Jitterbug!

Guess where I'm going today???!?!?!!?

Ummm, yeah, nowhere. Ha, just bed. The walls are starting to cave in on me. Many people are asking me about the terbutaline pump and the monitor, and since I have a wee bit of extra time on my hands these days (pffff), I thought I'd show you what these things are and how they work. I had never seen a terb pump myself until it arrived at my house on Saturday. I had scoured the web in nervous anticipation, looking for pictures or diagrams, or something to ease my mind, but didn't find much. It would've been so helpful to see some pictures beforehand and get a better idea of what to expect.

I'll start by showing you what my belly looks like while I'm hanging out in bed:


There are actually two separate devices here. The first is the terbutaline pump, which is the little black thingy with buttons. It is attached to a tiny blue tube which is inserted into my right leg. The second is a toco monitor, which is the belt around my waist and the little grey box with lights.

First up, the terbutaline pump. Terbutaline is a drug designed to relax smooth muscle (i.e. lungs, uterus). It's actually intended to be an asthma drug, but is widely used "off label" by OB's who want to calm the uterus and lessen the frequency and intensity of premature contractions. Terbutaline comes as a pill (which I have taken with all 3 of my previous pregnancies), or in injectable form. My peri intends for this to be "long term use" (which, by the way, terbutaline has never ever EVER been proven effective at such) ... but since it's supposed to be long-term she feels the best method for me this time is a pump rather than the pills, which are taken every 4 hours. By contrast, the pump stays in 24hrs a day and administers a constant dose subcutaneously. Here's how it works:

I have a million little vials of terbutaline. They live in my refrigerator. The only thing I like about them is the hot pink label ... very "diva":

The vial gets inserted into this little hand-held pump:

It's size reminds me of those rockin' pagers we used to have circa 1998. Though it's a little thicker (width-wise) I think. The vial slides down into the back of the pump ... right underneath the cap you see on the top where the blue tube is attached. Each vial is pumped out at a slow continuous rate and lasts me about 24 hours. So roughly once a day I have to replace the vial with a full one from my fridge. This is a quick process and I only find it to be incredibly annoying b/c the thing beeps incessantly at me for several hours when the vial starts getting low. This morning it was every 10 seconds from about 4:30 am until I finally gave up and went downstairs to change it at 6:30 am. It's the same feeling you get when your smoke detector beeps non-stop until you change the battery (by which time you'd rather just throw the whole freakin thing out the window!)

The pump is programmable, it's all digital, so I can adjust my dose if needed. I can also administer an instant "bump", called a demand dose, if the contractions are bad and I need a little extra. It runs on one AAA battery. And taking a shower with it is quite a hoot. I'll leave that one to your imagination :)

Attached to the pump is a long blue tube, which delivers the medicine into my body through the little round button-looking thing you see on my thigh:

There is a needle, which inserts a catheter under the skin. The needle is then removed and the catheter remains and is taped down. The button-part goes on top and allows the tube to spin so I can move and sleep comfortably. Once it's in, you really don't feel it, promise :) This entire piece has to be removed and changed every 3 days. You have to pick a new location, open a fresh set of tubing and a new needle, and reinsert the whole thing. I think I'm basically planning to rotate back and forth from the left leg to the right leg. I also have the option of using my inner thigh, or my abdomen ... but since I already use my abdomen to inject the Lovenox every night I feel like I need to leave that whole area open if possible!

Once it's all situated, the pump itself can be placed inside an incredibly ugly navy blue canvas case/pocket protector/fanny pack thing, so it can clip to your waistband. Seriously it's the ugliest thing ever! I'm hoping to find a more aesthetically-pleasing cell phone case (if I can make the pump fit inside?) ... or if all else fails I'll just bedazzle the crap outta this navy blue nightmare! Ya know, for entertainment's sake. We'll add some rhinestones and some tacky bling and at least I will laugh when I look at it.

So that's the terb pump in a nutshell. Overall it's not as awful as I expected .... the pump itself isn't really the problem, it's the medicine that makes me miserable. The side-effects are super duper unpleasant. It's a heart-racing, hands-trembling, unable-to-breath type of thing. I'm finding the side effects with the pump to be slightly less severe than what I experienced with the pills. However with the pills you at least get a bit of a break, whereas with the pump it is constant, neverending, blahhhhh. So having done both now, I can't make up my mind which one is "better" or "worse". Obviously the pills don't involve needles so for that reason alone I'd say they have the edge.

My other contraption is a "Home Uterine Activity Monitor", it's identical to the toco monitor at the hospital or the peri's office, but thankfully it's a smaller version:

The purpose of this thing is to record uterine contractions. I have to hook myself up to this monitor a few hours a day, luckily it's not around the clock! The "belt" has the round monitor attached which goes around the belly, and is connected via the grey cord to a little rectangular box with lights and buttons. That's where I can turn it on and off, or if I'm feeling a contraction at the time I can push a special button so it's recorded on my toco strip. The little box also holds all the data recorded from the monitor belt.

When I'm finished recording and I'm ready for a break, I remove the belt, and the little rectangular box gets plugged into this machine next to my bed:

I push a few more buttons and then this machine wirelessly transmits the saved data (via satellite) over to a set of nurses, in FLORIDA of all places! After 5pm, or on weekends, the data gets transmitted to the "on call" nurses, who are in Philidelphia. The nurses download the data and it prints out as a toco strip, just like at the hospital .... the long paper strip with all the little mountains showing your contractions.

About 15 minutes after I transmit my data, I get a phone call from the nurse, who tells me how my strip looked. If I'm having more than 2 or 3 contractions per hour she will have me administer an instant "demand dose" on my terb pump. This forces the pump to give me 1-hour's worth of medicine over the span of 15 minutes. I then have to get back on the monitor for another 30-60 minutes and retransmit an updated strip, then wait for another call back. We continue this process until the nurse feels confident that my uterus is "calm", at which point I get to take a break from the monitor for awhile.

I had a similar monitor during my pregnancy with Jamin, though I like this one better because it's an updated version. The old one was analog and had to connect through my phone line (sort of like a fax machine). This one is all digital and it sends the signals wirelessly so it doesn't tie up my phone. That's a major plus b/c with the old machine it never failed that someone would call me at the precise moment I was trying to transmit my strip ... causing the machine to melt down and I'd have to start all over again. And a pregnant lady stuck in bed has VERY LITTLE PATIENCE for these kind of mishaps!

I'm headed back to Dr. Mann's office tomorrow afternoon ..... to see if all these stupid machines have made one bit of difference! The main things she'll be assessing tomorrow are: (1) cervical length -- has it shortened from 2.8 cm since last week; (2) Amniotic fluid levels -- did the second round of Indocin reduce the fluid or do we still have polyhydramnios; and (3) Placenta's location -- has it moved up at all or do we still have a complete previa.

I will try to do a better job of updating in a timely manner :) Pray for us!

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!

