule my appointment was asking me if I'd seen any signs of potential labor, and I said no, and then she joked, "Well, it can't be too far off, right? I mean, we know it'll happen sometime in this month!" It didn't sound too promising that she'd remembered to schedule my c-section last week! I was getting worried.

But then the doctor came in, and I asked her about it, and it turns out they had me scheduled for the 3rd, Tuesday. That was fine and all, but I was put in the book as two slots past her noon appointment. Which would really mean a surgery time at 3:30 or 4. You can't eat after midnight the day of your surgery, so I'd go ALL day without food. Tiny snacks throughout the day and a healthy dose of Zofran are the only ways I've survived the hyperemesis this long! One nurse said, "A late c-section time would mean you would be very hungry by the time it's over," and I said, "Forget hunger, I'd be sick as a dog!" Once I throw up, I can't stop, and by just a couple of hours, I'm in need of IV fluids. It's terrible.

Seeing this, Dr.Devine called up to Labor and Delivery herself (that's how you get stuff done) and asked if there was anyway they could get me in sooner. Low and behold, there was an opening for a 7:30 a.m. c-section on Monday morning! First spot of the day! So this time, I actually do have a definite scheduled spot. No amnios, no tests, no debating over it. So tomorrow will be my last ultrasound and NST at Dr.Atkinson's office. Thank goodness!!! I was really getting worn out by those appointments.

I think it's kind of neat. My birthday is January 2nd, and his will be March 2nd. Easy enough to remember...not that I'd ever forget it.

Travis and I began the baby countdown tonight in HOURS. I can't believe it! I was also able to sit down and talk to Dr.Devine about my fears before the c-section. I've never had surgery in my life. Actually, I've never even so much as broken a bone. I just didn't quite know what to expect, despite the fact that I've been addicted to "A Baby Story" on TLC for years. It's different when it's you. She reassured me, and I'm much less anxious. I say that now, but come Sunday evening, I know I'll be a total basket case.

This whole thing is almost over, and I'll finally get to meet this kid that's caused such a ruckus for so long. Sigh.

Please continue to pray that his lungs have significantly developed, and that he's ready for delivery on Monday. Please also pray that everything goes well, and we all turn out fine. Thank you so much for keeping up with us throughout all of this. We're on the very last leg of this pregnancy journey, and God has been good.

God bless,
Kathleen and Travis

Wednesday, February 25, 2009

37 Weeks, 5 Days

I'm so nervous about tomorrow! I'm supposed to hear back from Dr.Devine (or at least one of her nurses) to finally tell me what the plan for next week is! I've been excited and anxious and nervous all day. All over a silly phone call!

But, as I told Travis earlier today, it seems like every time I've gotten nervous/excited regarding a c-section plan, it seems to fall through... Over and over again. But I'll remain positive and hope that they were able to come up with something.

Talking to my friend Mary yesterday, I said, "I don't know what they're going to do to get me in next week," and she said, "They're gonna bump someone else, that's what! No one deserves to deliver their baby more than you. Someone's just gonna have to wait!" Lol I wish it was that easy.

But I tend to agree with her. It made me wonder if one of those women who was getting a c-section next week was just having a scheduled c-section because it was convenient, or because she didn't want to deliver at another date or something. I know people who have selective deliveries for convenience sake. While delivering him next week certainly would be convenient for me and my health, it's extremely vital that we get him out before we risk him going into distress. I can't let myself sit here and get jealous of random women I don't even know. That's beyond ridiculous. But waiting blindly has a tendency to make me a bit ridiculous.

Here is a picture of me from the 17th (when we thought we were going to have a baby) having an NST after my second amniocentesis:

Anyway, I'll update you tomorrow on what the plan is... if there is a plan.

God bless,

Tuesday, February 24, 2009

37 Weeks, 4 Days (New Date)

Isn't it strangely ironic how two months ago, they were doing everything in their power to prepare us for a preemie, and now we're doing everything in our power to keep him in there longer so he'll be fully developed and ready for delivery??

I'm back, by the way. We were without Internet for about three annoying weeks. The guys from ATT finally came by today and said that a vital cord was cut in the box downstairs that handles our phone line. That would explain it! Anyway, they replaced whatever it was and we're back on.

Quick update:
I'm still pregnant.

The scheduled c-section date, as you all know, was set for February 17th. After the amniocentesis on the 7th, however, they did some detective work and decided that my due date was off by about a week, pushing it to March 13th instead of the 7th. Really this information changes nothing other than my morale, which was slightly damaged by the news. I didn't even want to know if the due date had changed, and really I wish I didn't know, because now it's just a discouraging fact stuck in my head. It doesn't really change anything in Dr. Devine's mind though. She still doesn't want me to carry past the 7th.

Before, when all of this started, and he was having those heart decells, we were afraid we were going to have to deliver early, and we were doing everything in our power to get him as prepared as possible for an early delivery. Now that those heart decells have stopped (thankfully), we're playing a risky time-game again, only on the opposite side of the spectrum. Now we aren't praying for more time, we're seeing how long we could possibly push it before it's too much, and we risk putting him in distress again. This has been so complicated!

