NOT HAPPY.

So it turns out that a much-anticipated ultrasound scheduled for "early morning" translates in hospital time to 2:30 pm. I was just about outta my mind all day waiting and waiting and waiting.

They finally wheeled me down just after 2:00 and then I sat alone in an exam room for what felt like an eternity. More waiting.

At last the ultrasound tech appeared, got me changed into the lovely white sheet and we finally got started a little after 2:30. She spent a great deal of time observing and measuring baby's heart, brain, and other anatomy. Repeatedly she kept saying how beautiful and how perfect he looks. Thank you Lord. He is actually measuring big for the first time today -- about a week ahead of schedule. She was very pleased with this, since he's likely to be a preemie so the bigger the better. He now weighs 1 lb 10 oz.

Finally came time for the dreaded "transvaginal" portion of the exam, to measure the cervix. I seriously think I stopped breathing for like two minutes ........ anxiety overload. I've been so desperate for a good long measurement that would allow me to go home.

Alas, not today. Once again I knew the instant I looked at the screen. I could see clearly .... short cervix, and placenta hasn't budged. The tech took some measurements, said she was "stretching it" as best she could for my sake ..... but only came up with 2.0 cm.

I layed there alone again for another 20-30 minutes waiting nervously for Dr. Mann to come in and deliver her verdict. When she finally appeared I could tell she was pretty disappointed too. She knows how badly I want to go home to my family. She apologized and then confirmed what I already knew: I'm stuck here.

She then measured my amniotic fluid and said the polyhydramnios has returned. It's measuring 20 cm, which is not terribly high, but it's still enough to put extra pressure on the cervix and cause it to further shorten. We have seen repeatedly now with the last two pregnancies --- every time the fluid goes up, my cervix shortens. She ordered another 72-hour course of Indocin (my fourth now with this pregnancy), which should help reduce contractions and hopefully lessen the fluid.

She also ordered the betamethasone injections to begin tomorrow. This is a series of 2 steriod shots, given 24 hrs apart, which help to ripen the baby's lungs. It's basically a precautionary measure they take, so that if/when the baby comes early then they've already gotten a jump-start on lung maturity. I've had these before with both Jamin and Gracie so I know they work! Only downside is they hurt like @%$!!!!! ...... way worse than all my other shots combined ....... so I'm definitely not looking forward to getting those again. Maximum benefit of the betamethasone is at 2 weeks after getting the shots, and there is some benefit at 4 weeks post-shot. After that the beneficial effects seem to wain. She said they would repeat them again 8 weeks after, if baby hasn't arrived yet, which would be 32 weeks. They can only be repeated once.

Baby is head-down and sitting low, which - together with the extra fluid - explains the pain and pressure I've been feeling all week in my cervix. I'm reeeeeeally hoping the Indocin may help with this. The placenta has not moved since lsat week, so at this point we're still dealing with a marginal previa.

She's keeping all my other meds the same --- I got my weekly 17P shot yesterday, to fight pre-term labor. I'm still getting my lovenox shots and aspirin every night to prevent a blood clot. Subcutanous terbutaline which I get through my pump 24/7 to reduce contractions. I'm on Macrobid for the bladder infection. Colace and Metamucil twice a day for the inevitable side-effect that happens when you're laying still 23.5 hours a day. I get an additional calcium supplement and a folic acid supplement to counter-act bone loss that's associated with long term use of lovenox. Librax for the irritable bowel syndrome, which allows me to eat. Ambien at night so I can sleep in this awful bed. Protonix and handfuls of Tums for the heartburn. Oh, and a prenatal vitamin. And now of course we're adding Indocin and Betamethasone.

So basically I am single-handedly keeping the hospital pharmacy in business. I hate hate hate hate taking this much medication. Especially while I'm pregnant.

James is on his way up to see me, he tried to sneak out of work an hour early so he could get here before dark this time. I had sat here and cried for like an hour after my ultrasound, and in an effort to cheer me up my nurse called Dr. Mann and requested "wheelchair privileges" for me. This means that my visitors are allowed to wheel me downstairs to a little garden area where I can sit outside for a bit and get some fresh air. I am really looking forward to it .... everyone keeps saying how crisp and fall-like the weather is this week, and I haven't breathed outside air in 8 days so I'm eager to feel it on my face, even if it's just for a few minutes. It might just be enough of a relief to keep me from jumping out the window for another few days.

Please continue to pray for me. Emotionally I'm having a hard time with the idea of being here for another week or longer. My body and mind are both weary. I want my family back. I want my bed back. I want my life back.

HOTEL NORTHSIDE ........

I'm trying to pretend that it's similar to the Ritz-Carlton or the W Hotel (afterall, I do have a nice skyline view of the city) .... but when mealtime comes it's pretty hard to fool my tummy. Alas ... the food sucks, the decor is depressing, and the smell is pretty sterile. It's not a posh hotel. IT'S A HOSPITAL.