Never a Dull Moment: 14.5 weeks

Oh how I have longed to be one those lucky lucky women who seem to sail right through pregnancy; whose bodies just naturally know what to do ... whose biggest worries consist of what color to paint the nursery and what style of shoes best accommodate their swollen feet.

Alas, I will never be one of those women.

I used to feel a little bitter about it, but really, that's just ugly. Over the last few years I've learned to let go of the envy and instead embrace the struggle. God gets to show off in a major way every time I am pregnant, and that's pretty cool, right?

But being in the midst of the battle means there's never a dull moment at the Wren house. Such has been the case over the last few weeks. Around 12 weeks I began feeling abdominal cramping, which at that time felt like a dull ache similar to menstrual-type cramps. Upon seeing that I had a higher white count in my urine, Dr. Garcia assumed I must have a bladder infection, and started me on an antibiotic. Two days later we got the test results back showing there was no bladder infection afterall. Nurse Debbie called to share the "good news", and I immediately began to cry. Indeed this was not good news to me ... it meant that the cramps must actually be contractions.

Since that time they have strengthened a bit, in frequency and severity. They are now more distinguishable as contractions, coming and going, worsening at different times of the day and under different circumstances. In addition I'm now feeling pain and pressure in my cervix whenever I stand or walk for more than a few minutes. Today I saw Dr. Garcia and he insisted on an ultrasound to measure the cervix, even though I am seeing Dr. Mann tomorrow and she will be doing the same measurement. I love that he takes no chances, waiting 24hrs was just not even an option for him. He is a better-safe-than-sorry kind of guy, and that is just one of the many reasons why I adore him so.

The ultrasound showed my cervix to be 4cm long, which is great news! Dr. Garcia ordered me to start the 17P injections today rather than wait until week 16 as we originally planned. The 17-Hydroxy-Progesterone is the weekly intra-muscular injection that is thought to reduce the risk of pre-term labor. Aetna Pharmacy had already shipped the vials and needles to me about a month ago, but had not yet finalized arrangements for a home nurse to administer these to me each week. So when I came home from Northside, I retrieved my medication and began searching for someone qualified to inject it for me. My first stop was to the sweet servants at the local fire station, who helped me repeatedly while I was pregnant with Jamin and having blood pressure problems. They were eager to help today but explained that their regulations forbid them from administering an injection unless I became a "patient" which meant I would have to go to the ER! No thanks :) I almost got up the nerve to inject myself in the leg muscle (pure desperation!) when I remembered two sweet friends with some medical training. Gotta love generous friends who don't mind getting their hands dirty to do you a favor!

So I was able to get my first shot this afternoon, and beginning next week Aetna will be sending a nurse to my home each week to do these for me. The "standard" protocol requires 17P to continue weekly until 34 weeks gestation (though the thought of "standard" is almost laughable to me!) ... but if this is the case I will have about 20 more of these shots left. This got me thinking about my Lovenox shots, and for the sake of entertainment I decided to count those too. Now I'm wishing I hadn't counted! So far I've had 67 Lovenox injections (tonight will make 68), and if my math is right I have about 196 more to go. I haven't shared the bad news with my tummy yet (it won't be too happy).

In happier news, we are insanely anxious to finally learn the gender of the baby! I've had three ultrasounds in the last three weeks (one today in fact), each time hoping to learn whether we'd be on Team Pink or Team Blue this go-round. Alas, each time the technician could only manage to tell me: Team Yellow. Ugh! I hate hate hate hate hate not knowing! And yes I do realize I am an impatient brat and yes I know that most women have to wait until 20 weeks to find out. I have no earthly idea how these women control themselves that long because I would literally pull my hair out if I was forced to wait until then! So kudos to you ladies! You have much more self-control than I do!

Hopefully our waiting game will end tomorrow, when I see Dr. Mann. She assured me at my visit 3wks ago that we would definitely be able to tell the gender this time ... so unless the baby is curled into a teeny tiny ball with a metal plate covering the pertinent parts, I think our membership on Team Yellow will finally come to a close. James, Gracie, and I are all hoping for Team Pink this time, though James says he has a "feeling" it's a boy. Gracie has her heart completely set on a sister, who she plans to name Moe. She has very firmly made up her mind and I'm pretty sure she's not changing it. I tried to talk to her about the possibility of another brother, to which she declared that we will just dress him in pink and call him Moe anyways. So this could present a slight problem. And I am cheering for a girl, just because the last two have both been boys and it would be fun to have some pink in the house again. But of course I know that my plans are not God's plans (only took me 31 years to figure that one out!), so I will take whatever He gives me :)

Stay tuned for the big announcement tomorrow!

How Low Can Ya Go?

Last week I got a call from Dr. Duncan's nurse at Emory telling me the results of my latest Protein S labs, which were taken at 10weeks gestation. My "Free Protein S" had fallen to 19 (!!!!), down from 25 at 7weeks gestation and roughly 48 pre-pregnancy. "Normal" is considered to be somewhere between 60-150ish.

We knew this was coming, since Protein S naturally falls during pregnancy (even for the "Normal" folks). So while we were expecting them to fall, we were never expecting them to fall this low. The hematology nurse who called freely admitted she's never seen numbers in the teens before, which I also expected, but even so hearing it out loud didn't feel too good.

I managed to confine my mental freak-out to just a day or two, and now I'm just taking comfort in the fact that God's got me covered. And the icing on top of that cake is knowing that Dr. Duncan is monitoring me very closely, and there is no doctor more qualified for this scenario than he is.

In fact, I'm feeling so confident, that I'm now taking bets on just how low my Protein S will drop before this is all over with. We expect that it will continue to fall as the pregnancy progresses, the lowest point being at the end of the pregnancy. So now it's just a game of "How Low Can Ya Go?" .... without triggering a disaster, of course. Anyone want to take a guess? We need to award a prize to the person who gets closest without going over!

I'm thinking if numbers in the teens are nearly unheard of, would I just be a complete freak of nature if I had a single digit number? If so, then that's my goal. Just another chance for God to show off!

BRING IT ON PROTEIN S!!

Tonight I'm reminded once again what a complete miracle Gracie is. I'm always calling Jamin my "miracle boy" and eager to share with anyone who will listen how God brought him here. But knowing now that my Protein S drops to unheard-of levels in the first trimester of pregnancy ... and knowing that I was clueless and unmedicated for my entire pregnancy with Gracie ... and knowing that we both survived ... seriously blows my mind!

I'm also resolving not to whine anymore about those stupid Lovenox shots. Yes they hurt and yes I absolutely hate injecting myself every night, but since they are keeping me alive right now I suppose it's only fair to stop complaining about them.

Thank you God for Lovenox!

Fast Forward!

