38 Weeks and Jenny is Still Pregnant

BabyJ did her usual routine this morning at the doctor appointments: healthy heartrate, lots of movement, and spikes in her heartrate to match her activity level. The US showed normal amniotic fluid around her, and that the blood flows from the placenta and within BabyJ's body are normal. My blood pressure has remained 100/60, and my weight continues to creep up -- I registered 30 pounds above pre-pregnancy weight on the scale. The doctor was content to send me back home, still on rest, though I am now allowed to either a) increase my activity around the house a little, or b) walk around the block twice in a day. I am allowed out of the house for sedentary activities: to go to a movie or to get my hair cut, for example. Progress! We have a growth ultrasound next Tuesday, and if she maintains her growth, I may be allowed to go back to normal activity. If her growth falls off, induction is possible. The waiting game is hard, but knowing we are both healthy and stable is comforting.

I am asked regularly, "How are you doing?" Mentally I'm disappointed and frustrated at this forced rest; I would never choose this lifestyle for myself, and poor Jeff is doing pretty much everything for the household, about which I feel pretty guilty. Emotionally, I am far better off here at home, with Jeff, Abby, Cosmo, and BabyJ's stuff all around me than I was at the hospital. Physically, I am stiff and sore, though I have little water retention in my lower extremities so the painful leg cramps have disappeared completely. My butt hurts from all the sitting and reclining, and there are kinks in my back and ribs that come and go, depending on what resting positions I choose. My overall energy level is lower now that I am so inactive. BabyJ is growing, and breathing after a meal is becoming a challenge. Some nights I struggle for hours to find a comfortable position to sleep, turning from side to side seemingly every hour with frequent trips to the bathroom (since baby's head rests on my bladder). The physical challenges are probably due to being very pregnant rather than the bedrest, and I'm certain what I think is 'normal activity' for me would be impossible at this stage anyway. So I suppose I should be grateful for this opportunity to lay low before our lives get really crazy. But day after day in the same few rooms is getting pretty old.

"What do you do all day?" I read books and magazines, work on jumbles and crossword puzzles, do internet research, send emails, talk on the phone, eat regularly, and occasionally nap. Now and then I get a visitor. Sometimes I watch tv in evening, but the tube just hasn't held much lure for me. I am still monitoring a small group of students reviewing their algebra skills online, so there is some "work" to occupy my time, but it's low stress and most days doesn't take much time. And, of course, there are the doctor appointments to spice up my Tuesday mornings.

Thanks to everyone calling, emailing, asking if they can help, and being there for us during this challenging time. We know that BabyJ will be with us soon, and maybe these ultrasound images from today's check-up can help tide all of us over until her arrival. (These are similar to the ones we posted about 4 weeks ago, the first one being her face profile, and the second one being a frontal view of her face. The profile is certainly easier to make out, and I think it's the cross-section of the umbilical cord that looks a little like bubbles in the upper left part of the image.)

Inauguration Day 2009, on the cusp of Capricorn and Aquarius

Jeff and I headed up to First Hill at daybreak this morning, for our weekly doctor visits. Our appointments were not well-timed with today's inauguration activities, which was disappointing. Of course, BabyJ needs to be our top priority right now, regardless of American politics. However, we do have TiVo, so we'll be able to watch the broadcast later.

We started with a quick ultrasound. BabyJ's blood flows are stable and in normal range. The amniotic fluid volume index has dropped a tiny bit, but it's still in the low end of the normal range, just as it has been for the past several weeks of ultrasounds, so no concern there either. I did have a bout of dizziness and nausea laying flat for the ultrasound. They tell pregnant women not to lay flat for a reason! Then we went up to OB dr's office. Turns out she was over in the hospital delivering a baby, so we waited at bit to see her. But in the mean time I learned I have now gained 26 pounds since the beginning of the pregnancy, and my blood pressure is still quite low, 100/60. After these measurements, we headed to the back of the office for a fetal monitoring session. BabyJ once again was a star on the monitor, and I had one minor contraction during the 40 minutes.

