Wednesday, December 31, 2008

Yesterday's Appointment with Dr. Davis

Yesterday I celebrated 30w 5d and Baby Boy has officially had the benefit of an additional six weeks in the womb compared to his sister born at 24w 5d.

At yesterday's appointment, Dr. Davis performed a growth scan and Baby Boy is measuring on target for his gestational age. His approximate weight is 3 lbs 6 oz, a whole two pounds heavier than his sister was at birth. Curious as to how much Our Girl weighed at this stage, I referred to her NICU calendar where I tracked something positive each and every day of her NICU stay. (I still keep a daily calendar of what I consider to be "milestones" or cute things she says or does. In fact, today is the last day of my second Hallmark calendar (started the day of discharge) and I need to decide if I will keep a third year of notes for her. Baby Boy of course will have at least as much as his sister... so I hope and plan to, anyway.)

So the NICU calendar indicated that 30w 5d was day 42 of our NICU stay. Our Girl had just self-extubated the day prior which happened to be Labor Day and was off the vent successfully the third and final try. She was on a CPAP of 7 or 8 and weighed 2 lbs 5 oz. Clearly, the hard work of surviving takes its toll on these micro preemies. Just baking away as nature planned, allows for crucial weight gain and development that is seriously thrown off course when these tiny babies are thrust into the world too soon. It is realizations and comparisons such as these that really break my heart. Although, if you watch the attached video of My Girl singing "Jingle Bells", my thought is that most people would never know her life began the way it did.

While Baby Boy's measurements all average out to his actual gestational age, his tummy was measuring on the small side. What I love about Dr. Davis' techs, is that they just do the testing necessary to confirm that all is okay. Yesterday, this meant that without instructions or asking permission, my tech went ahead and confirmed that blood flow was appropriate and that Baby Boy wasn't compromised in any fashion. This is very reassuring as I love the better safe than sorry approach to medical care and you can't check me or my baby enough! For this reason, I have decided to have Dr. Davis and his team continue to follow my pregnancy on a weekly basis, performing the necessary growth scans, AFIs, NSTs, cervical checks and lower uterine segment screening for any sign of thinning.

It is very true that although my whole day is consumed by a Dr. Davis visit, I have a routine down and the techs in the office all know me and my situation. I feel 100% confident and comfortable with the care I am receiving and with little time left in my pregnancy feel it's in every one's best interest to keep a good thing going.

In other news, my fluid level came up to 10.5 this week. Each week since I was flagged for potentially low levels, my fluid has increased. This is all reassuring. My NST was reactive as well although uterine irritability was detected but I suppose that is nothing new.

I felt bad when as Hubby and I entered Dr. Davis' office to talk, his phone rang and he was clearly discussing with the person on the other end that I was going to be one of his OB patients. Long story short, I explained that I am more comfy delivering closer to home and so our plan for the remainder of the pregnancy is that Dr. Davis will continue to follow me weekly (as mentioned above) and my new group will see me every other week and ultimately perform my amnio and delivery. Gosh, it feels like a weight has been lifted off my shoulders! I have it figured out!

Earlier today, I put a call into the new doc I met on Christmas Eve. She called me back this afternoon and I confirmed that I would love for them to take me on as a patient, all the while co-treating with Dr. Davis. It made me feel so good that she was excited to talk to Dr. Davis not only about my records, but also about Transabdominal Cerclage! She was thrilled to learn of another doctor who performs the surgery! Spread the word!!!

So while I was hesitant to put up two Christmas trees this year because I had visions of being on bed rest or worse, in the hospital or visiting Baby Boy in the NICU, I am happy to report that instead of all the negative thoughts, I am actually able to help Hubby take the trees down! I wouldn't be here, on the eve of the New Year, the eve of 31 weeks, on my feet, helping out without this TAC!!!

Thursday, December 25, 2008

Merry Christmas!

All I wanted for Christmas this year was to continue to remain pregnant with Baby Boy - and my Christmas wish came true! I am officially 30 weeks today and our Christmas couldn't have been merrier!
30 weeks is a huge milestone for me as I have never before started my weeks with a "3". In fact, this was such a big deal that I pulled out Hubby's birthday stuff from April when he, himself, turned a different kind of 30.

Kim was kind enough to stop by today to administer my 15th P17 shot. It is so hard to believe that I only have five left! This pregnancy is really flying by and if I don't have any issues arise, Baby Boy will be here in just about 7 weeks. Dr. Davis wants to schedule my c-section on the early side and I will be given the okay once Baby Boy's lung development is confirmed.

This leads me back to my on-going dilemma of where to deliver... yesterday, I met with a group of women doctors who could deliver me at Lankenau. Perhaps it's the fact that I met with a woman but the approach was so different from the old group of mine. I felt comfortable immediately. My heart is telling me to stay local, that it will be easier on Hubby, easier for my mom to visit and easier for Precious Miracle to meet her brother. I am familiar with not only the NICU team but also the hospital itself, I know the lactation consultants and feel confident in the hospital as a whole, which this new doc pointed out, you never know when you'll need a specialist. God-forbid something should happen during my surgery, she encouraged me to consider a place with top-notch medical professionals who could jump in at a moment's notice.

This doc is willing to see me and co-treat with Dr. Davis (no egos here!) and left me with the impression that she supports what I have done and her in own words, "there is no such thing as too much monitoring" supports my plan for care until delivery.

She was very flexible and offered, on her own, that I would be guaranteed to have one of the physicians in the group deliver me regardless if they are on-call or not. This was amazing comfort to me. She also put thought into my amnio (on the assumption we get to that point) indicating that she would like it done in the hospital just in case. She also said if I needed to deliver at Paoli for whatever reason (bad weather, couldn't get to Lankenau) that I go where I need to go, they will take care of everything else! What a refreshing bit of info whereas the old group made me feel like it was a mortal sin to visit another hospital.

