Coming Unglued.

Today marks 17 days in the hospital, and my extended stay here is really starting to take its toll. I’m not sure how to accurately describe it, other than to say I am utterly and completely exhausted in every way imaginable.

My physical condition has really deteriorated over the last 3-4 days. The baby is fine, and my cervix seems to be holding this week so I am celebrating those accomplishments, as they are really the two most important things at this point. Aside from those positives, though I am really struggling physically. I am pitifully weak …. the “I-can’t-possibly-walk-myself-to-the-bathroom” kind of weak. Upon standing, my legs immediately begin to burn and it takes incredible effort to move them. Taking ten steps feels like the equivalent to running a 5K. I can no longer stand up for the short time it takes me to brush my teeth. Instead I now have to sit down while I brush because I literally can’t hold myself up for 60 seconds. Even laying still in bed feels exhausting, I have this tingling all over and a heaviness in my chest that makes breathing feel like a chore. I ache everywhere. I just don’t feel normal in any way.

This has been the subject of several discussions of course, first with a few nurses and then with my doctors. Everyone seems to agree that what I‘m feeling is a result of “de-conditioning”, or my body just sort of shutting down due to not moving for such a long period of time. I’ve been in bed for 7 weeks now, though the last 2 here at the hospital have been way more extreme that what I did at home, as I am literally lying still for all but maybe 15-20 minutes a day. I have leg exercises, which the physical therapist taught me the first week here, that I am doing every day in bed. Though I am told the exercises will not really improve my condition, I still do them because I’m hopeful they will slow down further deterioration.

I have a hard time believing that I could feel this drastically horrible just because of “de-conditioning” …. this is not my first rodeo and I’ve done many long weeks of bedrest before and never felt this bad. But there doesn’t seem to be any other obvious reason … my blood pressure is staying up around “normal”; my hemoglobin and hematacrit are low but not insanely dangerously low. I’ve decided that perhaps it’s simply because my bedrest has never been this drastic before now … in the past I’ve always managed to get up for a little bit each day, whether it was throwing a load of laundry in the washer or walking downstairs for dinner. Now I am laying constantly, 99.9% of the day and I suppose that must be what’s making the difference in the way my body has responded.

Emotionally I am finding myself in similar territory. I mostly swing back and forth between moments of intense frustration, sadness, and overwhelming anxiety. I am annoyed and angry at my body, my circumstances, my confinement, and my inability to do even simple things by myself. I am homesick and sad because I miss my kids, my husband, and my old life. And I’m nearly paralyzed with worry and fear because I can’t quite seem to shake the feeling that something awful is about to happen.

Fighting the fear has become a daily battle. I mostly try to not think about the possibilities, and often I’m successful with that. But there are moments when it catches up with me and the anxiety is too strong to ignore. I am terrified at the thought of having a micro-preemie, or worse -- another stillbirth, and I find myself over-analyzing every bump, gurgle, and twinge I experience … Is my water breaking? Am I bleeding? How many contractions have I had this hour? Why isn’t the baby moving? It’s like waiting for the sky to fall. And I realize that, here I am again, now 25+ weeks into the pregnancy and I haven’t allowed myself to bond with this baby and I refuse to even give him a name for fear of “jinxing” it. As if that makes one bit of sense.

I also have equal amounts of worry for my family … this whole experience has been so hard for James and Gracie and Jamin. What condition will my family be in when this is all over? Will my kids be scarred and traumatized because their mother was absent for so long? Will my husband survive the stress of being thrown into single parenthood? Will Gracie be able to focus in school? Will Jamin start acting out in resentment? Already I can see the little cracks forming but I feel helpless to stop them. My kids appear to be struggling a little more this week … Gracie with some attention-seeking kinds of behaviors and Jamin melting down whenever he is separated from his dad and throwing frequent temper tantrums. And then there’s James … he is so strong and he puts on a brave face, but I can see in his eyes that he’s struggling and it hurts me.