So after a short exam with Dr. F., I was sent home for another week of laying low. I am now allowed to sit up more, but the instructions are still to stay off my feet for another week. I asked about walking around the block to get fresh air, and she said I could sit outside in a chair, but wanted to put off the walking around the block for another week. Sigh. So here I sit, resting. For the next two Tuesdays, I go in for another set of appointments just like today, with the ultrasound in two weeks including more growth measurements. There are no signs that BabyJ is coming any time soon, so we can relax for another week or more, as she grows and we cherish our last few moments as a couple before we become a trio. And there will not be a new Capricorn in the household!

Back Home Again

More good news this afternoon when Dr. F. got a break in her schedule to come talk to us. I've been sprung! I am home!

Bedrest is still ordered for the foreseeable future, and I will go to various offices on First Hill next Tuesday for a check-up, fetal monitoring, and an ultrasound. This ultrasound will measure the amniotic fluid volume and monitor blood flows in the umbilical cord and in the baby; it will not measure growth. Dr. F. acknowledged to us that bedrest at home is not as restful as bedrest in a hospital, but now that I've been on hospital bedrest, I do know what I am supposed to do to comply. Plus, here at home, I have Jeff, Chief of the Bedrest Police Force to keep me in line! If I continue to remain pregnant with a healthy BabyJ, it's possible that the bedrest will be phased out over time, but we need to cross that bridge when we get there. For now, it's great to be at home with Jeff and the cats, and all the baby gear surrounding our existence here serves as a stark reminder that this crazy bedrest/monitorings/ultrasounds adventure will end soon with a beautiful baby girl that will change our lives forever. (Not that she hasn't done that already!!!)

More details on the ultrasound results this morning.... The session started with the tech (a different Seattle U grad than last time) telling us they would get in touch with the doctor about the results before we left the room, in case they needed to do an amniocentesis today. That alarmed me a little, because I hadn't heard Dr. F. mention an amnio to us before. However, I know from talking with other drs. that had seen me on rounds and the nurses who took care of me that an amnio would be used to check lung maturity (apparently there is a protein in the amniotic fluid that gives them lung maturity info). I knew we wouldn't need one, though, because I was so sure BabyJ had grown!

The tech spent quite a bit of time taking pictures and measurements, etc. At one point it took 3 or 4 tries to get a good reading on a vein in BabyJ's stomach, because she was moving around so much! When the tech finished her work, the measurements of BabyJ's femur, abdomen, and head were put into a computer model that gives projected weight and percentile figures. Before the report was finalized, the US dr. came in to remeasure BabyJ's abdomen, as she thought the abdomen looked a little pinched (I guess there is a picture that goes with the measurement). She assured us even at that point that we were out of the woods, over the 10th percentile already. She did the measurement 3 more times, and then I heard her say to the tech, "Let's use this one to err on the side of caution." After a few more minutes, she came back with the 16th percentile figure and the 5 pounds, 10 ounces projected weight at this time. So BabyJ is somewhere between 5 and 10 days "behind schedule," so to speak, of a 50th percentile baby. We were told that some of the difference between the 5 and 10 days can be attributed to the different due dates the drs. are using. (Dr. F's due date is 2/11, and the US office I've been to says I'm due either 2/7 or 2/9, depending on which visit's data they use.)

So being above the 10th percentile means that BabyJ is no longer considered IUGR (=growth restricted). Dr. F. told us that either something happened to slow her growth, or she's just a small baby. Dr. F. will continue to keep an eye on the situation, with weekly check-ups, and maybe even another growth ultrasound at 39 weeks (3 weeks from now). She said that usually they wait 3 weeks between growth ultrasounds due to the variability in the measurements, but she went just 2 weeks with us this time because it wasn't worth waiting for better data if the baby wasn't growing. (We agree!) So as of today, BabyJ's arrival date is less certain than it sounded a couple of weeks ago, as Dr. F did not mention inducing me next week when I hit 37 weeks. The current thinking is that if BabyJ's monitorings and blood flow ultrasounds continue to look good over the next few weeks, the bedrest may be phased out, and we may even make it to 40 weeks! She did say that she wasn't sure we'd want to go past that; she may induce labor near the due date if BabyJ hasn't arrived on her own yet.