My stay here started unexpectedly on Tuesday. I had two doctor's appointments scheduled, my OB at 11:00 and my hematologist at 2:30. At the OB's office, I saw the midwife Wendy for the first time, since Dr. Garcia is on vacation. Wendy came in and chatted for a bit about my lovenox, measured my belly, and announced I was all set to leave. Skeptical, I asked her, "aren't you gonna check my cervix?" Since Dr. Garcia checks it every single week, it was hard for me to believe I was gonna get out of there without wearing the tissue paper sheet for a least few minutes. Especially since the night before I had been up until 2am with excessive contractions -- 7 per hour -- and a malfunctioning terbutaline pump.

She agreed a cervical exam was a good idea. Two minutes later I heard her announce that I am dilated 1cm, and immediately we both knew how lucky it was that we checked. Prior to this exam we have been seeing cervical thinning, or effacement, for several weeks. But no dilation until now.

Wendy instructed me to get dressed, and by the time I made it out to the hallway she already had Dr. Mann (perinatologist) on the phone. Dr. Mann's office is just around the corner on the first floor of the hospital, so plans were made for me to head straight over, sit on the toco monitor for a bit, and then have an ultrasound.

I grabbed a quick sandwich at the deli in Dr. Garcia's building and went straight over to Dr. Mann's. I only had a few contractions while sitting on the monitor, so I was hopeful that she would check me out and send me home. That hope faded the second the ultrasound technician got started and I saw the image of my cervix on the screen. Instantly I knew it was bad. It was visually shorter (effaced), and before the tech even began taking measurements I knew I had just landed myself in the hospital.

Dr. Mann entered the room a few minutes later, and with a sarcastic smile she said:

"WELCOME TO HOTEL NORTHSIDE! Your room is ready and waiting."

I tried to remind her that I've been a guest of "Hotel Northside" several times before and it has never been a relaxing stay. But she wasn't dissuaded. My cervix was measuring 1.7 cm long, down from 2.8 exactly one week ago, and dilated 1cm on top of that.

I asked her if I could at least go home and pack a bag, which prompted her to look at me like I had six heads. She responded, "Absolutely not. But I will allow you to put your pants back on, and those cute high-heeled shoes which you won't be wearing again for a really long time". Super. Then she told me I would be staying for "a while". I asked her for clarification, "do you mean I'll be here for weeks and weeks?", to which I got a resounding YES.

They literally brought a wheelchair to the ultrasound room, and wheeled me straight upstairs to admissions. Before I even had a chance to make a few phone calls, I was a in labor & delivery room on the high-risk floor hooked up to the monitors. I scrambled to call my hematologist's office to cancel my 2:30 appointment, and started making a list of necessities for James to pack and bring to the hospital. Of course, the list included my makeup and flat-iron, so maybe I'm presumptuous to call the entire list "necessities".

They started me on Indocin, the 72-hour tocolytic, and re-inserted my terbutaline pump. The rest of my meds stayed the same. I was poked, prodded and jabbed about once every 45 minutes for the next 24 hours or so. The steady stream of nurses coming in and out with medications and such made it impossible to sleep. I began having what felt like cervical pain "down low" sometime around 3:30 am, which prompted the midwife to wake me up for a cervical exam at 4:00. She took a urine sample and decided I had a bladder infection somewhere around 4:30 am ...... which meant more medicine ......... and as it turned out I got a total of about 2.5 hours of sleep that first night.

Yesterday afternoon, Wednesday, I was moved upstairs to the "HRP" floor. This is the high-risk perinatal unit, where they send women who are on hospital bedrest to gestate for endless weeks. I was settled into room 105 just before dinner and had yet another terbutaline pump placed in my leg. Around 8:00 pm I began hearing the most horrific noise emanating from the room next door, which I quickly discerned to be the sound of an unfortunate woman barfing her guts out. She vomited violently, without stopping, for about an hour and a half. When she wasn't puking she was crying loudly. It was so pitiful (and yucky) to listen to, I felt so sad for her. My nurse finally came in and explained that my neighbor had hyperemesis and has these violent spells of vomiting day and night. In her next breath she said she had already put in a transfer request so I could get moved to a quieter room. Everything in a hospital seems to run in slow motion, of course, so it was midnight before I was finally transfered down the hall to room 120.

