Thursday in A Billion Words

Things are still stable here. Well, maybe not my emotions today, but otherwise things are stable. I'm feeling fine still and Monkey is still doing really well.

I had an ultrasound this morning to check amniotic levels. Although the report hasn't come back yet it was pretty clear that there wasn't much in there. I'm still leaking a little and the tech said that his bladder was really full so he was obviously still making use of what fluid there is. It was a discouraging way to start the day. Our (nice) perinatologist from yesterday had said that amniotic level really isn't a primary indicator. He said that some women come in with none and carry for weeks and others come in full and stay full for weeks. There are some chances of increased cord compression, and some increased chances for placental issues, but the fact that amniotic fluid is low is not a deciding factor in any decisions. It doesn't really change the plan or course of action. Monkey's heart rate and reactions to contractions (I still get several braxton hicks contractions through out the day) is more of an indicator with how he's doing. Even knowing that, it was hard to see that there was so little fluid. Fortunately, Monkey has been great all day and has been reassuring all of us that he's still fine with no issues noticed in his heart rate so far. 

Today was also hard because I had an interesting nurse and had to see the first perinatologist again from Sunday. My nurse was nice, friendly and competent but kind of brisk and had a way of making me aware of any little thing that I was doing that might not be following orders (most of which I didn't realize and none of the other nurses so far have felt the need to tell me). Things like taking my hospital bracelet off while I'm laying in bed or having my own prenatal vitamin. She was okay with it, just needed me to know it wasn't technically okay. Which I actually appreciate. I may prefer to go against protocol but I am still a rule follower and if I'm going to break a rule I like to know I'm doing it and have a good reason for it ;). It was just the way she went about letting me know who was in charge. 

I can't complain though. I've had amazing nurses during my stay so far and this was the first personality conflict I've had (outside of the first perinatologist), and that's really all it was. Speaking of the first perinatologist.. she was back today and I suspect will be around for a few days. You could tell that she wasn't happy that I had disregarded her recommendations. Her words were, "I see that you negotiated with Dr. [nice guy] and have your plan set to 35 weeks." She then proceeded to remind me of the risks I was taking and went on her way. It was short at least, just not sweet. 

The frustrating thing with this is that there are things I'd like to discuss with someone in her position. Some things I could have asked today and some things I know will come up as time goes on, as information comes in or as situations change. I'd really love to have a doctor that I feel has some regard for my desires, thoughts and/or feelings as a mother. I'd really love to have open dialogue about the risks and the possible outcomes. I'd like to better understand some of the intricacies of these risks in order to make a more informed decision as things come up, assuming I have the luxury of time to do so. I'm not pretending that I'll suddenly have years of med school under my belt and that we can have a colleague-like discussion, I'm just saying that it would be nice to be treated like a person with a brain and to have the option of understanding what may or may not go on with my body and my baby, rather than blindly follow and trust someone else's supposed infinite wisdom. I'm not saying they don't have wisdom, I'd just like to use that wisdom to make a decision that we feel comfortable with.

I think I was running on a little more hope yesterday and today took some of the wind out of my sails. I have a lot of faith in my body to fight infection and in the natural birth process, but I also know this isn't the natural birth process and most of those bets are off. I know it's idealistic to think that I'll get through this without being induced or without delivering preterm. Not that it hasn't been done before, because it has! I just realized today that some of the things I was holding onto aren't necessarily indicators of anything. We really do need to take it one day at a time, no matter how badly I want to believe in a certain outcome. I don't want to naively sit here telling myself it's going to be just fine. I do want to have realistic expectations, which would be some combination of what a great doctor can discuss with me and the things I know about my body. I also need to remember that God really is bigger than this and can do amazing things, unrealistic, unexpected things even!

Anyway, Blake came back today and it was such a relief to see him. My sweet mother in law brought him a favorite local pizza for dinner and we had a nice visit with her for awhile. Eventually he decided to head to my parents' house to bring some things up there for Emerson, get a decent nights sleep and to be there when Emerson wakes up so my mom can have a bit of a break.