And of course, maintaining just a small link to Precious Miracle, I learned that the resident who was part of her birth (she was actually the doc who discovered I was bleeding and got my c-section in motion) is now part of the group. I highly doubt she remembers me but I did stop her in the halls many months after Our Girl's birth to thank her.

Anyway, my heart feels like the decision has been made, not to mention the fact that Hubby is pretty adamant about my not delivering in Jersey. The comfort and peace in my heart is one of contentment, like I just know this is the right thing to do. I suppose my fear or concern is hurting Dr. Davis' feelings - I know, he's a professional and will understand, it's just so hard for me and as I've said before, he's the reason I am celebrating 30 weeks on Christmas Day 2008!

Tuesday, December 23, 2008

A Jersey Birth?

I saw Dr. Davis today for my now weekly NSTs and AFIs. My fluid was just under 10 today and Dr. Davis is happy if it remains at this level for the remainder of my pregnancy. I asked the nurse if the testing was still necessary and she said once you start monitoring you don't stop until delivery. So, I am signed up for the next seven weeks or so. It's actually reassuring to know that I have a standing appointment each week.

Today marks 29w 5d, exactly five weeks from the gestation at which My Girl was born. I can't believe Baby Boy has been cooking for an extra five weeks! It is truly amazing!

Back to my appointment. I was scheduled for 10:30 this morning and didn't leave the hospital until 2:00. There was really no idle time as I brought my latest book and read a page at most. An ultrasound with Patty started things off. My fluid level was checked as was my uterus for any signs of thinning (this was my request as my latest concern is uterine rupture). Then my cervix was evaluated and thankfully it remains long and closed.

I went for my NST and Baby Boy was quite active. He had some really nice accelerations and no contractions were recorded. Although, I will state for the record, I had three horrible contractions last night that woke me out of sound sleep at 3:28 A.M. They were all within a 15-20 minute period. After speaking with the nurse it was determined that my full bladder could have had an influence on the uterine activity. Otherwise it sounds like the low pelvic pressure I am experiencing now on a daily basis is "normal" and par for the course.

From there I had a very long and very nice conversation with Dr. Davis. I brought my records from my old group (the ones I requested in the event of that feared snowstorm that would cause me to go to a closer hospital) and Dr. Davis did a complete exam. When I say complete, I do not mean an internal, but he weighed me, did a breast exam and measured my uterus, which for the record had never been done by my old group in spite of numbers being written into the appropriate column on the prenatal care worksheet. I am a bit concerned that these numbers were just "made up" as a tape was never taken to my abdomen nor was ultrasound used to determine the height of my uterus.

Dr. Davis then called for copies of my most recent pap test (which was completed prior to conception) and all my labs. He was working to set up my complete file as I am now one of his OB patients. He informed me that he only takes about 10 OB patients at a time and that within the past five years has only missed one birth and that's because he was in Houston at the time.

I feel quite flattered that I would be one of the women he selects/agrees to provide this kind of care for. I feel that he is very invested in this pregnancy, as if it were not for him, Baby Boy would not have been able to remain in the womb five weeks longer than his sister. I am 100% sure of this and therefore, have absolutely no regrets about having my pre-pregnancy TAC placed. I would do it over again in a heartbeat! So when my old group questions me, they do not make me feel bad at all. If only every decision I encountered was made as confidently as this.

Trying to figure out which of the several hospitals Dr. Davis works out of my delivery would occur in, I asked if I should schedule maternity tours to familiarize myself. Right then he escorted me out of his office and took me on a full tour of Labor and Delivery, the c-section rooms, the NICU, well baby nursery and post-partum, which is where I recovered from my TAC placement earlier in the year. While Dr. Davis himself is a wonderful physician and I trust him completely, the facility at South Jersey Regional Medical Center is not exactly one that gets me excited. I can't quite put my finger on it except to go back to my initial impression which holds true every time I drive up to the place: it looks like a prison.

The Antenatal Staff is wonderful but I can't be 100% certain the same is true for the staff in Labor and Delivery and my experience with post-partum was a little iffy. For example, the one nurse who gave me a medication to combat my itchiness that counteracted my pain meds, in spite of my asking for plain old Benadryl.

Anyway, this is the latest situation - that Dr. Davis is willing to deliver me. It feels only right to have him take us full circle in this process: from pre-conception TAC to actual delivery of our Baby Boy. I am still torn, however...

Sunday, December 21, 2008

Doctor Update

I spent Thursday and Friday researching different OBs in the area. I have decided that I don't want to drive into the city for care or delivery since I am already driving pretty far to see Dr. Davis. My search for a new doctor has been limited to the suburban hospitals, specifically Main Line Health.

There was one group that came highly recommended - as in everyone who commented on my run-in post, gave me the same name/group of docs. I have an appointment scheduled to meet one of the male doctors in January. They only deliver at Paoli and since Paoli only keeps babies born at 32 weeks gestation, I didn't think it was really necessary to push the issue and see the group sooner. I will be just a few days beyond 32 weeks when I have my consult.

I called around to a few other groups who insisted on knowing where I got my care to this point. It would have been easier for me to have just relocated to the area instead of leaving a local group. When I pushed the issue, I discovered that these other groups don't want to take anyone who is "high risk".