This morning I was taken downstairs to Dr. Mann's office for an ultrasound. We found my cervical measurement had increased significantly since my admission, up to 2.9 cm! So this was fantastic news, but not enough to inspire confidence from Dr. Mann. She said she was keeping me here, for three reasons: (1) I gave her a "really good scare" and she wasn't quite over it yet. (2) My cervix seems to be voilatile, and just as quickly as it increased length, likewise it could loose length overnight. And (3) I had only about 16 hours of my Indocin course left, and we had no way of knowing if the crazy contractions would return as soon as my last dose wore off. She did not want me at home when coming off the Indocin. So her plan is to re-evaluate me with another ultrasound next Tuesday. Depending on how the cervix looks at that time, and what's going on with my contractions, she will make a decision on how much longer I stay at Hotel Northside.

For now I'm settled in and trying to make the best of it. It is incredibly hard being so far away from home and I miss my family like crazy! As much as I really don't want to be stuck at the hospital for weeks and weeks, at the same time I know that if I'm lucky ........... I'll be here for weeks and weeks. "Viability" is considered 24 weeks, this is when premature birth carries a 50% survival rate. My immediate goal is to get to week 28, when survival is over 90% and the long-term outlook is relatively good. Once God gets us to week 28 then I will start praying for week 32. Please join me!

Ending the Hiatus!

So I'm sure all 4 of my blog fans have undoubtedly noticed that I've been totally absent lately. The last few weeks I've been quite grumpy and just couldn't really think of anything remotely positive to say. Every time I would log on and start to update my blog, a bunch of angry complaints and whines would pour out and, not wanting to preserve my ugliness for all to see, I would hit the delete button. Trust me when I say, you should thank me for it.

So here's the condensed version of the last three weeks, to catch you all up to speed:

From an emotional standpoint, I've been a bit of a mess. Super hormonal, super grouchy .... and super annoying I'm sure. Mostly this has stemmed from an overwhelming frustration at my confinement, my inability to do anything for myself without some version of a babysitter chastising me like I'm 10 years old again, and my general lack of freedom and normalcy. Cabin fever doesn't even begin to describe it. We're talking about TEN FULL WEEKS of bedrest, afterall. Then there has been my constant inner battle, dealing with my intense discomfort for depending on other people, and my general refusal to accept help. My control freak issues have been especially ugly to deal with. The Lord is really trying to work that outta me and I've just been kicking and screaming the whole way.

From a medical standpoint, not much has changed. My cervix has continued to shorten, and at last measurement was back down to 1.7cm, which was the same measurement I had the day I was admitted to the hospital. The polyhydramnios has also returned, so I was back on another 72hour course of Indocin to try and reduce the fluid. We won't know if that was successful until tomorrow, when I see Dr. Mann again and have another ultrasound to measure everything. At this point, even if the extra fluid is not gone, our options are limited, because Indocin can not be taken at or beyond week 32 (can cause heart defects in baby past that time). So the course I took at week 31 was our last shot at reducing the fluid.

I've had a few issues w/ my blood work .... mostly my hemoglobin and hematocrit levels are continuing to lower, this is mostly just causing me to feel wiped out and icky. At my last two visits to the hematologist, my blood pressure was way low, around 80/59 .... so they gave me some IV fluids to try and perk me up.

Dr. Garcia told me yesterday that my cervix is now about 1cm dilated, which is really nothing to write home about.

So it's with much amazement that I report: I am still pregnant, and I could likely stay that way for a while longer! If I'm just being honest I must admit, I NEVER NEVER NEVER in a million years thought we'd get to week 33. But here we are, and I'm embarrassed to look back and realize once again that my faith has been sorely lacking.

Saw my OB yesterday, the hematologist today, and will see my peri tomorrow. I am interested to see how Jamin has grown since our last measurement, he should be about 4.5 - 5 lbs now if all is well! Isn't that astounding?

I promise I won't take a long absence again .... after all, I have 4 whole fans who are counting on me! But the break was a necessary one, and for your benefit, I promise!

2.7 and holding!

Today was my weekly check up with Dr. Mann. My cervix is measuring 2.7 cm, which is only 1mm shorter than last week. This is great news.

The fluid problem, however, is much worse. It's measuring 31cm, which is about double where it should be. Dr. Mann says the fluid is way down low in the pelvis and is putting even more pressure on the cervix. The baby is also head-down, which is additional pressure as well. She feels confident that if we can get the fluid under control, then it will help slow the cervical thinning.

To try and lessen the fluid, she is putting me back on another 72-hour course of Indocin. We did a course last week but have no way of knowing if it was helpful at all. One of the unwanted side-effects of taking Indocin (for those with "normal" pregnancies), is that it can reduce amniotic fluid. It does this primarily by slowing the baby's renal function (kidneys), literally making them urinate less often. Since amniotic fluid is primarily composed of baby's urine, then less urine = less fluid. So for women with normal amounts of amniotic fluid, this side-effect is a dangerous concern. For me, since I already have too much, this side-effect would actually be a desired outcome. Indocin also helps calm contractions, since it's a NSAID drug and relaxes the muscles.