I am desperate to go home and I’m hoping that perhaps once I get there some of my physical and emotional conflicts will begin to lessen. I had my 18th ultrasound two days ago and Dr. Mann was pleased … my cervix has lengthened back up to 2.5cm. The polyhydramnios has improved a teeny tiny bit. The placenta has not moved since last week, but my docs are now saying they could attempt a vaginal delivery based on it’s current location.

After the ultrasound, Dr. Mann said she was initially planning to keep me here until I hit 28 weeks, but if I wanted to “try” going home for a bit she would allow it. So we are cautiously planning for discharge sometime tomorrow (!!!!!) as long as my symptoms stay stable. I CAN NOT WAIT. I am trying not to let myself get too excited, in case it doesn’t happen, but that’s really hard to do of course. She warned me that there is a high likelihood I will end up back in the hospital again, and seemed fairly certain that we should anticipate that happening sometime in the next few weeks. From what they’re telling me, most likely I will have to return sometime soon for a magnesium sulfate wash. The possibility of needing this is highly distressing at the moment because I’m told the side effects are awful. More on this later. For now I’m pulling the denial card and it’s working quite well so I’m not ready to give that up yet!

Pray for us.

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.

21 Weeks and still standing! Well .... mostly laying.

Oh gosh .... where to start??? There is so much swirling in my head right now, I've got a major case of Kristi-brain at the moment. Worry overload.

First a bit of good news: I saw Dr. Mann last week for my weekly ultrasound (Lucky #13!!!) and we finally saw something to be happy about. The Polyhydramios is gone. Yep, that's right: GONE. Praise the Lord! The second round of Indocin did it's job, and my fluid is now measuring 16cm, which is considered perfectly normal. It's been so long since I've had anything "normal", I was beginning to forget what that feels like. But now I remember ...... ahhhh yes it feels fabulous.

My cervical measurement was stable, in fact it actually increased ever so slightly to 3.1 cm, so that was also good news! Our other big concern, the placenta previa, has not moved. It's location remains unchanged (boo). Before now, Dr. Mann kept expressing confidence that it would eventually move, though that was weeks and weeks ago. So I asked her, "Are you still feeling confident that this thing is gonna move?" .... to which she got very quiet and paused for an awkwardly long time, and then responded "Well I really hope it's gonna move!"

Ummm, yeah. I really HOPE it's gonna move too, obviously! But you conveniently didn't answer my question.

A week has passed since that conversation, and so as you can imagine that's more than enough time for my brain to kick it up a notch in the worry department. This stupid previa has scared the crap outta me since the day we found it. When you combine a previa with blood thinners and preterm labor ..... the possibilities are downright terrifying! The potential for disaster is way too high for my liking.

So today, at my OB appointment with Dr. Garcia, I had to pick his brain for a bit. He is always such a straight-shooter with me, he doesn't sugar-coat things. I ask him a detailed question, and he gives me a very detailed answer. 100% of the time. It is the reason why I trust him so completely. So many times before, with other doctors, I felt like I had to ask the same question 4 different ways before I was given a semi-complete answer. But Dr. Garcia does not beat around the bush, he doesn't leave me wondering, and I absolutely adore him for it.

So I asked him today .... at what point will we know whether or not this previa is going to move?? He told me 28 weeks. He said the next 2+ ultrasounds I have with Dr. Mann should be very revealing ... if the thing is gonna move we should start seeing some form of slow migration happening in the next 4-6 weeks. If we get to week 28 and it's still a complete previa, we can be pretty certain that we're stuck with it and we will have to develop a plan for how to deal.

So of course I had to ask .... in the event we're stuck with it, what will our plan be? He explained that he would have to consult with Dr. Mann and they would have to get creative and, as he said, "put our thinking caps on". But as of today, his recommendation would be:

1. Switch immediately from Lovenox over to traditional heparin (these are cousins; Lovenox is a form of heparin). The reason for the switch is to increase your chances of not having blood thinners in your system at the time of delivery. A single shot of Lovenox stays in your system for 24 hours. And once it's in, there is no way to reverse it. So if you go into labor, or need to do an emergency delivery, within 24hrs of your last shot ...... you're in trouble. Traditional heparin, however, stays in your system for 12 hrs (which means you need two shots a day instead of just one). But the advantage is that if an emergency delivery is needed, or you spontaneously go into labor, you've just bought yourself 12hrs. Also, the effects of heparin can be reversed, with another drug (can't think of the name), which can be given as a shot at the hospital. This shot can fully reverse the effects of the heparin within a few hours, at which point it is safe to deliver.