I made one other appointment with a group of women doctors who deliver at Lankenau. After speaking with three different people, one of the doctors personally called me to better understand my situation. She was very nice, explained they have had other patients with a Transabdominal Cerclage (TAC) and was curious to know who my surgeon was. Her big concern was sending me for testing as the MLH Perinatal Testing Centers are usually run by my old group. I assured this doctor that all my testing is able to be completed by Dr. Davis. She didn't seem to mind that I would also be followed by Dr. Davis. I meet this group on Christmas Eve.

So now I need to come up with a list of questions about philosophies and office procedures. For example, the Paoli group delivers their own patients as one of the five docs is always on-call. I am not sure the same is the case for the Lankenau group but I do know that Main Line Perinatal is not one of their covering offices.

The big thing that I go back and forth on is where do I want to deliver. Paoli is much closer to home and where Precious Miracle was discharged from. Lankenau is where Precious Miracle was born and spent the first 85 days of her 105 day NICU stay. Both have meaning, just in different ways.

Thursday, December 18, 2008

29 Weeks!!!

Thank you to all who responded to my last post. I am feeling better about things and now that My Girl is down for her afternoon nap, plan on calling a few OBs (all of which have been recommended) to see if I can't coordinate a new practice to take over my care. I am unable to set foot in my old practice let alone allow them to put their hands inside my abdomen, be the first human touch my baby receives and perform his circumcision. That's just plain old crazy!

I called Dr. Davis last night after I calmed down and told him what occurred yesterday. My big concern was his professional relationship with his out-of-state colleagues. I didn't want my situation to negatively impact his interaction with his medical peers.

He told me he is always available to give me care and whenever I need him, just call. The plan at this point remains what it was: that I will continue to see him weekly for monitoring. Obviously, we don't have a crystal ball to predict what the future holds. He assured me in the event of an emergency, wherever I end up will be required to provide me with care. All I can do is what I've done all along and that is to take things one day at a time. We don't know how far I will go with this pregnancy but I can say, I am very pleased with reaching 29 weeks! This in no way means I am ready to have Baby Boy anytime soon, I'm just in awe of reaching this point in my pregnancy.

I received my 14th P17 shot this morning, thank you, Kim!

And in other more positive, preparatory news, I ordered some bedding options from Restortation Hardware Baby on Monday. They are having some fabulous sales at this point and I got an additional 20% off. (As an aside I always check for additional savings no matter where I shop.)

Other exciting news is that My Girl has successfully transitioned to her new "big girl room"! This has allowed me to mentally and emotionally get to a point where I am now ready to start laundering clothes and bedding while organizing other necessary baby items. We now have two "new" rooms off our second floor hall, the offical "big girl room" and "Baby Brother's room". My Girl has spent three very successful nights thus far in her new full-size bed, quite a difference from her toddler bed-crib conversion.

Wednesday, December 17, 2008

A Bad Day...

Where do I begin? I had two appointments scheduled today to deal with issues surrounding both of my children. The first was a prenatal appointment and while I was planning on discussing some pretty significant concerns surrounding my care, felt it would go relatively well. The second appointment was the annual IFSP for My Girl's Early Intervention Services. This meeting was slated to be a challenge as I was prepared to "fight" to keep her SLT and OT services on a weekly basis. My preparedness was all backwards and I am sitting here still recovering from the hearty cry my first appointment of the day caused.

What I am about to write is my interpretation and take-away from my appointment this morning with my local group. I realize every story has two sides, that each party has their own reality and views any particular situation through their own personal lens. My personal documentation of today's events is in no way intended to defame or smear.

I will admit there was no rehearsal on my part nor did I have a list of notes with me to keep me on track. This meeting was sincerely a "heart-to-heart" and those were the words I used with Dr. C when he entered the room. My agenda, so to speak, was strictly to convey my concerns, fears and wishes as a patient in a thoughtful and sincere manner.

My first point was that it would mean a great deal to me if Dr. C was the physician who delivered my baby. I should have known when I got a lecture about how over-worked he feels that I should have packed up my stuff and left. I mean, how professional is it to unload the burden of your hectic work schedule on your patient? I learned he is on-call 50% of the time. He is scheduled to work the weekend before Christmas (although he mentioned he was traveling with his family this weekend too), the weekend after Christmas, New Year's Eve and New Year's Day. The only time off he is getting this year is Christmas Eve and Christmas Day. The practice is responsible for six hospitals, dealing with high-risk calls coming from the home base of Lankenau, sister hospitals, Paoli, Bryn Mawr, Riddle and two others, Pottstown and Montgomery. He needs to be on-call for transports and in fact, has women right now on antepartum who could deliver at a moment's notice. He even told me he is considering not delivering any longer, it's just too much.

Okay, well, sorry I asked. So the bottom line is unless my c-section is scheduled, there is a 50/50 chance that Dr. C will be the one on-call to deliver me.

The conversation transitioned to my amniotic fluid level and the non-stress tests that Dr. Davis feels should be preformed weekly. I explained that while I expressed concerns about my contractions and uterine irritability to Dr. G, I was always brushed off, given the same canned answer about more than five contractions in an hour. I explained to Dr. C that while I've really tried to like Dr. G, realizing he is regarded as a fine doctor and that I need to put my personal differences and opinions aside, always feeling as if I am being talked down to with a condescending tone is hard to take week after week. Not to mention the fact that I felt like my concerns were never properly acknowledged and always minimized.

Because of this, I made an appointment to be evaluated by Dr. Davis. His team happened to, as part of the normal protocol, scan my baby (which my local group hadn't done since 20 weeks) and check my fluid level. I explained that since this discovery of borderline fluid last week, I have increased my fluids and started the Procardia around the clock. This combination has helped curb my uterine irritability.