A few weeks have passed since my last post, I've been generally whiny and feeling an overwhelming lack of energy ... to the point that the very thought of blogging was enough to make me tired. Blahh. Here's a condensed version of the last few weeks:

I've had three more ultrasounds ...... the 5th being at the Perinatologist office due to sudden onset of heavy bleeding around 9 1/2 weeks. Dr. Mann was not available, so I saw one of her colleagues Dr. Matsumoto ... or as she calls him: Dr. HOT-su-moto. She calls him this because, well, he's kinda young and hot. Not really the guy you want to see when you have to explain how you have blood gushing from your nether-regions. Yeah, so that was a pleasant experience. The good news is that he was able to very clearly see that the blood was originating at the cervix -- not the placenta -- so that was a best-case scenario for us really. Disaster averted.

My 6th ultrasound was done about a week later, another "quickie" scan at Dr. Garcia's office. And the 7th was last week, with Dr. Mann during our nuchal translucency screening. It was so fun to see the baby again ... wiggling and spinning and waiving. The best part was that I got excellent results from the screening and all seems to be progressing just as it should. I was only 12w1d at the time of the scan, but even so Dr. Mann offered to take a peek at the "special parts" to try and determine the gender. She squinted and strained and did everything but stand her her head ..... but alas, just too early to tell. She said if we'd had one more week it would've been so much more clear. I knew ahead of time that the chances of being able to determine the gender at 12wks is super slim so I really wasn't surprised or disappointed. I see her again in 2 1/2 weeks and she promised we would know for sure by then! :) I am still hoping for team PINK, all the while recognizing I get absolutely zero say in the matter and will simply have to take whatever is given to me! James says he is cheering for team Pink, but has a "feeling" it's a boy again this time. Only time will tell!

I saw Dr. Duncan (aka Dr. Genius) about two weeks ago for my hematology appt. My bloodwork from the previous appointment (taken around 7wks gestation) came back showing my Protein S levels to have plummeted down to 25. It is normal for Protein S to decline naturally during pregnancy, but it's definitely not normal for it to drop this low. We expected it, though, since the exact same thing happened at the very beginning of my pregnancy with Jamin, when my level was about 24 at week 7. The concern comes from the fact that my Protein S will continue to fall throughout the pregnancy, so then it becomes a game of "how low will it go???" All we can do is continue to watch it and adjust my Lovenox dosage as needed. But oooohhh how much better I feel this go-round just knowing I am in the hands of one of the most competent hematologists in the country and he is watching me closely. He took another 800 bottles of blood from me at my last visit and I am still waiting on those results. His nurse is actually supposed to call me tomorrow, fingers crossed.

I am now 12w5d and beginning to have some painful cramping. I saw Dr. Garcia today for my regularly scheduled appt ... he says I have a high # of white cells in my urine so he's speculating the pain is caused by a UTI, aka bladder infection. He sent off a culture of course, but the results will take 48hrs to get back to us so in the meantime he's already started me on an antibiotic just in case. Tonight the pain is literally worsening with each passing hour, so I'm beginning to feel a wee bit nervous and praying it's really just a UTI and not something more worrisome. I began having contractions with Jamin around week 16, and with Isaac at week 12 so of course my mind is already running away with that possibility. He also gave me a pap while I was there today (just because it was time), and so now I'm bleeding profusely again because my stinkin cervix apparently is so frail it begins to bleed if the wind blows too hard or if someone stares at me too long. Doesn't take much.

So I'm back to where I started: feeling generally whiny. Now you see why I took a break from blogging?? :)

Fingers, Toes, and Pink Hair Bows...

So I had my 3rd and 4th ultrasounds this week. The 3rd being on Wednesday at Dr. Garcia's office. I was 9w0d at the time. This was a "quickie" ultrasound just to make sure we still have a heartbeat and all is well, since I'm too early for them to pick up the heartbeat on the doppler. He has a mini-sized bedside machine which he can wheel right into the exam room and do a quick scan, no need to schedule with the ultrasound tech and use the "Mucho Grande" machine. I think that's so cool that his office does that ......... have I mentioned lately how much I adore my doctor?!?!?! Gosh I'm here to tell ya, having a doctor you completely trust with an office staff that's caring and efficient -- well unfortunately that's extremely hard to find and therefore is pretty much priceless in my book.

Baby measured exactly 9w0d so growth is right on target. I was reminded once again how amazingly developed an unborn baby is, even this young ... we could see little arms and legs clearly visible, and an irresistibly cute profile that reminds me a bit of a gummy bear. As Dr. Garcia fumbled with the machine trying to get a good recording of the heartbeat I asked him, "Do ya see a pink hairbow in there?!?!" He laughed and explained he was trying to look at baby's heart (okay okay, slightly more important than the hairbow), but then joked that maybe he did in fact see something sparkly around the cranial area. He later printed a picture for my memory book, asked the nurse for a red pen, and stepped into the hall. He came back a moment later and handed me the photo, which had one small hand-drawn modification. It didn't show up well when I tried to scan the image and make it digital, so I used photoshop to enhance it a bit. You get the idea:

Still too early to tell for sure, but undeniably I am already itching for some more pink in the house. It will be at least 4-6 weeks or more before we'll get an actual ultrasound view that will tell us pink or blue (poo! I hate waiting!). So until then I'm thinking lots of pink and sparkly thoughts and pretending to be patient.

My 4th ultrasound was this morning, and it was 100% medically unnecessary. Just for the sake of a good cause (well, okay, and my own entertainment too)! My pals at the Pregnancy Resource Center, where I volunteered for a few years before Jamin arrived, called me this week asking if I would be their "model". They were training some new ultrasound technicians today and basically needed a preggie person to be their guinea pig. I was happy to oblige! I got to stare at my little one on the screen for almost two hours and share time with some sweet women so it was definately a win-win for me! I didn't spot any hairbows this time, but I did get to see something even cooler: the baby is moving already! Seriously, I'm certain I've had at least 50 ultrasound scans between the 4 pregnancies but there's something about seeing those little hands waiving at you that just never gets old. I was so tickled to have the chance to see baby kicking and wiggling, especially at 9w3d, and struck once again how God can pack such amazingness into something so tiny.

Here's a little video glimpse from this morning .... it's a pretty blurry image but you're looking at baby's head on the left side of the screen, belly in the middle, then legs and feet kicking on the right-hand side.

Hebrews 11:6

I had two more ultrasounds this week (details to come in a later post, promise). Baby's measurements exactly matched my LMP this time, so growth is going just perfectly and the heartbeat is strong and right where it should be! I dunno why exactly, but for some reason I was surprised by this good news. It's either my general lack of a positive attitude, or my lack of faith in God's goodness and power, or maybe it's a combination of both. But during the week I spend waiting in between doctor's appointments I find myself convinced that the pregnancy is doomed and I begin telling myself not to get too attached. For my last two OB appointments, in fact, I've shown up there fully expecting to hear some kind of tragically terrible news. I mentally prepare myself for it days before I get there. And then we do an ultrasound and I lay there like a dumbfounded fool because all I keep getting is perfectly fabulous good news. So I leave the office feeling fantastic and excited, and roughly 2-3 days later the doom and gloom sets in and the process repeats itself.