2. Immediate hospitalization if I have any bleeding at all from the previa. If the bleeding gets "bad" (exactly how much is considered "bad" I have to wonder???) ... then he will deliver via C-Section regardless of gestational age. Assuming we have no bleeding, and we can get a few weeks further, then ....

3. Administer betamethasone (steriod) injections around week 33. This is a series of 2 shots, given 24hrs apart, which boost the baby's lung maturity. Because lungs are the very last thing to develop in the unborn baby, premature delivery means that major lung problems are frequent and dangerous. I've had these shots with both Jamin and Gracie, and I firmly know they work! They also hurt like a $%&@!!!!! but that's beside the point :)

4. Perform an amniocentesis at week 34. This will assess the baby's level of lung maturity. I had this with Jamin as well. There is some particular type of protein that they look for, it's presence indicates the lungs are mature enough and it is safe to deliver. Assuming all looks well, then ....

5. Deliver via C-Section at week 34.

I'm obviously freaked out that the doctor's best case scenario assessment with a previa involves delivery 6wks early. But I know that he would never ever in a million years recommend that unless it was the absolute best alternative for the baby. And there are a lot of "if's" to get to that point so there are many factors playing into this scenario which could change. So to a small extent it's like trying to predict the unpredictable. At the same time, though, it's the unpredictable part that has me so worried. There are so many things that could happen which would force a delivery even earlier than week 34.

My biggest fear at this point, which I shared with Dr. Garcia, is that I will have further cervical change, which will cause the previa to start bleeding, and since I'm on blood-thinners it will be really bad .... they will be forced to deliver, and we'll end up with a very very very premature baby. Nodding his head, his response was "that could very well happen, and that is my biggest fear too. But we are already doing everything humanly possible to prevent that from happening. At this point all we can do is react quickly if/when something happens".

He did say that sometimes cervical thinning by itself won't be enough to cause bleeding, it depends on how quickly the change is taking place. He said cervical dilation is more likely to cause bleeding. So I took this as a glimmer of goodness because in the past I have tended more toward very early thinning, like 20+ weeks, but then not dilated until like 30+weeks.

He stated repeatedly that the previa still has a chance of moving sometime over the next seven weeks, and twice he said "I really hope it moves". Hmm, now where have I heard that before?

Solitary Confinement; Day 3 of 148

Friends, I have landed myself in the Slammer. The Big House. The Black Hole. The Pen. Or as my doctors and I like to call it:

THE COMPLETE LACK OF INDEPENDENCE AND MISERABLE CONFINEMENT ALSO KNOWN AS EXTENDED BEDREST.

Ugh. Extended .... as in .... a really long period of time. Twenty-one full weeks to be exact. Or 148 days. Or 3552 hours. But who's counting?

The last few weeks have been crazy and overwhelmingly stressful and ....... let's just say I haven't been in the best mood. Needless to say, blogging has landed somewhere around #450 on my list of Top 500 Things to Worry About. So while there are so many complicated things going on at the moment (more than I can possibly blog in one sitting), let me try to summarize how I got here:

12.5wks: I started having contractions

13wks: I began the weekly 17P injections and was told to reduce my activity and "put my feet up" as much as possible. Though Dr. Mann never explicitly said the dreaded "B" word, James and I knew what was coming and decided to plan ahead. So we began searching for a nanny to help out here at the house during the week.