Somehow, the conversation turned to the fact that I was not recommended by my local group for a Transabdominal Cerclage (TAC). That I was spearheading my care, which is unheard of and not a good way for anyone to seek medical care. The doctor is the doctor, not the patient. The literature does not support a woman like me to have a TAC. Dr. C then indicated that I should have tried a TVC and if that failed, then consider something more drastic. I was flabbergasted! I pushed him back asking him if what he was saying was that I needed to have another micro-preemie or worse yet, lose a baby due to a failed transvaginal cerclage?! I reminded him that I sought other opinions and that Dr. Davis was not the only physician to confirm my lack of "stitchable cervix". In fact, Hubby later reminded me that it was Dr. C who gave me the name of the doc downtown who was ready to perform a TAC on me as well.

I told Dr. C that not once did he check me to confirm that a TVC would be feasible. He then went on as usual, quoting literature stating that there is no way to confirm cervical competency in a non-pregnant woman. At this point I mentioned my instinct, that I knew in my heart the only way to carry a pregnancy to term (or closer to term than last time) was with a TAC. Dr. C informed me that my instinct was worthless and the only reason Dr. Davis placed my TAC was because I was dealing with Post Traumatic Stress.

Basically, something that women on Abbyloppers do all the time, consult an MFM along with a primary OB/Peri, was seen as a personal slight against my local group. Dr. C indicated that the relationship should be based on trust to which I responded that it's a little hard to trust someone who I sought help from on a Tuesday only to learn on a Friday that my membranes were bulging. I told him that pregnancy for me is HELL, that I trust no one and nothing and that my faith in the TAC has only truly become concrete as I've seen each passing week, beginning with the week I delivered my daughter.

It looks like my group never supported me, never valued me as an educated patient involved in my own care. They were offended that I would continue to see Dr. Davis, that I would put two doctors against each other. I defended that by explaining to Dr. C that he and his own colleague can't even agree, that their differing opinions are as good as being seen by two independent practices right there.

For some reason, stupid me allowed Dr. C to finish the exam. I allowed him to check my fluid level, to check my cervix. He wrote me orders for weekly AFIs and NSTs. I cried the whole time. Dr. C tried to scare me into thinking it was unrealistic to rely on Dr. Davis to be available to deliver me. How ridiculous for me to call him when it's time and expect him to meet me at the hospital and perform my c-section. How ridiculous.

So while I didn't officially blow up, didn't storm out with my chart in hand, didn't stop the Director of Development on my way out as we passed in the hall (thankfully he was distracted and didn't notice me) I left with tears streaming down my face, confused and torn yet knowing in my heart it's time to find a new group if I want to deliver in the system.

My emotional ties to delivering at Lankenau are many. The most important thing for me is the NICU team. This is where My Girl was born and while I could go to the other three hospitals in the system and end up with the same neonatologists, the nurses would all be different. I wanted the comfort of familiarity in the event we ended up with a significant NICU stay. Thankfully, with each passing week, the level of care is slowly (in theory) diminishing. Once I get to 32 weeks, I will no longer require a level 3 nursery.

Last week upon leaving my appointment I ran into a woman from the Development Office. She told me to call when I am ready to deliver, that she would hook me up with the brand new, top notch suite on the new L&D floor. Ironically, it sounds like the room that the part of the NICU where My Girl spent her first months of life, overlooking the seminary: a view that brought us great comfort.

And finally, coming full circle, I really wanted to breastfeed Baby Boy in the Lactation Room off the NICU that is named for and dedicated in honor of My Girl.

Lankenau Hospital has always held a special place in our hearts. It is the place where Our Girl was born far too early, the place where her life was stabilized and the place where she fought so hard to live. It is the place that we are forever indebted too, the place where our charitable hearts are. We take pride in knowing that our story has been instrumental in assisting the hospital secure $1,250,000 in donations for the NICU. It's hard to leave this behind and deliver elsewhere.

I called my support mom, Lori, the woman who helped me through My Girl's birth. Her son was born 12 years ago at 23 weeks. Lori and I talk several times a week and she was just the person I needed to help me through today. She had me pull over as I was driving in hysterics. She calmly helped me through and eventually I stopped sobbing.

Tomorrow, once my head is a little less foggy, I need to reassess and decide what course I am going to take. Do I deliver with Dr. Davis, all the way in New Jersey? Do I stick with the group that clearly doesn't value me as a patient? Or do I find a new group in the system?

Tuesday, December 16, 2008

Monitoring, Monitoring and More Monitoring...

Today I saw Dr. Davis. I probably should clarify what seeing Dr. Davis entails: first of all, unless there is an issue, I usually see one of the very skilled ultrasonographers in the Antenatal Testing Unit for any combination of studies including, fetal growth scans, cervical measurements and amniotic fluid level checks (AFI). The images are then transmitted via computer to his office and usually after a pretty long wait (I don't mind, he's worth the drive and every minute I've spent waiting in his cramped waiting room) he calls me back to talk. He reviews the images, takes his own measurements, answers my questions and never makes me feel rushed. The visits usually end with a hug and he walks me out to the desk with my chart and gives my follow-up instructions to Lisa, the scheduler.

All of Dr. Davis' techs are great and I like them all, having confidence in each of them. However, that being said, Patty is still my personal favorite as she was there at my preconception consult. She performed my scan today and I explained to her that I was concerned I didn't receive an accurate AFI on Friday. After a quick peek at Baby Boy, Patty moved on to assess my fluid level. There was a big black area that could have been mistaken for fluid (I really learn something new each time I get a scan) but once Patty turned the color on, highlighting what I imagine to be blood flow, it was determined that the big mass of black was not fluid but a lump of cord. This technique was not employed during my Friday scan when my AFI came back at 15.