All of this sounds SO much more positive and sensible that the noise we heard 13 days ago (admittedly without growth data at that time, it was appropriate for the doctors to be cautious). Thank goodness! The plan on the table suggests we'll be adding another Aquarius to the household, though we're back to the possibility that she and I will share a birthday. We'll have to see what the next few weeks bring. But my time in the hospital was well-spent: we have a birth plan and we are about as mentally and emotionally prepared for labor as we can be before it starts. The baby preparations at the house are nearly complete, and we have just a short list of things we still need to get either for us or for BabyJ. We have chosen a pediatrician, and we know a TON of specifics about Swedish's services for us and for BabyJ. In my time on the antepartum unit, I met several nurses who also work in the birthing suites, so I may actually see one of them on the big day. In addition, I know if I do end up getting induced, I will likely start that process in the antepartum unit, maybe with a nurse I've already had, and I can labor there for quite awhile (as long as I don't need pain meds) before heading to the birthing suites for delivery and, hopefully, rooming in with our little girl. So there are a ton of positives to my 13-day "vacation" at "Club Swedish." Right now, though, we are exhausted from the intensity of the last 2 weeks!!! We are looking forward to getting to bed early tonight, together, in our own bed, and facing a new day with far less worry and stress.

Thanks again to everyone who called, emailed, visited, wanted to call and/or visit, did things or offered to do things for us, kept us in their thoughts and prayers, and sent us positive energy of growth. Our network of support is so awesome and we don't take it for granted for one minute!!! Thank you!

A Growth Spurt!

Good news at our ultrasound this morning! BabyJ has grown quite a bit, pulling herself out of the 2nd percentile into the 16th percentile for her gestational age. The US measurements estimate her current weight at 5 pounds, 10 ounces. We are waiting for Dr. F. to come talk to us in person about next steps. Stay tuned!

Thanks to all of you who have sent us your positive thoughts and prayers. It worked!

xxx,
Jeff, Jenny, and BabyJ

Holding Steady

Today's ultrasound (this time conducted by a graduate of the Seattle U ultrasound program) revealed nothing new: blood flows and the amniotic fluid volume index were in the normal range. Her head is still down, face pointing to my body's left side. A few of the blood tests have come back negative, so we still have no clear explanation for BabyJ's small size. Dr. F. popped in around lunchtime to give me her read on the US results, and the doc from the clinic who is officially on rounds today, Dr. Cole, saw me this evening. Dr. C. said that all signs are pointing to a constitutionally small baby, and when I asked why they would induce labor at 37 weeks in this case, she said maybe that wouldn't be necessary (which makes me very relieved). But first, we do need to make sure that BabyJ grows enough to stay on her own 2nd percentile growth curve, and so....

As Tuesday's growth ultrasound grows nearer, I am getting pretty nervous, and the 35 weeks of raging hormones aren't giving me a fighting chance to remain grounded, either. A nurse said to me last week that she knows the women of the ante-partum unit live and die by their ultrasounds, and now I know what she meant. My stress level this afternoon jacked up BabyJ's heartrate and she had her first less than perfect monitor strip. (Interestingly, how this gets fixed is that I just lay there with continual monitoring, occasionally changing positions, until things calm down and look normal again. Unfortunately for me, that took 3.5 hours.) What I need the most is good sleep; rest where I can read and gather information I'll need for labor, delivery, and bringing baby home; and time to work through my stress, which I honestly prefer to do mostly by myself. I promise that if I need you, I'll call or email to ask you for a favor. Otherwise, the best that you can do for me is to keep us all in your thoughts, send us positive energy, and remaining willing to help us out after BabyJ comes home and we become sleep-deprived lunatics (I know THAT'S just around the corner!).

Stay tuned....

Capricorn or Aquarius?

Tonight will be the 9th night that Jenny has spent at Club Swedish. This week has been busier than last, complete with a neonatal doctor consult, more blood flow ultrasounds (Tuesday and Friday), a blood draw, and a frank conversation with Dr. F. Ultimately the news I think most people are interested in is “how long will Jenny be in the hospital?” and “when will we get to meet BabyJ?” While we don’t have definite answers for you, we do have some ideas about what will happen next. Here’s the scoop for the moment.