14.5wks: My home nurse started making her weekly visits. I had ultrasound #10 and found out we are once again on TEAM BLUE - it's a boy! Dr. Mann also discovered I have Placenta Previa. These are categorized in order of severity as marginal, partial, or complete. Mine is a Complete Previa ..... because, it just wouldn't be a Kristi pregnancy if it weren't the worst case scenario, of course! I was told there was a "very good" chance the previa would resolve on it's own as the pregnancy progressed. If it didn't resolve, however, this would exponentially complicate matters since the biggest risk with a previa is hemorrhaging and of course I'm on blood thinners (Lovenox and Aspirin, to combat the Protein S Def), and also I tend to have early cervical thinning / preterm labor which in the case of a hemorrhaging previa would require immediate Csection, and could potentially be a very premature delivery.

17.5 wks: We hired a nanny, though she needed to work out a notice with her previous employer so she hadn't started yet. I had ultrasound #11, at which Dr. Mann reported a slight improvement in the location of the placenta, though I still had a complete previa. But she was hopeful that it may continue to move and eventually resolve itself. My cervix measured 3.5 cm long, which was down from my last measurement (4cm) a few weeks ago but still on the lower end of the "normal" range so cautiously we considered this a bit of good news. However she also found a new problem: Polyhydramnios. I had this with Jamin's pregnancy as well, it's basically too much amniotic fluid around the baby. There are several risks associated with this by itself, for me the most urgent being that it increases pressure on the cervix causing it to thin and dilate too early (which is already an existing problem for me). So again it's one more issue to further worsen the other issues. While all the complications are happening independently of one another (the previa, the preterm labor, the Protein S Deficiency, and now the polyhydramnios), the end result is that they all interact to negatively effect eachother and essentially make the next problem even worse.

I was given an oral medication called Indocin, which I also took repeatedly during my pregnancies with Isaac and Jamin. This drug is used to help slow contractions, though one of its (normally undesirable) side-effects is that it tends to reduce amniotic fluid. For most women this would create a problem, but for someone like me who has polyhydramnios, this side effect is actually what we're trying to achieve. The downside is that Indocin can only be taken for a max of 72 hours, because any longer than that can cause heart defects in the baby.

18.5 wks: Dr. Garcia signed a "Georgia Disabled Persons Parking Affidavit" and I was able to obtain a temporary handicapped parking pass. This felt a bit upsetting at first, but I quickly found it to be incredibly helpful and quite a relief for me, particularly during my weekly parking adventures at Northside. I had ultrasound #12 with Dr. Mann, which showed the previa unchanged and the polyhydramnios still present (meaning the 72-hrs of Indocin I took last week did not work). Worse news was that my cervix was now measuring 2.8cm (down from 3.5 just one week ago). I'm told a "normal" cervix at this gestational age should be somewhere around 4-5cm long .... whereas 2.8cm would be normal sometime around 36-38+ weeks gestation as delivery approaches. All of this brought Dr. Mann to finally utter that awful word that I've been so desperately hoping to avoid: BEDREST. She also told me to repeat a second 72-hr course of Indocin, and ordered a terbutaline pump and home monitoring of contractions with a toco machine (will blog more on this tomorrow).

I left there feeling extremely unhappy though not one bit surprised .... we knew all of this was coming, it was more just a question of when. The only thing that kept me from going into a complete panic was the fact that the new nanny, Sara, had just started working. Her first day was on Monday, and I was ordered to begin total bedrest on Tuesday! Yep, that's God's timing folks.

Today I finished my 3rd day of bedrest. Only 145 more to go! (Let's pretend that makes me feel better). I'd be completely lying if I said I'm not immensely freaked out by the long road ahead of us .... the list of complications we're facing and the potential for disaster has my mind spinning most days. But even still, I have this peace knowing that I seriously have the most amazing and highly-qualified team of doctors, and they are throwing everything but the kitchen sink at me. There is no medicine I'm not already on. There is no treatment, no intervention available that we're not already doing. They are literally doing every single thing in their (limited) human power to make this work ....... and guess what that means?? It's no longer up to us. This entire journey rests solely in God's very capable hands, as it has since Day 1 before my doctors and I even knew what obstacles were waiting for us. I don't know for certain that God has another happy ending in store for us, though of course that's what I'm praying for. But I do know that regardless of how this whole thing ends, He will carry us through and we will survive.

Please continue to pray for us!

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 ........