It is a constant mental battle -- and a spiritual battle, I'm embarrassed to acknowledge -- and I'm trying really hard to fight harder and stay focused and not allow myself to fall into that pitfall each week. At church this past weekend my pastor spoke about how fear will give us memory loss ...... we get so scared that we forget the miracles God has already done for us in the past, and instead we focus only on the scary circumstances we're in at the present and we begin to think surely we're doomed.

Well as you can imagine that message certainly hit me like a ton of bricks.

He might as well have cued a big spotlight right onto my chair and waived to me from the pulpit. Hello! Kristi! God is speaking to you! Are you listening? DUH. I mean, could I possibly be a more ungrateful, unfaithful doubter? Look what God has already done for me! Look at the miracles He has performed! They are all right here recorded in this very blog, should I need a reminder. Not to mention the fact that there is living proof of His miraculous power, giggling and toddling around my house with a big baldy head and chunky little legs, and I stare at him all day long ... how could I possibly forget?? How could I have the audacity to doubt? Is my faith so weak and my trust so frail as to think God isn't capable of doing the EXACT SAME THING He's already done before?

Well I'm determined to fight the fears and the unbelief, and I know the only way to do that is to get my head in the Word and keep it there each and every day. But I need help, friends, I need accountabilty. So if you are my brother or sister in Christ I'm asking you first to pray for me and second to call me out when you see me. Hold my feet to the fire! Ask me how I'm doing and if I'm standing firm. I know myself well enough to know this is a serious area of weakness for me and I also know that without faith it is impossible to please God, so this is certainly not something I'm willing to ignore any longer.

Also feel free to smack me in the head every once in a while, it's for my own good so I'm giving you permission. I promise not to freak out. It will be like that V8 commercial ....



"And without faith it is impossible to please God, because anyone who comes to him must believe that he exists and that he rewards those who earnestly seek him."
Hebrews 11:6

The newest member of "Team Wren" ....

..... is a jolly 'ol Scottish lad named Alexander Duncan, or as I've nicknamed him: Dr. Genius. Seriously, this guy is insanely brilliant. And he has spent the last 40+ years researching and treating thrombosis patients just like me.

Most hematologists are actually practicing as an oncologist/hematologist, this was the case with my previous doc, Dr. Munjal, and 95% of other hematologists in practice. These doctors must have a wide range of specialty .... they primarily treat cancer patients and as such they usually specialize in bone marrow, stem cell transplants, and the like. The result is that these doctors, though considered "hematologists", only end up with a basic working knowledge of the less-common hematologic issues like Protein S Deficiency. Dr. Genius, on the other hand, does zero oncology. And he does not specialize in a wide range of hematology problems .... instead his entire career has focused on basically TWO THINGS: 1) Congenital and Acquired Thrombophilia (yep, that's me); and 2) Complications of pregnancy due to hemostasis (hello! me again). He literally sees more thrombosis patients in a week than most "specialists" will see in a year (or at least, that's what he told me!).

He is widely published, highly regarded as an expert, and patients travel from all over the country to see him. Not to mention, he's kind of like a big teddy bear with his irresistible Scottish accent and his grandpa-like demeanor. How fortunate I am that he practices in Atlanta, and moreover that he is now officially the newest member of "Team Wren". I would love to brag and say that I researched this guy and sought him out for his clinical specialty, moving mountains in order to score an appointment with him ... but that's not so. The truth is that I landed in this guys' lap without even knowing it, all of which was God's work and I was oblivious at the time. I consider this the first miracle of Pregnancy #4, and the details are just too cool not to share....

On May 13th I was having my annual "pow-wow" with Dr. Munjal, my hematologist of almost 4 years. Outside of pregnancy, I just see her once a year to check on my numbers and make sure all is well. My last visit with her had been shortly after Jamin was born (April '09), and at that time they actually scheduled my next visit for May 13, 2010. So I literally had this appointment written on my calendar for a full year. Mid-way through our visit, Dr. Munjal began telling me some things about Protein S Deficiency that totally didn't make sense to me .... things which were 180 degrees contrary to everything she had told me for the previous 3.5 years, and things which were completely contrary to everything I'd read and researched.

This was not the first time I'd had a bad experience at her office. Recall Nurse Know-Nothing advising me to "google it" last year when my Protein S #s were dangerously low. There were other little things too, which bothered me from time to time but I ignored them b/c the thought of switching doctors was too overwhelming.

So here I sat in her office that Thursday afternoon, completely dumbfounded and confused by these crazy things she was telling me, feeling like I was in the twilight zone or something. Always being one to wear my feelings clearly on my face, Dr. Munjal obviously noticed my displeasure and finally asked if I wanted a second opinion. I thought for a moment and then agreed to her offer.

She proceeded to refer me to her own partner, at a second office .... gee thanks. When I caught on to that I told them NO THANK YOU, I would like a referral to someone outside of this practice please. The nurse suggested Emory, and I said fine.

A few moments later I was sitting at the receptionist's desk while she set up my referral over the phone and faxed all my medical records over to Emory. I asked her the name of the doctor I would be seeing, she told me she didn't know -- it was a large group with many doctors and they would decide who wanted to see me once my referral went through. I left there annoyed at my experience with my doctor of almost 4 years, but feeling grateful that I would be getting someone else soon who would probably be better in the long run. I wouldn't really need to see them for another year anyways so in the grand scheme of things it wasn't a super big deal.

TWO DAYS LATER I DISCOVERED I WAS PREGNANT.

And immediately it became a super big deal! So as I laid there on the bathroom floor that Saturday night bawling my eyes out, with all the fears hitting me like a ton of bricks, it suddenly occured to me: I don't even have a doctor right now!!! Could there possibly BE a worse time to be in-between hematologists?!? Of course, you know the rest .... I completely freaked out because, well, I am Kristi afterall, and that's what I do.

Monday morning I got a call from a lovely lady at Emory who had received my referral and wanted to bring me in sometime in July or August for a consultation. I sheepishly explained ...... "well, something major has changed ..... uhhhhh ..... I'm pregnant." She managed a polite "Oh my!!" and immediately understanding that July or August would not work, she scheduled me to come in within a matter of days. Just as we were hanging up the phone I asked her the name of the doctor I would be seeing. She gave my Dr. Genius' name .... which I scribbled on a piece of paper .... and as soon as I hung up with her I consulted my good friend, Google. When I pulled up Dr. Duncan's profile on Emory's website I nearly fell outta my chair. Here I had just obliviously fallen into the lap of one of the most highly esteemed experts at precisely the time when I would be needing him most.

Instantly it hit me that God had orchestrated this entire thing, and for the first time in days I stopped crying and felt a bit of peace knowing that God was in control of this entire pregnancy and He already had all the details figured out for me.

