Updates and More Details

So I have now spent 3 nights at "Club Swedish," and I am starting to get to know the routine around here and am settling in to some semblance of one for myself. Vitamins come in the morning about 9 am. My 40 minute fetal monitoring sessions are at 6am, 2pm, and 10pm, but I can ask the nurses to start them a little earlier or later if I want. My vitals are taken at this time as well. It takes 30-45 minutes for food to arrive after I order it, so waiting until I'm really hungry to order is not a good idea. Doctors show up whenever they have a chance, usually in the morning, but there is no guarantee of what time. Nurses are glad to get things for me, but I have to ask. I can go for a ride in a wheelchair once a day, for about an hour, but other than that and personal hygiene, the idea is for me to rest in bed.

I am grateful my room's window faces southwest. I get good light during the day. Yesterday was sunny and I think that helped my mood a lot. Swedish has wireless and I've been using my laptop. Thanks so much to Dad and Pat for this fantastically well-timed Christmas gift. Without it I'm sure my spirits would be much lower. For anyone who has called or emailed and not heard back from me yet, know that I am grateful for your kind thoughts and well wishes. Sometimes too much happens at once and I can't get back to everyone before the next monitoring, or meal, or bedtime.... I talk to friends and family on the phone a lot and have had some visitors, too (thanks Deann, Emma, Kaylin, Pita, Ed, and Marcela for dropping by already). Jeff spends a lot of time with me and is also holding down the fort at home -- he is as steady as a rock and I am so blessed to have him. BabyJ is with me all the time, and her regular movements remind me why we're here.

Jeff resting by the window

So why are we here? To be clear, I do not have preeclampsia (=high blood pressure), nor am I in pre-term labor. The official diagnosis has several names: "intrauterine growth restriction" (IUGR) or "small for gestational age" (SGA). BabyJ's ultrasound (US) on Tuesday included some size measurements as well as Doppler measurements of blood flows and measurements of pockets of amniotic fluid. As I mentioned in the previous post, she measured very small in size, but the good news is the blood flows and amniotic fluid look really good and normal. The US measured blood flows in the arteries of the umbilical cord as well as in some of BabyJ's arteries (in her head, in her abdomen) -- the technology is really amazing! So if BabyJ is getting good blood flow, why is she so small? Well, that is the question we can't yet answer definitively, as we don't have enough data. We may never get a satisfactory explanation. But here are some possibilities, many of which focus on the placenta.

1) Maybe this particular placenta was not engineered to last 40 weeks; it could be nearing the end of its productive life, therefore no longer properly nourishing BabyJ in recent weeks.
2) Maybe this particular placenta has some sort of structural defect, and it has been improperly nourishing BabyJ for some longer period of time.
3) Maybe the umbilical cord is attached to the placenta in a non-optimal position, so that it's not bringing the best nutrition to BabyJ.
4) Maybe the placenta, cord placement, etc. are perfect, yet the genetic information that combined from me and Jeff to become BabyJ resulted in a very small sized person.

The treatment the doctor has prescribed is bedrest and fetal monitoring. If any of 1-3 above are accurate, bedrest may help BabyJ grow by diverting additional amounts of my energy and blood to feeding her. If 4 is really what's going on, then bedrest certainly won't hurt BabyJ, though it challenges her parents, as many of you understand. ;-) So here I sit/lay, waiting to see if bedrest gives her a growth spurt, or at least helps to maintain her rate of growth to date. We won't know if she is growing until the next set of US growth measurements. Unfortunately, though US is great technology, there are still errors in measurements taken by US. As much as 10-20%! So we have to wait long enough for the next US so that if the measurements indicate some growth, that the change in her size is outside the margin of error. We've been told we need to wait 2 weeks for the next growth US. And so that's what we're doing -- waiting. Waiting, resting, and hopefully, growing.

Jenny on the fetal monitor



The monitor in action



In addition, the fetal monitoring measures 3 things: fetal heartrate, fetal movement, and muscle tension (to document any uterine contractions), and I can see graphs of these data sets as they are recorded on a strip of graph paper that rolls out of the monitor next to my bed. BabyJ's heartrate varies between 125 and 150 (very normal), spiking as high as 180+ when she is very active, which is very often (whether she is on or off the monitor). The spikes are a sign of health; just think of what happens to your heartrate when you walk briskly up a flight of stairs. A lethargic baby struggling in her environment wouldn't move much and her heartrate wouldn't vary much, but that's not happening to BabyJ. Last night's nurse, Lynda, claims we're writing a handbook on good "strips" here in my room; all of the nurses and doctors have said how great the monitoring info looks, which is very reassuring. Also, we had an US yesterday to monitor blood flows again and to look closer at the placenta, the umbilical cord, and amniotic fluid, and those results came back looking normal, indicating BabyJ is healthy (except for her size). Here's an article I found on the internet that helped me better understand what's going on (and what the doctors do NOT seem to be worried about). The flow chart towards the end is way cool; it appears to me that we are following the recommendations of the left-most column on this chart.

http://www.racgp.org.au/afp/200509/8694

Another thing I've learned from the monitoring is that I am having Braxton-Hicks contractions, which are "warm-up" contractions that prepare my uterus for the labor contractions that will bring BabyJ into our world. I seem to have a few decent ones each monitoring session. Sometimes I notice them, other times I don't or I attribute the sensations to BabyJ moving around. We'd have cause for concern if BabyJ's heartrate dipped when they occur, but that is not the case. So the monitoring sessions continue to reinforce our confidence that she is healthy in there.

Jeff and I are in a pretty good state of mind because we firmly believe, with the evidence that lies before us, that BabyJ just so happens to be a small yet healthy baby. We do expect that BabyJ will grow in the time I am resting here, but until we know how much, guessing what happens next is a total crapshoot. I have heard to count on staying here for about 3 weeks, getting us to 37 weeks, which is considered full-term, and then they'd induce labor after checking that her lungs are appropriately mature; there is also the possibility that at some point with enough growth and health documented I could go home, probably continuing the bedrest there until it is time for BabyJ to arrive. There hasn't been much talk of a C-section, which is just fine with me. We'll have to give you more information on the possible culminations of my hospital bedrest when we know more. If you want to send positive thoughts, energies, and prayers our way, we'd be grateful; please focus them on BabyJ growing while remaining stable and us maintaining strength as a family unit though we are unfortunately separated far too much right now. We will get through these few weeks and the prize at the end will be worth every minute.