She also wants to give me a fetal fibronectin test (Ffn), to assess my risk for delivering within the next 14days. I had this test done with Gracie, so I'm pretty familiar with it. Ffn is a glyco-protein that is usually only found in the cervix when delivery is immanent. So if we find the proten present (+ result), we know something is much more likely to happen within the next 14 days. Conversely, if we don't find the protein present (- result), we know we have a very good chance of making it at least 14 more days.

The purpose of the test is really to give doctors a better snapshot at the time-frame they are facing, to determine if more intervention is necessary. When I had the test done with Gracie at 33 weeks, it came back positive. At that point I was hospitalized again, and given the steroid injections meant to boost her lungs in preparation for an early delivery. As it turned out, she was in fact born roughly 2 weeks later.

Dr. Mann was unable to obtain the Ffn sample today at my appointment, because she had already completed a vaginal ultrasound, and by doing so had compromised the "sterile environment". Eww. Because of this, she's calling my super-fab OB, Dr. Garcia, who I'm already scheduled to see this Friday, and asking him to collect the sample and run the test at that time.

Soooo .... until then I'm still stuck here in bed, praying for a negative result on Friday so we can relax a bit.

Viablility: YES! Bedrest: NO!

So today was a day of good news/bad news. Which should I report first? Hmmm.

Good news: I have offically reached the all-important, super-vital milestone known as fetal viability. This is the gestational point in pregnancy at which doctors declare that a baby has a chance of long-term survival if born early. Most doctors will not intervene to save a baby before this point.

I am praising God for the miracle of 24 weeks! He alone has provided me with a very highly-skilled team of expert doctors, given us the right medicines, and strengthened my body for the journey.

I was thrilled to head back to see Dr. Mann today (perinatologist), for another ultrasound and our weekly pow-wow. I've been especially nervous these last few weeks, knowing that the cervix was starting to show signs of effacement (thinning) between weeks 16-18. During that time, my cervix thinned from 4.0 cm to 3.5cm, but has stayed put since then.

Which brings me to the bad news: At today's measurement, the cervix is down to 2.8 cm. And there's more: polyhydramnios. This is a fancy word meaning there's too much amniotic fluid surrounding the baby. Dr. Mann explained that this is a major problem because all that fluid causes additional pressure on the cervix, causing it to thin even more. Excess fluid alone can cause pre-term labor and delivery. Added to the fact that I already have a previous history of preterm, am continuing to have frequent contractions, and now a very thin cervix ..... it's an enormous concern to my doctors.

She explained that polyhydramnios can be caused by different things: 2/3 of the time it's "idopathic", which means no known reason. About 15% of the time it indicates gestational diabetes in the mother. In the remaining cases it can be caused by a baby with birth defects, or any of the trisomies. At this point she is feeling confident that I fall into the 2/3 category, for whom this happens "just because". I will have my diabetes screening in two days, so we should be able to rule that out soon. And they have already checked the baby's anatomy top to bottom a million times, but she spent extra time double-checking his heart again today just in case. She reports all looks fine and she sees no indication of any defects.

Dr. Mann then proceeded to tell me the word I've been dreading to hear since this all began: Bedrest. I knew I was gonna end up here at some point, so it's not like it's a surprise or anything .... I was just really hoping we'd get much further along before we had to deal with this. With Isaac and Gracie both I was on bedrest about 6weeks each time. And I nearly lost my mind being cooped up like that! If we make it to the end this time it would mean SIXTEEN weeks of bedrest. Seriously a marathon. They may have to put me in a rubber room sometime around week ten or so.

I am trying not to panic. The doctors keep telling me that as long as the cervix stays above 2.0 cm then it's not time to freak out. I would be lying if I said I wasn't full of fear ... I am. But I'm trying my best to fight it and not let it paralyze me. Of course I will do everything within my own power to keep this little guy inside and healthy for as long as the Lord allows. And my doctor's have all assured me they will do everything humanly possible on their end. I am confident in their skill and I am grateful for the excellent top-notch care they are providing me. I guess the challenge once again becomes accepting the fact that this is out of our hands for the most part: God and God alone will decide the day and time that our little boy will come into the world. I am trying to take comfort in knowing that He already knows the time, and He already has the details worked out. Being the kind of person that needs to control things, of course this is quite hard.

Dr. Mann has put me on a 72-hour course of Indocin which we are hoping will accomplish two things: (1) slow contractions and (2) reduce the amount of amniotic fluid. I was on this medication back during the chaos with Isaac, so I'm quite familiar with it and I have high hopes that it will help this time. It can only be taken for 72 consecutive hours, though, which is the main drawback of this medicine, since longer dosages can result in heart problems for the baby. I will take my first dose tonight as soon as James gets home and has a chance to run to the pharmacy for me.

Aaaaaand so ..... the rollercoaster ride picks up speed ........