Bottom line, my fluid is nine this week, up from last week's seven. This is an improvement but nothing like the 15-16 range which is considered "normal". After my ultrasound I was hooked up for a non-stress test (NST) where both the baby and I were being monitored: he for heart rate and me for contractions. It really was painful to hear the nurse say that Baby Boy is still real small and that it may be hard to pick up heart rate accelerations because he is still "neurologically immature". Janice is a very nice woman also and very knowledgeable, I might add. I explained to her how much it hurts to hear something like that as My Girl was born exactly four weeks earlier at 24w 5d gestation. Moments like these are really sad and painful reminders of just how much My Girl was gypped by not getting more time in the womb. It's an open wound for me.

Anyway, Baby Boy looked great and I informed everyone I saw that I've had a really good week. I then saw Dr. Davis who confirmed that things are looking good but it's in my best interest and my baby's to continue to monitor things with weekly AFIs and NSTs. I couldn't agree more when he commented about how much we've invested in this pregnancy (as does any expecting mom, I would hope) and that it would be a shame to have something that is presenting as a potential issue slide past us and become an issue such as growth restriction or fetal demise. He is being extra cautious with me and I really appreciate that approach!

So, this leads me to my big dilemma which I imagine more light will be shed upon tomorrow when I meet with Dr. C: do I drive all the way to South Jersey each week or will my local group be willing to support this aggressive approach to monitoring?

Monday, December 15, 2008

Hiccups and Other Twinges

After my last pregnancy, women who didn't necessarily know my circumstances, would try to compare pregnant-mommy notes. For some reason, a popular topic was fetal hiccups. I was never really sure that I ever felt them with My Girl and now that I most certainly have felt them with My Boy, know that hiccups were something I never got to experience the first time around.

Baby Boy has had several bouts with the hiccups recently and there is no mistaking that the rhythmic bumps coming from my insides are just that. It's a strange feeling and I find myself counting them once I realize what they are.

Speaking of strange feelings, nothing compares to the twinges that occurred last night around my cervix. Baby Boy was sleeping soundly, as was I, until I needed to use the bathroom. Well, that was enough to wake him and keep him awake for a little playtime. My cervix was his trampoline and I swear he was either bouncing off my stitch with his feet (he's been breach) or he was strumming it like a guitar with his little hand. The sensations were so uncomfortable that I woke Hubby to let him know it felt like Baby Boy was about to burrow himself out of me. I tried changing my position several times but he was very determined to keep the fun going at my expense. It was so bad at certain points, I was prepared to move tomorrow's appointment up to today.

Otherwise, I've been feeling pretty good. In fact, I've once again pushed myself a little more than I should have this weekend, although the consequences of such have not been as debilitating as weeks' past. Saturday was another busy weekend day with yet one more visit with Santa Claus and dinner out for a friend's 30th. Yesterday was a down day though and offered some time to rest and rejuvenate as I prepare to tackle the week ahead.

28w 4d and counting...

Saturday, December 13, 2008

Yesterday's Appointment

I will admit that I was not looking forward to my appointment yesterday. It was scheduled with Dr. G and I called earlier in the week to see if it could be rescheduled with Dr. C but he was booked for the week. I feel like I've hardly seen Dr. C and feel like we need to have a heart-to-heart. I have decided after much thought that if he is unable to deliver me, I will do my best to get to Dr. Davis to have him perform my c-section. My hope is that this delivery does not occur on an emergent basis, that I am able to confirm Baby Boy's lungs are mature and then schedule my delivery from there. Dr. Davis is aware of my desire to deliver this baby as soon as he is ready, preferably not a moment sooner and not many moments later. I need to convey this to Dr. C and also inquire about his willingness to be available to deliver me regardless if he's on-call or not.

Anyway, back to yesterday. I am really trying to take it easy but felt it would be okay to meet two friends for lunch. My mother-in-law came over to watch My Girl and I left a couple hours in advance of my doctor's appointment. It was nice to have a meal with adult conversation without having to entertain, cut chicken fingers or make frequent trips to the restroom on the heels of the words, "I go potty poop".

In fact, I planned my time so well, I arrived about 1/2 hour early for my appointment. I had my book club book with me and was looking forward to "free-time" to just sit, relax and read.

I entered the office and checked in with the receptionist. I informed her that I had a scare on Saturday night with some contractions, bad weather, no child care and this panicked feeling that I would need to call an ambulance as Hubby would have to stay home with Our Girl and I most certainly couldn't drive myself, and therefore, for peace of mind, would like a copy of my chart as my local rescue organization is not going to drive me to a hospital almost an hour away when there are two, no three within a few minutes from my house. She informed me in her usual tone that my local hospital affiliated with the same health care system will not deliver me. I snipped back that I cannot labor and the worst case scenario would be that oh, yes the would have to deliver me and I'd like my chart on the off-chance this happened. She was non-committal, saying I'd have to speak with the doctor or nurse about it.

I decided not to argue and went to my usual seat in the waiting room, almost right in front of the desk and most certainly within ear-shot. The phone rang and her voice lowered and well, you know that feeling you have when you think some one's talking about you, well I had it. My first thought was that the doc was in the back of the office and that he heard me talking and called up to find out was going on. I decided to brush it off, I mean how paranoid can I be. And who really cares if they're talking about me. So I headed off to leave my routine urine sample.