Dr. Duncan is the Medical Director of the Special Coagulation Laboratory at Emory University Hospital. He is also the Medical Director of Emory University Hospital's Hemapheresis Unit. And now he's been appointed as the Hematology Director of Douglasville's own Team Wren, which I'm certain has to be the single most minuscule accomplishment of his career but nonetheless I'm quite thrilled to have him!!

Meet Baby Wren #4!

Well, it's official. We had our second ultrasound last week, this time we saw a teeny tiny embryo and a perfect little heartbeat fluttering away at 133 beats per minute. Baby is measuring 2-4 days small but Dr. Garcia feels that all is well.

My actual due date is January 19, though of course our ultimate goal will be 36wks again which would put us around December 22-ish. At this point I feel compelled to confess:

I am still in complete disbelief that this is actually happening.

Dunno why I can't seem to wrap my brain around the whole thing ... we've known for weeks now and yet I haven't seemed to move past the shock and denial of it all. I certainly am beginning to feel pregnant --- a little nausea here and there and fatigue so severe that most afternoons I have to prop my eyelids open with toothpicks. I'm still in the gym twice a week (trying to hold on as long as I can ...) but in general I just feel WEAK. It's weird how something so tiny can physically wreak havoc on you in a matter of days really. From an emotional standpoint I would be lying if I didn't admit I'm feeling quite disconnected from this little life, which I know from experience is just a self-defense mechanism so I'm trying not to heap guilt on myself for it. I know the bonding part will come in time .... I'm planning to not let myself wait until 20+ weeks like I did last time!

I've been back on the lovenox injections nightly for about three weeks now .... needless to say my poor abdomen is completely covered in dark purple spots. I actually never completely got rid of the bruised-tummy look, despite the fact that I was off the shots for a total of 1 year and 4 days. I've been carrying around two gigantic brown bruises, about 2-inches in diameter, on either side of my belly-button for over a year now. These are souvenirs from Jamin. I've had several different doctors look at them (hematologist, dermatologist, obstetrician), and they've all told me various versions of the same thing: these are signs of deep tissue damage caused by repeated trauma of lovenox and heparin shots. They may continue to fade with time, but all of my doc's have gently suggested that I try to get used to them, as they are likely to be permanent without some kind of laser treatment. My hematologist explained that the heparin is probably to blame more than the lovenox ... bruising and scaring on heparin tends to be worse and I was injecting heparin for a total of 16 weeks due to preterm labor, rather than the 2 or 3 weeks we had originally planned. I am quite offended that nobody warned me about this ahead of time! And I'm secretly hoping that maybe if I am able to stick with the lovenox for a longer period of time this go-round maybe I can avoid more ugly scars. Well, a girl can hope anyways. In the meantime I've been trying to rotate my injection sites around every night, in an effort to share the love so to speak, and not bombard one or two spots repeatedly. I have no idea if this means that I am less likely to get two giant areas of "tissue trauma", or if it just means I will end up with twenty little spots of "tissue trauma". I also can't decide which is worse.

A month ago I was actually looking forward to getting a new bikini this summer. Now ........ mmmmm ......... notsomuch. Here is the last "normal" picture I will probably have of myself for awhile, taken on Memorial Day (7weeks) before the bruising got bad:

Please excuse my ultra-grumpy expression .... I think I was annoyed at James because he was rushing me. :) Not my fault ......... it's the HORMONES!!!

Foggy Brain

So much has happened since we discovered our pregnancy shocker, my brain is on overdrive but still can't seem to keep up. Apparently it is still in stage 1: SHOCK AND AWE, and hasn't been able to fully move on to stages 2,3,4,5,6,and 7 which include analyzing repeated doctor visits, scrutinizing lab tests, inquiring about prescriptions, organizing insurance paperwork, and all the rest.

After the home pregnancy test on Saturday 5/15, I called my OB, Dr. Garcia (who I absolutely adore) at my earliest opportunity which was that Monday. He wanted me to come in immediately, so I went that afternoon. He did some bloodwork, which came back showing my progesterone at 35.12 and HcG at 701. So we were happy with those results. The following Friday night 5/21, I began spotting of course. Never fails, I've done this 4 times now! And it always seems to happen on a weekend, when I have no way of getting in to the doctor. The panic set in full-throttle and I laid low all weekend, tried to stay off my feet, and started the internal pep talk where I attempt to convince myself not to worry.

By Monday 5/24 I was back in Dr. Garcia's office for an ultrasound. I was 5w5d along at that time. They could see a gestational sac and a yolk sac, but no embryo. They could also see blood, but couldn't determine where it was coming from or what was causing it. He basically told me it was 50/50, could go either way ... either I had ovulated a little late in my cycle, making it a few days too early to see an embryo, or the pregnancy was not viable and was doomed to miscarry. I tried to stay positive but found that to be difficult, particularly because we had seen Jamin's heartbeat via ultrasound at that same gestational age. He did more bloodwork, and the results came back on Tuesday showing progesterone at 42.4 and HcG at 10,526 ... a very encouraging sign.

Wednesday I saw my GI Specialist, Dr. Manocha, who has been trying to help me manage some problems since February. I was given an endoscopy in March and found to have gastritis, an H.Pylori infection, and Irritable Bowel Syndrome. I've been on multiple medications to help alleviate the pain and symptoms .... all of which I had to stop taking cold turkey the day I found out I was pregnant. Unfortunately there is pretty much nothing he can give me now that I am preggo, so with sympathy in his eyes he told me to call him next year after I've delivered and stopped breastfeeding. In the meantime I guess I will have to grin and bare it, and pray it doesn't get too unbearable. I have days where I have almost no symptoms and I feel fine, and then a flare-up will come and I'll be miserable for several straight days. There seems to be no reason or pattern behind it, though we do know that hormones and stress tend to aggravate it.

Thursday I was back at Dr. Garcia's office to repeat the bloodwork. Those results came on Friday and showed progesterone at 37.3 and HcG at 20,878! In a healthy pregnancy, HcG is supposed to double every 48 hours, so this was a reassuring result for us since it was roughly twice the level that was measured on Monday afternoon. Based on the bloodwork alone, we are now feeling confident that the pregnancy is viable. The nausea and EXTREME fatigue I've started feeling over the last three days are just icing on the cake. Annoying to deal with, but good sign of a healthy pregnancy .... so I'll take it.

I go back Wednesday at 1:00 for another ultrasound and exam with Dr. Garcia. I will be 7w0d so we fully expect to see an embryo and a strong heartbeat!

God has a sense of humor!

Sooooo, after a year's absence, I'm back to blogging. Of course that can only mean one thing:

I AM PREGNANT. AGAIN.

Yep, go ahead and scrape your jaw up off the floor. Don't feel bad, I had that very same expression on my face for a solid week. No I'm not offended. I promise, whatever you're thinking, I've already thought it ten times over.