Speaking of my mom - what a rockstar she is! She's really the glue holding this whole thing together. We'd be lost without her help with Emerson and I'd really be lost without her bringing me food (homemade butter!!) and some other basic amenities like decent hand soap and shampoo/conditioner. Not to mention she's doing my laundry and also watches my one year old niece four days a week and keeping up with their household. It's a lot to put on her at once!

Food, that's another thing. If you know me, you know I'm kind of into healthy eating ;). The quality of my food really matters to me as does the nutrient density of what I put in my body. On top of that, I am gluten intolerant, so that limits what I can eat quite a bit. One accidental meal with gluten and I have horrible joint pain for around two weeks. That's no fun on a good day but while pregnant and stuck in bed it's really miserable. I also don't eat hydrogenated oils (like soybean, canola or palm oil) because they give me headaches and body aches (kind of like I have the flu), as does refined sugar. Again, on a good day a little slip up with these isn't the end of the world but it's a bigger deal when I'm pregnant and my body is so sensitive.

So no sugar, bad oils or gluten means I have the following options for hospital food: cream of rice cereal or cheese omelet for breakfast and for lunch and dinner I can have rice and steamed vegetables with either salmon, beef patty or chicken. I also get a fruit cup and a salad and/or veggie plate with each meal. Yesterday I discovered they have real olive oil and balsamic vinegar, so it's been a treat to have some sort of dressing for my salad. Again, thankfully my mom has sent in some food for me and Blake bought some things at the store too. I'd certainly rather eat the same thing everyday than feel miserable though, so I'm not complaining, I just think it's kind of a laughable menu.

Just now during my hour of monitoring, Monkey had a little drop in heart rate to one BH contraction, so the hospitalist is playing it safe and having me on constant monitoring through the night. While this has happened once before and the doctor then said it wasn't a big deal since all of his other reactions to BH contractions were normal and he is so stable otherwise... this doctor is more conservative and wants to cover his bases. Although it's harder to sleep with the monitors on, I understand and appreciate his approach and hopefully it won't be too long of a night. This is the kind of thing that is certainly easy to compromise on. It doesn't really effect Monkey and I can deal with it. More information is good when the cost of getting it is minimal so I'm happy to comply. This will also (hopefully) help relieve any worry in the back of our minds about his low amniotic fluid levels and the room his cord has. Let's hope the night goes well and that little man shows us he's doing fine still! 

Monkey Update: the Long Emotional Version

Our little Monkey is already making waves! Despite how uncomplicated this pregnancy has been and how healthy I've been and how good I've felt.. my body is apparently not sure how much longer it wants to host Monkey. While I'd be happy to meet him soon, I'd also rather he spent a little more time cooking.

HOW IT STARTED
It was Sunday morning, Sept 20th, I was 33 weeks 3 days. We were staying with my parents, in town for a shower I'd enjoyed the day before. I woke up with heartburn a little after 4 AM and got up to go to the bathroom. This was all very routine at this point but after I went to the bathroom several times I realized something was wrong and I was leaking fluid. I've heard stories of moms thinking their water broke but it was just a weak bladder, but my bladder was empty and fluid was still coming. I was hoping there was some other explanation as to what was happening but when it didn't stop, in my heart, I knew it could only be one thing.

I sat on the edge of the bed and just cried to myself for a few minutes as the reality of what was likely happening went though my mind. I silently sobbed as I processed all the changes that I should expect. If this was really amniotic fluid leaking this meant so many changes. It meant I was saying goodbye to my home birth plans. Most likely goodbye to having a full term baby. Goodbye to being able to protect him from the world by having him in the comfort and familiarity of our home and having him with me at every moment. It meant saying goodbye to him joining our family with just us for a few days, quiet, intimate. It meant saying hello to him sooner but in an environment full of strangers and strange germs. It most likely meant saying hello to the NICU and needles and tubes. He would need more than just me, which is all he's supposed to need. Medications, plastic, disposable diapers, all those things that I wanted to avoid because I'm me. I knew I was going from minimalist to full-on medical. A total 180 was going on in my head. I prayed through this for a few minutes and surrendered my hopes and plans. God knew this was going to happen, He wasn't surprised and I trust that He will take care of us. He is bigger than all of these unknown things that are coming at us.