See, with SGA and IUGR babies, their risk of cardiac distress or even stillbirth goes up significantly after the 38th week of pregnancy. They (being the doctors) don't really understand this phenomenon, but it happens, and there's enough evidence of it happening to scare Devine away from pushing any further beyond that point. Great! Let's just take him out now!


The second amnio was performed on the 17th, with full hopes of the steroid shots taking effect and pushing his lung maturation to the safe delivery zone. However, we got the scores back that day and 3,000 had only grown to 7,000. Dr. Devine wasn't concerned though. She said it isn't something that can be measured laterally. It isn't something that gradually increases until you're at that precious point of 50,000. She said babies just go from immature (which he's at) to mature. Boom. By either due date, I'm full term at this point, which is reassuring. However, as I'm learning, that doesn't necessarily mean that baby is ready to be born. Reassuringly, Devine doesn't think this is anything to be concerned about either. She told me last week that she had a patient who has delivered four babies with her. She said that the first two children were delivered at 38 weeks via c-section, and both had to be in NICU for about a week on oxygen. The second two babies she decided to hold out on, and delivered them at week 40. Neither of them went to NICU. So while the pregnancy books and websites all say "Congratulations, you're now at week 37, which means if baby were born today, you'd have a healthy full term infant," it isn't necessarily so. All babies are different, and some just take their time getting there.

But with Josiah we can't risk holding off until week 40 because he's SGA. It's too big of a risk. And honestly, I'd rather have a baby on oxygen in NICU for a little while than risk a stillbirth. There is no debate about that.

Dr. Devine was appalled at the reaction of the nurses in antepartum, and reassured me that they were just being dramatic and bored. She said that she has seen numbers that low, and it didn't shock or worry her at all. And while Dr.Atkinson expected the chances of his lungs being developed to be about a 50/50 shot, Dr. Devine said in her opinion, it was more of a 10/90 shot. In other words, not only was she not surprised at how underdeveloped his lungs were, she wasn't even expecting them to be ready- on the 7th or the 17th. That made me feel better. She said babies who have fully developed lungs before they are full term are generally the children of sick moms. The mothers suffer from hypertension, gestational diabetes, placenta previa, etc., and somehow baby's body knows he will have to fight to survive, and he will have to do it fast, because his delivery is coming sooner than a normal healthy baby's. She said that since Josiah isn't remotely ready to be delivered yet (or at least he wasn't when we took those little peeks into his world), that just lets her know that he isn't in any kind of distress. His body isn't overcompensating or working double time to get ready for delivery. His body is reacting like a baby that would be born at 40 or even 42 weeks.

So that's all wonderful news. I never thought that his underdeveloped lungs could actually mean that he's doing incredibly well! I was thrilled to hear that, and since then I haven't really worried about it.

I just hope he's ready whenever he's delivered. They tried to schedule me for another c-section at the hospital for any day next week, and all slots were full. The nurse said that she'd let me know on Thursday what Dr.Devine had come up with. She was strictly adamant on not letting me carry past the end of next week, so I have full faith it'll be sometime next week...I hope.

Good news though, she isn't doing anymore amnios...which is good, because that last one REALLY hurt. She's taking a "ready or not" approach, which I fully support. We can't risk giving him another two weeks or so to continue cooking. This means he realistically may have to spend a little time in NICU, something I thought we were past, but again, I'm ok with that. As Dr.Devine said last week, we've come so far in this pregnancy, and overcome so much, I would hate for us to get over-confident in these final weeks and put him at risk of falling off the wagon. We're in the strange zone where taking extra time is actually bad for baby. Go figure.

Anyway, I'm just so beyond ready for this to be over. I was worried that I would be overly discouraged after the 17th didn't pan out, but I wasn't. Travis and I still spent a wonderful day together, and I knew it would only be a week or two more from that point.

Please just pray that whenever he's delivered, he's ready and healthy. That's what I pray constantly for him. Thank you so much for your continued prayer and support. We'll get there eventually!

God bless,

Saturday, February 7, 2009

36 Weeks, 0 Days

Well, we found out bad news today.

Yesterday I went in for a weekly ultrasound and they measured Josiah at 4 pounds, 4 ounces, which I thought was fantastic, until the sonographer told me that his new weight placed him lower than the 3rd percentile for his gestational age. They had a hard time getting him to move on the monitor during my NST earlier in that same appointment, and I'd complained about decreased movement as well. This concerned Dr. Atkinson (the new drop in size coupled with the decreased movement), so he ordered an amniocentesis this morning at the hospital to test for fetal lung maturity to see if his lungs were stable enough to deliver as early as this week.

We were so excited, and absolutely certain that his lungs would definitely be mature enough (surely this late in the game, right?) and got everything ready for baby to arrive even sooner than the 17th. We even installed the car seat in the car this morning. Dr. Atkinson made it sound like if his lungs were found to be mature enough, he'd deliver him as early as Monday or Tuesday of this week.