When I came out of the restroom, I learned that my instinct was correct, I was the subject of this "secret" conversation. The receptionist informed me that Dr. G was running late as he had a "procedure" to do. He wanted her to call me and let me know he needed to push my appointment back. Well, here I was, 1/2 hour early for my 2:30. Having had lunch out and rush hour traffic not too far off, I really didn't feel like hanging around that long for I knew my symptoms of overdoing it would soon surface. Not to mention my book would be finished in no time and I hate to be idle.

Since I was just evaluated by Dr. Davis on Monday, I reasoned with myself in a matter of seconds that I could forgo the cervical exam. The main reason I was there was really to get my amniotic fluid level checked. I made my proposal: if the nurse is able to give me my progesterone shot and check my amniotic fluid level, I can skip my appointment with the doctor altogether. Well, I opened another can of worms by suggesting my fluid level be checked. After the perplexed look I received, I volunteered that I had visited my other doc, the doc who placed my stitch, and that because I was having contractions, I was thoroughly evaluated. My fluid level was low and after my week-long drinking binge, I was to have it rechecked.

Long story short, the nurse was able to do all of the above and even managed a quick weight check (oh gosh!) and a blood pressure reading as well. I sensed that I had overstepped by visiting Dr. Davis as she defensively inquired why they would check my fluid levels. Must I explain this again?

My fluid supposedly measured 15 but I really question the methodology used to obtain the measurement. I am not a doctor, nor am I a nurse or an ultrasounographer (although many of My Girl's physicians ask me what medical training I have) so I can't say for certain, but my hunch was that when she didn't know which buttons to press on the machine, my measurement might not be totally accurate. Based on my observations, reading and research, I would have taken measurements from different starting points too, again leading to questionable accuracy. But again, this is just my opinion and you know what they say about opinions...

I will keep sucking down the water and wait things out until Tuesday when I follow up with Dr. Davis again. I am feeling tons of movements from Baby Boy and apparently when there is dangerously low fluid, movements are very difficult to detect. His nudges, flips and kicks are very reassuring to me.

On another note, my glucose screen came back normal.

So, I didn't have a full appointment yesterday, which was probably a good thing. I am really not in the mood to defend myself as it will just get me worked up and that is not something my body needs nor does my baby's.

Finally, in my heightened emotional state, I couldn't help but wonder what "procedure" the doctor was detained with. My wandering mind settled upon the idea that there was a woman out there receiving at that very moment, a rescue transvaginal cerclage. My heart ached for her and her baby and the horrible thoughts that were most certainly dancing though her mind about the safety and well being of her unborn baby. It is moments like these (real or imagined) that I am really, really thankful for my Transabdominal Cerclage (TAC), for Dr. Davis and for my own desire to pursue something my heart was telling me was absolutely necessary in spite of other doctors telling me I was crazy.

Hubby and I were in awe of my reaching 28 weeks and my growing bump (dare I share these photos of my most pregnant tummy to date?). We both acknowledged that without my TAC, Baby Boy wouldn't have had a fighting chance. And he has this fighting chance thanks to his brave, strong and determined big sister who endured her own undeserved hell to help her sibling.

Hubby's view of his children at 28 weeks gestation:

Baby Boy 12/11/08

Our Girl 8/17/06

Thursday, December 11, 2008

No Doubt About It!

It seemed last week there was some confusion as to what gestation kicked off the final phase of pregnancy. Some said 27 weeks while others said 28. Well, here I am at 28 weeks, so it's official no matter how you look at it: I'm in the third trimester of my pregnancy! How good it feels to be this far along!

Since seeing Dr. Davis on Monday, I have been keeping a low-profile. I have relied heavily on Hubby, my mom and my mother-in-law. I have been drinking more than I ever imagined I could handle in hopes of an increased amniotic fluid level measurement on Friday (tomorrow).

It's amazing how much better I feel when I rest and how that can give me a false sense of my abilities. There is only so much sitting around one can do without feeling like a lazy lump. Yesterday while Hubby and My Girl were out, I took a shower, made the bed, put away two loads of laundry and picked up a bit. By the time I got back downstairs, I was ready to sit with my feet up again as my crampiness and heaviness returned.

At this point, I am doing a self-induced purge of my schedule, keeping only very necessary appointments and sending Hubby or one of the grandmothers to take care of the rest. Poor Hubby is going to have to suffer through the last Kindermusik class of the semester next week. I know he feels rather uncomfy being the only adult male in the room parading around in a circle and singing songs. Songs, I might add he knows all too well as we make a habit of listening to Kindermusik CDs while in the car. For some reason, he doesn't really look at this musical knowledge as an advantage.

In addition to my increased fluid intake and rest, I have also kept up with the Procardia around the clock. The only new sensation I am noticing is that I am hot most of the time. Since I typically run cold on the temperature scale, it is taking some getting used to as I don't want to freeze my family by turning our heat down. I have opted to dress in less layers instead.

I feel pretty good overall at 28 weeks. My legs are beginning to cramp at night which is not fun but soon enough, I fall asleep and forget all about it. Baby Boy is quite active at times which is very reassuring.

On a final note, My Girl had a GI consult today. She knew we were heading to the doctor and in the car (my mother drove) stated exactly that: "we're going to doctor" - I pushed her a bit and asked her what they were going to do at the doctor. "Doctor checks Baby Brother!" she declared with certainty. She continues to amaze me this 24 weeker of mine... even though it was her tummy that was getting checked today instead of mine.

Tuesday, December 9, 2008

Another Milestone?

Hmmm, I wonder if my glucose screening counts as a pregnancy milestone. I pushed the test as late as I could (I was instructed to complete it before 28 weeks) and knowing it was "lurking" out there in the future as something to look forward to helped me get through the past week. You see, as gross as some women might find it, this was one of the many things I personally felt "robbed" of during my last pregnancy. On the scale of grief, the glucose test pales in comparison to the most important loss of My Girl not getting what she needed and was entitled to in the womb. But on the whole, having a premature baby is accompanied by many losses and this well-known drink the solution and have your blood drawn test was one of them.