I pulled myself together and woke Blake up. Told him what I thought was going on. We agreed we needed to go to the hospital and have the fluid checked. I woke my mom up and told her what we were doing and she went to sleep in our room so someone would be there when Emerson woke up.

As we drove to hospital we nervously talked, hoping we were overreacting, praying everything was going to be okay. Discussing the irony that we were far from home, in a loaner car while ours was being worked on. So much going on in our lives and yet it was all possibly coming to a halt.

We arrived and the ER sent us up to OB triage. They did their usual bit (tons) of paperwork and did a swab test to see if the fluid was amniotic fluid.

It was.

So then we began the conversations, what to expect, what the progression might be and what the outcomes would be if Monkey was born that day, the next etc. It was all so hypothetical. I wasn't in labor. I had no contractions. They did an ultrasound to estimate his size and check to see if I was effaced. I wasn't. My body wasn't preparing for labor in any way. I just had an unexplaned rupture in the amniotic membranes. Preterm premature rupture of membranes (pPROM it's called).

I was admitted, given a room and we waited to see some specialists to get some more answers before we made decisions about medications and interventions. We talked to the neonatologist and got more information about the likely status of Monkey's lungs if was born now, in a few days or in a week etc. We discussed the standard protocol for a premature birth and the risks vs benefits of keeping him in vs letting him be born if that's what happens. We were specifically looking for information about the use of betamethasone to mature his lungs. Our admitting dr said that at 34 weeks they consider the lungs developed and that steroids would no longer be a benefit. We were very close to 34 weeks so we were considering waiting the time out without it. However, the neonatologist said that more recent studies show a benefit from the steroids through 35 weeks. It would reduce his risk of lung disease by 30% or more to have the steroids. There are no statistically significant side effects for the short term. It would likely suppress our immune systems some, which is what I wanted to avoid, but lung disease can be a life long issue. The research does say that more studies need to be done on the long term effects but currently no side effects are known. Lung disease might mean a longer NICU stay, a difficult time feeding due to breathing interventions and possibly life long effects. We felt like it was probably in the best interest to give the steroids and hopefully he wouldn't need as much NICU time.

Our next issue was the protocol for preventative antibiotics. Two through IV and one orally. I am not a fan of antibiotics. I am a fan of having a healthy immune system through healthy good gut bacteria and have worked very hard to have a good microbiome so that when Monkey is born he gets a good dose of good bacteria to colonize his digestive system. It's a big deal to me and antibiotics would ruin this completely. If I had any sign of infection I would understand but at this time there are no signs of infection and although I'm at risk for infection the longer I have ruptured membranes, there are ways to limit the risk. And of course if I begin to show sigs then I'd take the medication.This is kind of a big deal to them that I am refusing this, but they agree to it. I've also clearly been labeled as a protocol breaker at this point ;).

Next we see the weekend on-call perinatologist (high risk preterm OB specialist). Up to this point everyone has been very understanding of our questioning their protocols. Very patient in my needing more information vs taking their word for it and very respectful of our desire to feel like we are making informed decisions. Our first perinatologist was not really any of these things. She is a specialist and expected us to purely respect her opinion and take it as law. She said I needed to take the antibiotics, needed to have a manual exam and needed to be induced at 34 weeks. The benefit of keeping baby in longer than that was not any greater while the risk for infection just continued to increase. I asked if we could discuss the induction at 34 weeks and she essentially said it wasn't a discussion point, it needed to happen. There was no reason to wait longer. As such, I asked if antibiotics were really necessary. To her, their purpose is really to prevent labor starting, since an infection could cause labor to start. Since I was so close to 34 weeks I didn't see the point in it. She agreed to this (shockingly) and I didn't ask to discuss any of her other recommendations. We did ask her if there was any way to find out why/how this happened or if we'd ever find out. She said we probably wont ever know why it happened. I didn't have any of the risk factors for pPROM, I was healthy and had experienced an uneventful pregnancy up to this point. It's just one of those things they can't explain. We also discussed the details of her plan to induce me.

