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."

Seven.

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.

Kathleen