The growth ultrasound scheduled for next Tuesday morning, 1/13, will provide the missing piece to this puzzle.
a) If BabyJ measures as if she has not grown much, the plans are to induce labor and get her out into this world where she can gain weight without relying on the placenta in Jenny’s body. In this case BabyJ will be a Capricorn!
b) If BabyJ continues on her 2nd percentile growth curve or actually gains enough weight to bump her up to a higher percentile for her gestational age, then the bedrest is working, and Dr. F is likely to decide to have Jenny carry BabyJ to 37 weeks before inducing. In this case BabyJ will be an Aquarius! There will still be bedrest until then, but it’s possible Jenny can rest **at home.** This little carrot has been tossed out in a couple of conversations, but we're not clear what circumstances will allow for that option as an alternative to bedrest in the hospital.

So we’ll have to wait and see what Tuesday’s ultrasound growth measurements show. And then there always remains the possibility that BabyJ will choose to arrive of her own volition sometime before any induction takes place. But in any of these scenarios, BabyJ will arrive well ahead of schedule, in January.

The neonatal doctor who dropped by for a visit on Monday explained some of the issues for small babies who are born a little early. There are three main concerns: lung maturity, body temperature regulation, and feeding without choking. With Jenny just past the 35 week mark now, and with the plans for BabyJ to be born at week 36 or 37, we’ve been assured her lungs will be ready to breathe air. They are not even talking about giving Jenny a steroid shot to help mature BabyJ’s lungs – each OB doctor we ask says her lungs will be fine. Body temperature regulation can be a problem for low birth weight babies because of their lack of body fat, but we were told that this is rarely reason enough for hospitalization in the NICU. It’s the skill of feeding that may keep BabyJ in the hospital a few days. Apparently, sometimes little early babies don’t quite understand the sequence “suck-swallow-breathe.” (You can imagine that the sequence “suck-breathe-swallow” might be problematic! It'd be more like "suck-breathe-choke-get pneumonia." Definitely not good.) But it’s been said that it really only takes a couple of days for babies to sort that out. Then, when Dr. F. was asked on Tuesday what she thought about BabyJ staying in the hospital or coming home with us, she said very definitively, “I think your baby will go home with you.” So BabyJ’s prognosis is very good at this point.

The blood flow ultrasound on Tuesday went well and showed BabyJ’s is still head down, back and rump toward one side of Jenny’s belly, and feet up near Jenny’s ribcage on the other side. At one point BabyJ very demurely stacked her hands on top of one another and tucked them under her chin – it was very cute. The ultrasound technician for Tuesday’s ultrasound explained lots about what she was looking at and measuring in the vessels, which Jenny loves to hear. (The technician graduated from BCC, in fact!) All the blood flow and amniotic fluid measurements were deemed normal, and the ultrasound doctor on staff did not even come in to interpret the results. The next day, Dr. F. said the blood flows looked good and she didn’t expect to see any changes in BabyJ’s condition this week. The monitor strips continue to look great, as every nurse and doctor who sees them says. So we are in a holding pattern. Waiting, resting, and growing.

And then there is one more bit of info that came out this week that was new to us. The ultrasound on 12/30 indicated that BabyJ’s restricted growth is symmetric rather than asymmetric. Symmetric restricted growth means that her head and body are measuring proportionally small; with asymmetric restricted growth, the head circumference is closer to normal gestational size but the rest of the body measures small. It sounds to us that, in general, asymmetric restricted growth is often caused by placental issues late in the pregnancy, while symmetric restricted growth often indicates something like an infection affected the growth rate earlier in the pregnancy, or the baby is just constitutionally small. So Jenny’s blood was sent for some tests (we don’t have the results yet), to see if there is evidence of some kind of infection that may explain what’s going on. As far as we’re concerned, the symmetry of BabyJ’s restricted growth makes us believe even more strongly that we just so happened to make a small baby.

With another blood flow ultrasound to attend in the morning, it is time for this post to come to a close. We’ll try to keep you updated as we get more news. Thank you for all your calls, emails, and positive thoughts. We really appreciate them!

Ultrasound Pictures

These pictures are from last Tuesday's ultrasound. She's a whole week older (and hopefully bigger) now! The first one is a profile shot of her face, and the second one is a frontal shot of her face. Look for two eyes, a "snout," and an open mouth. Her right eye is near the top of the image, as that side of her head is resting on the uterus wall, and her forehead is on the right side of the image. She looks a little like she pressed her face against a window!