Everyone seems perplexed, and rightly so .... so to clear up a few common questions let's just get a few of the nitty-gritty basics out of the way:

1. No, we were not trying. In fact, we were actually "trying" to schedule a vasectomy, having just gotten the referral 4 days before discovering the surprise.

2. No, I had no clue. No symptoms, no "little feeling", nothing. Not even remotely on my radar. I had a period, which started ... and then abruptly stopped .... and never came back. After a few days James convinced me to use an old test I had shoved in the back of the linen closet just to put my mind at ease so we could go out and enjoy our date night without any worries. Yeah that didn't quite go like we planned.

3. Yes there were lots of tears. And a few words I'm now embarrassed to admit I said. I actually collapsed in a heap and finally laid on the floor of my bathroom closet sobbing. No they were not happy tears. Let's just say it was not my proudest moment. Among my immediate concerns, were "How in the world are we gonna survive this again?"; "Please don't make me tell my Mommy!"; and "Promise me that no matter what happens I will never have to drive a mini-van!"

4. Yes I've stopped freaking out. And yes, I'm now equal parts excited and terrified. But there's lots of both.

The next question everyone keeps asking me is ... "Scared, but WHY???" Assuming that these folks either have major short-term memory loss or just flat don't get it, I'll clarify. Forget the fact that spilling the beans to my mother felt like the emotional equivalent of being 15 yrs old and telling her I'm pregnant .... I guess I could best describe it this way:

95% of my fear is surviving another pregnancy: The wild ride of ups and downs ... the stress and worry at every single doctor visit, the cervical measurements, the hospital stays, the endless months of bedrest, the shots, the home monitoring, the burden on my husband, my kids, and our family ... watching my health deteriorate before my eyes. In all honesty I don't feel like I've recovered from the last roller-coaster ride, emotionally OR physically. And I still have the stupid bruises on my stomach to prove it.

5% of my fear comes from the thought of what will happen AFTER the pregnancy, at the end of the battle when a healthy baby is finally here, God willing ... I do worry about taking care of three, dividing my time even further, etc ... all the normal mom stuff. The two little ones will be roughly 20 months apart (again, God willing) so that of course seems like a huge challenge, but honestly there is only a very teeny tiny part of my brain that can see past the gigantic hurdle of pregnancy to even begin to worry about these things.

I think I summarized it best when I told a friend recently, I feel like I've just started climbing Mt. Everest without a single day of advance notice or preparation. The mountain that lies ahead of us is giant and rugged and I know it well. And the ugly truth is that I don't have the endurance, or the mental fortitude required to fight my way up to the top. Just the thought of it is overwhelming and exhausting and makes me want to quit. There is no way I'm gonna be able to climb that thing again.

After four straight days of crying I finally calmed down enough to open my stubborn eyes and see that God was already making arrangements and working out the vital details (like my new super-duper hemotologist Dr. Genius at Emory) .... and ever so gently He reminded me that I don't have to climb anywhere. I can just trust that God knows what He's doing and rely on Him to carry my whiny butt up.

So that's my plan.

THE FIRST WEEK HOME

So it turns out that caring for a brand new little life while simultaneously trying to recover from immese physical trauma will make it pretty much impossible to do any blogging.

My apologies.

Our first week home with Jamin was ...... well ....... a DOOZY to put it lightly. We were discharged from Northside on Easter Sunday in the afternoon and happily limped home to settle in. I had been having a lot of pain in the hospital, which I couldn't really understand because I don't remember being in much pain after Gracie was born. They were giving me 2 percocet plus 800mg of Motrin every 6hrs around the clock, which helped but never really took care of it. Since it was a holiday, the hosptial was a ghost town .... my doctor never came by for rounds on Sunday, and so as it turned out I was sent home with zero medication. I didn't sweat it though, just figured I could just take 4 over-the-counter Motrin and tough it out.

First thing Monday morning I made arrangements for Jamin to be seen by Dr. Kaufman, our fantastic pediatrician, because I could tell he had jaundice. We noticed it developing in the hospital, but the stupid on-call pediatrician there refused to test his billirubin levels for some reason. He is high risk in the first place simply due to his prematurity, and also the fact that we were exclusively breastfeeding. We could see him turning yellow, but they kept telling me he was fine.

Lukily Dr. Kaufman knows I am a vigilent Mommy, so when I called they told us to come right in. They confirmed that he was definately jaundiced and did a heel stick to test his billirubin. We also saw the Lactation Consultant while we were there to work out the last few kinks in our breastfeeding routine. At this point Jamin was nursing well and we were really starting to get the hang things. He and I make a really good team!

We had to run next door to Douglas Hospital to drop off the blood sample at the lab for the billirubin test. But to do this, we had to register Jamin as an "outpatient" of the hospital. Ahhhhhhh, yes ......... that means ridiculous waiting for some slow hospital employee to fill out 2 pieces of paperwork. While sitting in the waiting room I suddenly had this excrutiating pain in my upper-middle back. It was a sharp stabbing pain on my right flank. It came suddenly and the tears were immediate. James kept asking, "What happened? What did you DO?" and holding back sobs I could only manage to say "Nothing! I was just sitting here!" The pain was so intense and it hurt each time I took a breath. Mercifully, the slow lady finally called our name, processed our admission and got us out of there. I crawled home and took another 800mg dose of Motrin, which pretty much did nothing.

Tuesday morning I called Dr. Garcia's office about the pain and they instructed me to come in at 3:00. But first we had to go back to the pediatrician's office, as Jamin's jaundice was worsening. He was nearly glow-in-the-dark yellow at this point! They did another billirubin draw, which they found to be 14.1 (in the moderate range) and checked his weight. He was down to 5lbs 6oz. I left there and went straight to my own doctor's appointment, but had to see Mia the midwife since Dr. Garcia was in surgery. She walked right in and told me I had a bladder infection .... had the prescription for an antibiotic already filled out and in her hand. She didn't listen to a single word I said or give me more than 2 seconds to ask questions or voice my concerns. I explained that the pain I felt was high up in my upper-middle back on the right side, how could this be since your bladder is way down low in your abdomen? She brushed me off and mumbled something about me feeling much better by tomorrow on the antibiotic. I tried to explain that I was in immense pain and 800mg of Motrin was not helping ... to which she suggested I could also take some Tylenol.

As if that was going to help.

Annoyed, I grabbed my prescription and left. I figured I would just tough out the pain one more day, since she assured me that I would notice a huge improvement in 24 hours.

That night I woke at 2am to feed Jamin. I literally could not stand up out of bed, the pain was so horrible. All I could do was lay there and moan. I also began shaking uncontrollably with chills, which I've never had before. James panicked and called Dr. Garcia's emergency line, and the nurse there of course told him to take me to the ER. I refused to go. Why would I want to sit in the ER waiting room at Douglas Hospital for another 6hrs, to have some yahoo give me a pain pill and tell me to follow up with my doctor? NO. If I'm gonna sit in pain for 6hrs, I'd like to do it from the comfort of my own bed, and by 8am Dr. Garcia's office will open and I can actually receive some treatment. James thought I was nuts but knew that once my mind is made up it's a fruitless arguement on his end.