They did the amniocentesis, which I was scared about, but it really wasn't that bad. It hurt, and the risks they warned me of right before the procedure were terrifying, but everything turned out fine. Then they took me into a private room to do an NST for an hour while we awaited the test results.

The nurse came in after a little while and said that there were two separate tests performed to judge fetal lung maturity. She said in the first test, the number (I don't know what units it is measured in) should be 50,000 for mature lungs. After week 34, the baby starts producing more and more chemicals from his lungs working so this number increases by 15,000 apx. every week until it reaches the full maturity of 50,000. Josiah's numbers were 3,000.

I thought for sure I'd misheard the nurse.

She said, "I'm so sorry. I'm just completely shocked. I've never in my career seen numbers so low before. I honestly don't know what this means. There's a chance though that an error could have occurred on this test, which is why we order two. In the second test, which I'll get back in a moment, the magic number is 50. I'll let you know when I hear from the lab..."

We waited in silence, and my mind raced with all of the possible explanations for his lungs being so devastatingly immature at this point.

She came back into the room. She said, "Well, the second test results came back, and like I said before, fully mature lungs would register at a 50 on this test. His registered at 7."


Dr. Atkinson was expecting the first test to register around 40,000 and the second test to show up somewhere in the 40's. (The two test results correlate with one another.)

But 3,000 and 7? The nurse just kept reiterating how shocked she was, and how she'd never seen anything like this in her career, nor had she ever heard of such a thing. I wanted to hit her.

She left the room, and I was in complete shock. So had his lungs just stopped developing all together? What did this mean? If this certain chemical put off by his lungs was supposed to increase by 15,000 every week at his age, then even if we kept him in until full term, 40 weeks, he still could not reach the ideal 50,000 they were looking for. How is his lung development so severely delayed?

The nurse came back into the room, this time with news from her charge nurse. My face lit up with hope of some positive information. She said, "I just asked my charge nurse if she'd ever seen numbers like this on a fetal lung maturity test, and she hasn't either. The only thing she can think of is perhaps your dates are off."

So I said, "Ok, assuming my dates are off, what gestational age would be consistent with such low output readings as his?"

She fumbled a little and said, "Well, I don't really know. That's lower than any 30 weeker I've ever seen. Maybe 28 weeks?"

I became very frustrated with her at that point and said, "There is absolutely NO WAY I am EIGHT weeks off! That's ridiculous and quite impossible."

Then Travis spoke up and said, "Well, there have always been debates about your actual due date. I mean, didn't they toss out the 15th of March at one point?"

I said, "Yes, so that would put me ONE WEEK off on my due date. One week. So, say I am 35 weeks pregnant and not 36. His numbers on his lung development are still devastatingly low. That does not help."

The nurse simply shrugged and said, "I really don't know what to tell you... I spoke with Dr.Atkinson on the phone, and he really sounded like it may be a dating issue. He didn't mention anything else. I can't think of what else could cause such a thing, but then again, if it's a dating issue, then either your due date has been miscalculated by more than a month, or his lungs are still developing at an alarmingly slow rate."

She left the room and I completely broke down and cried. When she came back in, she saw that I was crying and offered the words of support, "I know it must be disappointing to think you're coming to the hospital to deliver and then find out he's not quite ready..."

I said, "I'm not disappointed about not getting to deliver! I'm terrified because those numbers do not reflect lung maturity that is compatible with life! I mean, could he survive if he were delivered with those numbers??"

She said, "Well, I definitely think so. We deliver babies at 24 weeks who survive, and we don't perform amniocentesis tests on them to find out their lung maturity, but I would imagine his is somewhere in the same neighborhood as a 24 week old baby."

Great. A 24 week old baby can be born with underdeveloped lungs and survive. But there is a simple explanation as to why a 24 week old baby would have delayed lung development to that extreme level. So what is the explanation for a 36 week old baby to have that same extreme level?? What's going on to cause his lungs to develop so slowly?

They sent me home with absolutely no answers, and only told me to call Dr. Atkinson on Monday and ask him what he thinks might be going on.

Travis clung to the date thing, and I guess it makes him feel better. She said that numbers that low would still be incredibly alarming for a baby at even 32 weeks gestation. So let's say in some crazy world they got off on my due date by as much as 4 weeks, a full month. He's still very very sick. I'm not trying to be pessimistic, but the off-dates thing doesn't make me feel any better. Regardless of dates, something is very wrong.

The doctor wants to perform another amniocentesis in 10 to 12 days, and see where his lungs are at that point. They gave me a booster shot of the steroids I received 2 months ago that were initially supposed to help speed up his lung growth. I don't see those results.

So the scheduled C-section is obviously off the table. Something new has been discovered that we need to figure out.

Please continue to pray, more now than ever. And please pray for my own spirits, which are waning incredibly fast.