The rest of the day went by with a few more test results coming back, constant monitoring for contractions and heart rate, and just settling into this new situation we found ourselves in. We didn't get a lot of sleep that night. There were moments of disbelieving laughter, moments of weeping and surrender in prayer and there was hope.

Blake and I had talked about getting away for a few nights, just the two of us before baby was born.. this wasn't exactly what we had in mind and was certainly more money than we were planning on spending. ;)

DAY TWO
Monday morning came and as the day progressed we saw that I was stable and even more important, Monkey was stable. His heart rate was great, still no contractions, no signs of infection etc. I felt the same as I did a few days ago and Monkey was behaving the same as he always did. I don't think he even knows that something is going on!

We spoke to a new perinatologist and voiced our concerns about induction at 34 weeks. Primarily, I'd like to see Monkey cook as long as we can let him. I understand that statistically his chances for thriving are no different between 34 and 37 weeks, but common sense would indicate nature and God had intended him to stay in the womb longer. The average outcome might be the same when you look at a large group of babies but this isn't the average this is our son. It's my job to nourish and protect him as long as I can. Additionally, being induced isn't ideal and can be unpleasant. It's not that I'm afraid of the discomfort, it's that it sounds so hard on our bodies. So unnatural. Here my body is closed up (save for a little leak) and not preparing for labor. Closed for business. Being induced when you're closer to full term and your body has begun opening the cervix but not dilated yet is one thing but to try to take me from zero to sixty purely by drugs just sounds hard on me and hard on Monkey. I feel like it might put him in more distress to have my body jack hammered open like that. I digress.

So the new perinatologist said that if we were uncomfortable with induction at 34 weeks he would be willing to discuss waiting until 35 weeks. He said that more recent studies are showing that there is more benefit in waiting until 35 weeks. So now the benefit of longer gestation does outweigh the risks of infection. We were really glad to hear this. So currently the plan is to wait until Thursday, October 1st for induction. I will (of course assuming things continue to go on as stable as they are now, and assuming I don't go into labor naturally) ask to extend that more once it gets closer because again, I want to keep this little guy where nature intended him as long as I can, and again, I'd really prefer for both of us that labor happen spontaneously. But I'm glad we've bought another week, even if it means sitting in this hospital room on bedrest for nine more days. We can take things as they come and reassess next week hopefully.

So for now we are praying that no infection creeps in, that Monkey stays stable and safe and that I don't lose too much amniotic fluid (or rather that I don't lose it faster than he can make it up), as there are some complications that could happen if there isn't enough amniotic fluid. Complications that could lead to an emergency surgical delivery, which of course we very much want to avoid. So far, they haven't seen any distressing signs of low amniotic fluid.

DAYS THREE & FOUR
Tuesday and Wednesday were pretty routine days. I'd settled into being here. I'd gotten some snacks and better food, figured out how to get a few extras from the kitchen, got some changes of clothes and permission to take a shower. I had some great visitors, including some time with Emerson. Things have been very steady and stable. I had time to kill but felt like I was being productive by filling it with continuing ed and some compliance training I'd been putting off. I also got a little Netflix time in. My nurses have been great and best of all, I got a new bed on Wednesday. I'd been on a delivery bed, which splits in funny places for specific purposes and is pretty hard but my nurse Weds morning came in and immediately asked for a postpartum bed, which is more like your standard hospital bed. I'm guessing I'll sleep better tonight!