So as soon as the office opened Wednesday morning, I called and went in to see Dr. Garcia, who was thorough and attentive as always. He said his guess was something with my kidneys, since they are way up high in the flank area (right where my pain was), and since I was having pain while breathing. Apparently your diaphram is adjacent to the kidneys, so each time you take a breath your kidneys get "bumped" a bit and can result in intense pain. The midwife, of course, would have figured all this out if she had taken 5 seconds to LISTEN TO ME the day before. The other possibility, he said, could be pulmonary embolism, since the pain was sudden onset and followed a "thrombophilic event" (i.e. giving birth) by 2-3 days. With my blood clotting disorder, a PE is one of the most serious risks I face and the highest time of incidence is the post-partum period. He assured me that a kidney problem was way more likely than a PE, but given that a PE can be fatal ......... we want to be 100% sure of course.

So off I went, BACK to Northside Hospital. My new home away from home. I told the admissions lady that I wanted a frequent-customer punch card .... "stay 10 nights get the next night free" or something similar. Soon after getting a room and settling into bed the chills came again and a new wave of pain had me in a heap of tears. The doctor came in to get my history, at which point I cried, apologized for being a wimp, and then cried some more. Apparently he could tell I was in serious pain because his first order was for IV Dilaudid. That marked the first time I had been pain-free, which felt fantastic, but sadly only lasted for about an hour. This was followed by a CT scan of my lungs, which required contrast dye to check for PE .... then an ultrasound of the kidneys to check for kidney stones .... followed by more Dilaudid .... followed by more IV meds to keep me from puking because of the Dilaudid .... followed by an IV of antibiotics ... and finally ending with something in my IV which just knocked me out cold. Seven hundred hours later I was finally discharged and sent home with a diagnosis: super-duper infection of the kidneys, with a touch of pleurisy. And, oh yeah, I still had that bladder infection too, but compared to the rest it has gone pretty much unnoticed.

So .... Good news: Kidney infection + pleurisy = easy to treat. Bad news: More painful than childbirth.

And worse yet, as a result of my latest hospital adventure, we were forced to stop breastfeeding. I was at stuck there for 8-9 hours (during which time James was at home feeding Jamin a bottle), and then when I got home I was unabe to move for another 8-9 hours (more bottles). James did 100% of the baby care during this time. Once I was finally up and around again, I had to "pump and dump" for 24 hours, because the contrast dye I was given during the CT scan is excreted in breastmilk. By the time I had pumped for 24hrs and had reached the point to safely feed again ...... my milk was gone. Seriously, dried up, not a drop left .... GONE.

I proceeded to cry about it the remainder of Thursday and most of Friday.

I am still completely devastated about the whole thing. He and I were getting so good at it, he was happy, I was happy, and then ....... we lost our milk. SO. NOT. FAIR.

Friday we were back at the pediatrician, again ...... to check billirubin and weight a third time. Good news on both fronts: billirubin is down, and weight was up to 5lb 9oz.

James returned to work Monday so this week it's been just me and the kids! We are adjusting well. Jamin is a laid back, roll-with-the-punches kind of guy. Thank you LORD! He is so precious and sweet and insanely tiny and omigosh he smells so good. Gracie has totally embraced the "Big Sister" role and adores her brother. I am sleep deprived, and physically functioning at about 40-50%, but otherwise fine. Emotionally I feel good, much less hormonal and wacky than I felt after Gracie was born. I did have one weepy moment two nights ago .... at 2am rocking Jamin is his blue chair. I was professing my unending love for him (!! don't all new Mommies do this ??), when I was suddenly overcome with sadness wishing I'd had the same opportunity to say those things to Isaac before he died. I only cried for a few minutes, then pulled myself together and moved along. I think one weepy moment is allowed considering all we've been through.

We are hoping that weeks 2 and 3 are much more relaxing and less drama-filled! Thank you all for your continued prayers and sweet thoughts. I will try to update more regularly as my (lack of) schedule allows!

A day of MIRACLES

Well, friends .... I have given birth to angel. I am so in love with him that it hurts. Here are the labor/delivery details, I will try to keep it brief (which clearly you know by now, is tough for me).

Pitocin and saline started about 7:30 am. The contractions instantly became quick and pretty painful. My awesome nurses had already called down to pharmacy and had a special epidural concoction (without fentanyl) waiting here for me so there was no delay. I had a long and detailed pow-wow with the anesthesiologist to discuss all the risks with the heparin and the fentanyl allergy. We had the epidural placed around 8:00ish. I had forgotten how scary that is, whewwwwwwww. Especially after the guy has just explained my risk for a spinal hematoma and paralysis.

About 5 minutes after the epidural, my blood pressure went down to 80/39. The anesthesiologist began running frantically and within seconds produced an injection of norepinephrine . That brought it back up a bit, but it never got higher than 90's/40's.

By 8:15 I couldn't feel my legs. Actually couldn't feel much of anything at all. At one point I even asked the nurse, "Am I still having contractions?". She replied, "ummmmmmmm, YES, they are huge and coming every 2 minutes!".

THANK YOU JESUS FOR THE EPIDURAL!!!!

At 8:30 the midwife, Joy, came and broke my water. I was so numb I didn't even blink. She reported at that time that my cervix was 4-5 cm dilated and 100% effaced.

Shortly thereafter, my beloved Dr. Garcia stopped in with a very uncharacteristically serious demeanor. He explained that he had a family emergency, his son was being transported to the hospital, and he was uncertain if he would be able to deliver me because he would be leaving at some point.

At first I kind of panicked, but then I reminded myself that God had already answered every prayer and that He had orchestrated every detail so I was trusting that it would work out regardless. We continued to hope that Dr. Garcia would be available, but made a back-up plan for the midwife Joy to deliver if necessary.

Between 9:00 and 10:30 I rested comfortably. Laura arrived with Gracie, Jessica with Adam, and my parents were both here. I was completely calm and relaxed with zero pain. Honestly if there hadn't been anyone else in the room I would've just fallen asleep. My mom stood by my bed and rubbed my legs, and I just layed with my eyes closed. I felt just an overwhelming sense of peace and calm. I did not worry, I did not obsess over details or what-if's, I didn't give any thought to all the things that could go wrong. THIS IS TOTALLY UNLIKE ME!!! So clearly the hand of God was at work! I swear I could feel His presence so close in that room and somehow all the scary things just melted away.

Around 10:45 the midwife came in and asked if I was feeling pressure like I wanted to push. I reported that I had not felt any pressure at all. She explained that she was watching my monitors out in the hall and it looked to her like it might be time for me to push. As she was talking to me about it, another contraction came and I did feel some pressure. So she checked my cervix and said, "the baby's head is HERE, it is definitely time to push, DON'T MOVE!"