This pregnancy is not intended to make up for those losses. That was never my or our intention - to right the wrong. But I do appreciate all the little things that most women might take for granted. Not saying they do, but they certainly might.

The test was not nearly as bad as it had been made out to be. I drank a bottle of lemon-lime solution, sat and worked on my Christmas cards, went back an hour later and had my blood drawn. It was as simple as that.

Monday, December 8, 2008

Low Fluid...

Since I still didn't feel right yesterday and last night, I decided to call and see if Dr. Davis was able to see me today. Sure enough, he was and my mom and I drove to New Jersey for my 2:00 appointment.

I had Patty, a wonderful ultrasounographer who was there the day I had my Pre-TAC consult. Baby Boy looks good and is measuring right-on for his gestational age of 27w 4d. His arms and legs are long and measure ahead but with his smaller stomach measurements, he averages out appropriately. He also weighs about 2 lbs 6 oz which is a whole pound heavier than My Girl was at birth.

My cervix is still measuring long and closed which is good news. The bad news and perhaps the explanation for my recent uterine irritability is that I have low amniotic fluid. The good news is that so far, Baby Boy has been unaffected by this latest finding. His blood flow was checked and no other problems are on the radar.

I was also hooked up to the monitors today because of my low fluid level and my complaints of contractions. I had four episodes of minor contractions in a 45 minute period. The nurse who worked with me acknowledged that just because something might not always show up doesn't mean things are not happening - basically I can have undetectable contractions that are very much real to me. She confirmed what I have believed all along, that a person like me with a history of a 24 week birth, be closely monitored.

I am exhausted at the moment as my mother and I closed the place. At 6:50 I called Hubby to let him know we were just leaving the hospital. It was a very long day.

There is a relief to know that perhaps it's the low fluid level that is causing my discomfort. I am to drink a measured gallon (I do drink a lot anyway and stay away from caffeine) and follow up with my other group on Friday to have my level checked again. I am hopeful that by getting my fluid back up my uterine irritability will be eliminated.

On another note, Dr. Davis has ordered the Procardia around the clock. So basically I am taking 20mg three times a day. We'll see if this helps. He did give me the realistic expectation that it won't totally eliminate all the discomfort.

I knew something just wasn't quite right and now I know that my feelings were valid. There is something else going on and thankfully I now have the knowledge to attempt to fix it.

Sunday, December 7, 2008

I Overdid It... Again

It's probably not in my best interest (nor the baby's) to push myself but it happened again this weekend. It's really hard not to overdo at times as the doctors (all three that I see) have not ordered me to follow any limited activity or bed rest guidelines.

Yesterday we took Our Girl to a breakfast with Santa. I was on my feet in heels much longer than I thought I would be. You see instead of just having breakfast, there was a dee-jay with dancing (no, I didn't dance) and I couldn't help but line the edge of the dance floor with the other parents watching our adorable children dance their hearts out. Here is a little idea of the draw that kept me on my feet...

After the festivities were over, I dropped Hubby and My Girl at home (nap time!) and ran off to an open house at an elementary school we are considering for our children. Not having the opportunity to change, I was still wearing my uncomfy heels which proved a huge mistake. I ended up walking the campus, breaking to sit when I could, but all in all, I was on my feet for about two hours.

From there, I pumped gas (I filled up for less than $30 and I was VERY empty!) and came home to pick up Hubby and My Girl. We then ran out to get our Christmas cards at Costco, I stood in line to make a return and then it was to Walmart to grab some additional Christmas lights. Hubby took Our Nut out to the car and I waited in the check out line only to have the woman in front of me decide at the last minute to void her whole order and start over. Knowing my body could take no more, I stormed over to the Customer Service Desk and demanded to be rung up. Every time I enter a Walmart, I swear I will never go back and last night was no different.

By the time we started heading home, the light flurries turned into something a little more and our ride was quite eventful. I am one of those nervous drivers when it snows while Hubby tends to have a little more confidence in his ability to manage the car. Well we ended up detouring just two miles from home, skidded to the shoulder on a back country road and detouring again just a mere 1/2 mile from home. Let's just say the stress was probably not good for me as my finger nails clawed into the sides of the seat. Thankfully, we made it home safe and sound.

In anticipation of a rough night, I took two Procardia pills as soon as we got home. I was in bed by 9:00 and thought I was home free - until about 12:15. That's when the contractions began. My script is for (1) 10 mg Procardia pill every 8 hours - Dr. Gerson specifically told me when he wrote the script he was giving me a low dose because of my size. Dr. Carlson told me not to bother with the Procardia and Dr. Davis said to double the dose and take it every six hours. Reviewing the various directions my multiple doctors gave me, I decided that when I had five contractions in a forty-five minute period, I needed to take more Procardia.

My mind was racing. The first thought was that of course, I brought this on myself. How stupid of me! I was convinced I was a having a 27 weeker. The roads were too bad for me to drive myself to the hospital. I couldn't expect my mom to drive over on bad roads, plus that would take too long. I couldn't disturb my poor neighbors to come watch our sleeping child at now 1:00 in the morning. The only thing I could do was call an ambulance.

Hubby and I lay in bed, he watching the clock and me making an effort not to make too much noise with each painful contraction. The audible ones he tracked, the silent ones, he had no idea occurred. If they were less painful, maybe they weren't real. We did our best to fall back to sleep.

Thankfully we made it through the night - me and Baby Boy still as one. My contractions started again and I took two more Procardia. Then I called the service. It was Dr. G on-call and I decided to have him call me back. He did his usual "calm down" talk - no I wasn't crying, just methodically reading through my notes so I didn't forget to tell him anything. Basically, I went through my contraction and medication time line. He reminded me that I am small (funny he still considers me small considering I look like a blimp these days) and that I can overdose on Procardia. I explained that Dr. Davis gave me different instructions and Dr. G asked who my doctor was... Hmmm, did I strike a nerve? My local group knows I still see Dr. D so why should he be offended I'm following his orders too? I mean come on, he isn't even on the same page as his in-house colleague, something I've been meaning to discuss with them.

Anyway, he told me as my pregnancy progresses, my contractions and symptoms will change. Lovely. Why is this not a talk that is incorporated into an office visit, a sort of update on the warning signs to look out for?

Bottom line is that each night now (since I have been waking up with contractions too) at 6:00, I am to take two Procardia. My doses are to be no closer than six hours.

So while I've sort of known that an increased activity level tends to cause discomfort, when I rest up and feel good, I forget that part of the pregnancy. Then days like Saturday happen when I totally overdo it only to play catch up with a major dose of panic and worry to go with it.

My main concern is to keep Baby Boy cooking as long as I can. But, I will admit, it is really hard to "do the right thing" when I have My Girl right in front of me, needing her mommy.

Friday, December 5, 2008

My Definition of Success

At 27 weeks 1 day in my last pregnancy, the equivalent of 17 days old, I was finally able to hold my baby for the first time. This perfectly illustrates why my definition of success is much more than achieving 27 weeks gestation. Granted, it is better than the 24w 5d my daughter got but still a devastating gestation to have a baby come into this world.

I think the scary part is that one might assume since Our Girl did so well having been born at 24w 5d, that Our Boy, with more time in the womb, would do just as well if not better. This mirrors a conversation I had yesterday with Dr. G that I don't feel it's possible that our family would be as blessed twice. I expressed my concerns that we are expecting a boy and that statistically, boys don't do as well as girls. The whole race factor comes into play too with African American babies having better statistics than Caucasian babies, with the "wimpy, white boy" at the very bottom of the charts.

Dr. G told me to disregard the stats, that a baby does as well as their genetics. This Baby Boy is of the same make-up as our Miracle Girl and that counts for something, at least this is the doctor's opinion. I am not willing to test his theory.

Our First Family Photo August 11, 2006

Thursday, December 4, 2008

Third Trimester???

Last night, I was counting down the hours to midnight in anticipation of the arrival of the long-awaited third trimester. I am officially 27 weeks today and with that, it was my understanding, came a new, never before entered (by me) marker of pregnancy. In spite of feeling a bit under the weather (sinus congestion), I was on a cloud, excited about this newly achieved personal milestone.

I had an afternoon appointment today for a cervical scan and shared my excitement with Nurse Barb, who probably didn't mean to, but totally burst my third trimester bubble, telling me it was common knowledge that the third trimester officially begins at 28 weeks. She casually told me, just one more week. I was devastated! Then Dr. Gerson entered the room...

Well, he just made my day and I have to say, today was my best visit to date! He agreed that the literature is conflicting stating that 27 weeks is listed in one source and 28 weeks in another. So, based on my source of the chart below (thanks, Jen!), I am officially in the third trimester and feel damn good about it!

My cervix continues to be long and closed and today, Dr. G told me he considers me a "success"! Well, it depends on how you look at it... I told him that to me, success is having my baby and holding him immediately after birth, something I didn't get to do with My Girl and something I know I wouldn't get to do with My Boy if he were born today at 27 weeks gestation. So to me, success has not yet been achieved, but with each passing day, becomes more and more likely.

Dr. G felt that based on my "success" I discontinue weekly cervical checks. Thankfully, he was receptive to the fact that I NEED these checks for peace of mind and since they are already scheduled through the end of the year, agreed that it was okay that I keep them on the calendar. Additionally, he said if I wanted to be seen, he would be more than happy to do so.

We then had a discussion about preemies and the NICU. He reminded me that survival starts at 23 weeks and is quite low. And with this low survival, comes high morbidity. He emphasized that I have reached the inverse of this and at 27 weeks, survival is high and morbidity is low (survival was quoted at 95%). It feels so good to be on the other side but I still know the potential road and complications that even a 27 weeker would face in the NICU. I opt to keep on cooking...

Tuesday, December 2, 2008

Decisions, Decisions...

When it comes to Baby Boy, we are still up in the air on so many things. The first and probably most important is his name. Right now, I've been calling him "no-name" in an attempt to get Hubby to sit down and review names with me. Hubby likes what he likes and when I suggest a name as he dozes at night, he is quick to shrug it off. I feel that we can't and shouldn't commit to a name until we've thoroughly researched all the options. A name is so huge and I want to make sure I have no regrets.

The other big decision is the bedding. To re-do the existing bumper would be cost-prohibitive so to make a new one, utilizing the same chocolate velvet fabric (purchased new) and a corresponding "boy" fabric is $350. I didn't think that was terrible, especially in comparison to what we spent for everything needed for Missy. I just emailed my friend to find out what is reasonable to spend on baby bedding. I googled the one and only ensemble I like from Pottery Barn Kids and it looks like that could be $350+. Granted, it's the full set, quilt, bumper, dust ruffle, sheet, etc., whereas otherwise, I would be just getting a bumper.

It is amazing that I am 26w 5d! At this point in my last pregnancy, Missy was two weeks old already and I still hadn't held her yet. This is such a better place to be and we are so thankful.