I was shocked! I hardly felt anything at all, no pain, just a tiny bit of pressure.

My room was soon filled with nurses setting up equipment and making preparations. Joy paged Dr. Garcia and got his voicemail. She didn't even know at that point if he was still at the hospital or not. She stood with me and held my hand while we waited for a call back. I was praying that he would respond, but at the same time was not afraid of what would happen if he did not. Joy waited by my bedside with the phone in her hand for 8 or 10 minutes. Every two minutes or so she would lift my blanket to peek, and would say, "okay, I don't see the head coming out yet so we are okay to wait another minute or two". She told me I had to stay on my side and hold still because if I turned to my back then Jamin was going to come out. Totally crazy!

Dr. Garcia did call back, praise God, and a few moments later he came in the room, slipped on a pair of gloves, and began giving me instructions on pushing.

I started pushing at 11:05. I pushed through three contractions. Again, almost no pain. After the third contraction Dr. Garcia reported I was about to tear and asked my permission to do an episiotomy. As soon as he did the episiotomy, he asked me to give one small push. I did and at 11:15 Jamin fell right out! He was crying before his trunk and legs were even delivered! We knew in an instant that his lungs were just fine, THANK YOU JESUS!!!

I immediately told James that the labor and delivery were seriously the EASIEST part of the whole pregnancy! And it's true. All the months of injections, IV's, blood draws, medication side effects, blood pressure issues, and sleepless nights ....... truly a million times more difficult than actually giving birth.

As you can well imagine, we are just overwhelmed with gratitude for what the Lord has done. I can honestly say I have witnessed Him perform an absolute miracle with my own eyes. He carried us through an onslaught of nightmarish obstacles, and ended the journey by answering every single one of our prayers. Tonight I look back on my posts from earlier this week, I look at all those prayer requests, and I smile. God must've just used that like a check-list or something. He met every need, even those that seemed almost impossible. And then He poured his presence over us so heavily today, at every single stage of the labor and delivery, His hand was there and every single thing just fell into place beautifully. We could never have imagined a more perfect experience.

Tonight the three of us are resting and just staring at eachother in disbelief! Jamin is being a little lazy with the breastfeeding, he just wants to sleep and sleep and sleep. We have hardly heard a peep out of him since he got here!

Please pray for James and I to get some rest tonight. And please join us in giving praise and glory to the Miracle-Maker!!!!

update per James "the trilogy"

"kid Awesome" is here! 5lbs 13oz and 18.5 in. he's handsome and agile! Kristi is doing great and Gracie is PUMPED! WREN out..

update per james volume 2

time to push, pray for me to be tough and I guess Kristi too!

update per James

probably wont be quite as detailed but here goes. they came in and broke Kristi's water about 30 min ago and now she is resting. Dr. Garcia may not be able to be here due to a family emergancy so if that is the case we will go with planB. the midwife. Kristi asked for you guys to be praying for Dr Garcia and his family as well. Wren OUT!

Getting Started

FRIDAY MORNING 7:40AM

Got up around 6:00, never could go back to sleep. Got a quick shower, which felt great. They've just started my IV, with pitocin and saline. I have to get another bag of saline in me before we can do the epidural - so that should be another 30 minutes or so.

The midwife is coming up in about an hour to break my water. Should go fast after that.

SO SLEEPY

IT'S 4:00 am. I AM UNFORTUNATELY AWAKE.

Contractions are very very painful. Having lots of pressure and pain in my cervix. I'm not hooked up to anything -- no monitors, no meds. They seriously haven't laid a finger on me other than the two little blood draws they did when I first arrived last night.

This pain is making me think I'm continuing to dilate. I don't know if I'm in "active labor" or not. But I do know my body well enough to declare that Jamin will be here today, whether they give me pitocin or not! He is coming on his own accord. So much for "induction"! Boy God's timing just amazes me sometimes.

I slept a bit from about 1:00 until 3:15 am. But been up since then. The contraction/cervical pain is keeping me awake, as well as really bad pain in my back. I'm also having trouble getting comfortable in bed due to the soreness in my belly at the spot where the amniocentesis needle was inserted yesterday morning. It is very sore to any movement or touch.

My bloodwork showed platlets at 173 and PTT was 26, both within nomal range. Praise God! So we are safe to go forth with the epidural. They are calling downstairs to pharmacy to make special arrangements for an epidural mix without fentanyl.

James fell into a coma-like sleep about 2.4 minutes after he laid down last night -- actually before the nurse even left my room and all the lights were still on! He has slept like a log all night and doesn't seem disturbed by the fact I'm up going to the bathroom every thirty minutes!

Pitocin and epidural should get started around 7am. I've got less than 3 hrs to get some rest. Please pray for epidural free from allergy problems, normal blood pressure, labor/delivery with no complications, Jamin healthy and strong.

Stay tuned .............

Jamin is halway here already, LOL!

THURSDAY NIGHT UPDATE, PART THREE:

10:30pm: Really quick ... Mia just came in and checked my cervix. I am already 4cm dilated and 90% effaced! Jamin's head is at +1 station, holy cow! She said they will start pitocin and epidural around 7am, then break my water. She said Jamin will most likely be here before lunch, in her opinion way before lunch in fact.

I am not hooked up to any machines or IV's for the night. So we can actually SLEEP! My nurse just came in and did a blood draw so they can run a PTT test. This will check my Factor X (clotting factors) to make sure it's safe to have the epidural tomorrow. Should have those results within the hour.

WE ARE GOING TO BED .......... GOODNIGHT!!!

T minus 9 hours

THURSDAY NIGHT UPDATE, PART TWO:

A quick update .... we're here at Northside. The admissions process was farily quick and painless, praise the Lord! I am in room C2 on the ground floor. My nurse is Rachael, she is super sweet.

We just finished the 60minute process of paperwork. I am hooked up to the monitors waiting on the midwife, Mia, to come by to confirm Dr. Garcia's orders for the night. I think we've got the Cervadil confusion ironed out, so I'm relieved about that.

I'm soooooooooooo extrememly tired, I'm really wanting to unpack my bag and get ready for bed so I can go ahead and get some sleep. Problem is I'm not allowed off the monitor until Mia gets here, so I'm stuck waiting for a bit. I'm so desperate for some shut-eye!

I'm anticipating that Mia will order IV fluids through the night like Dr. Garcia had planned, and then we'll begin pitocin first thing in the morning when he arrives. Should be early, like 7:30ish.

James is THRILLED with our room, because it has an actual "bed" for him rather than the fold-out chair thingy that requires the bottom 3 feet of his body to hang off the end! He says he feels like a frat boy in a dorm room. :) Then he noted that the only thing cooler than this arrangement would be if we had bunk beds.

Please continue to pray for us: good sleep tonight, no labor until the morning, labor/delivery free of complications and a healthy strong baby.

We will update in the morning...........