I had the same perinatalogist Monday through Wednesday, which was wonderful. He was very supportive and I found out on Weds, he was going out on a limb a little in supporting my 35 week plans, since it was going against protocol of the hospital. He had good information and data to support this decision though and I really appreciated him. All of my vital checks and non-stress tests on Monkey were coming back great. Everyone comments on what a happy little guy we have in there. I still feel great. I feel the same as I did last week despite all that is going on.

On Monday night, we had decided that Blake should go back home and work Tues, Weds, and part of Thursday. Things were probably as stable as they were going to be and we would rather save the vacation time for when Monkey was here with us. It was a hard decision but in the end a good one since things have remained steady and uneventful. It's been hard having him gone but again, I'm trying to make the best of the quiet time. It's the most time I've had to myself in years! I'm ready for him to be back though. I know he worries more when he's not here to see what's going on and of course there's the worry that if something happens, will he make it back in time. And of course, he's my partner in this journey and it's better when he's here to cry on his shoulder, vent about something and process the decisions. He's such a support to me and always makes things easier by just being here.

SO.. We'll see what the next week brings! Tomorrow I'm 34 weeks, so it's a relief to have easily made it to this point and there's hope that things will go smoothly through next Thursday. If all goes well, we'll have an October baby!

Monkey and the Second

We are the kind of parents that don't share (or necessarily decide on) a name until our baby is born, so we call this little guy Monkey.

I haven't talk much about Monkey's pregnancy and I've been pretty neglectful about taking pregnancy pictures. There's just something about your first pregnancy that allows for much more of this.. namely not having a kid yet ;) and there's something about all the unknown that made me want to document it more. In the end, I don't know that weekly bump pictures and all the details really make much of an impact in the long run. I think I'll enjoy looking back at some of the details I wrote down with Emerson's pregnancy and I do wish I'd had more time to journal a little about Monkey's pregnancy but I don't think all the bump pictures will get used. I thought I'd make a little book out of them, but a few are enough. Maybe I'll feel differently when my kids are older if they're more interested than Emerson is now. 

The thing about Monkey is that I don't know what to call this pregnancy. It's not my second pregnancy because I miscarried just before getting pregnant with him, but it's weird to call it my third pregnancy when I only have one living child. It's the awkward thing about miscarriages, especially really early ones. An interesting side note is that I've been pregnant almost all this year. (TMI warning) I got pregnant with the baby we lost on January first and got pregnant right away (unintentionally) after miscarrying. So there was a span of maybe two weeks that I wasn't pregnant. 

Monkey's pregnancy has been very different than Emerson's in a lot of ways. First, I have a better idea what to expect and that changes things. It's still exciting but not in that everything-is-new kind of way. Almost a little deeper because you know just how sweet it is to meet your baby. I also eat very differently now than I did with Emerson and as a result weigh less and have significantly less (basically no) joint pain, which was an issue with Emerson's pregnancy. Both Emerson and Monkey's pregnancies were/have been uncomplicated and easy by any standard definition of pregnancies, but for me, Monkey's has been better than Emerson's. 

Monkey's pregnancy was also bittersweet because we had just lost a baby we didn't meet. We also didn't really know why I miscarried but did know we were at a higher risk for miscarriage do to my genetic issue, which made us wonder if this was going to be a trend. Since my second pregnancy ended in miscarriage early, it wasn't clear if it was my genetics, just something that would have happened anyway or possibly low progesterone (the most likely candidate). This loss tainted the first few months of growing Monkey because I was so sure I was going to lose him too. We hadn't intended to get pregnant right away but (TMI) miscarriage changed my cycle enough that we didn't realize I was fertile when I was. I'd planned on having some labs done, taking some supplements, and giving my body and emotions time to recoup. 

I didn't really accept that I was going to ever meet Monkey until I was about 16 weeks and still doing fine. By then I was well into my second trimester and hadn't been able to really celebrate or document the pregnancy. It was just too hard. There's a funny stigma about miscarriages, especially early ones. It's like your aren't really supposed to talk about it or act like it was your kid. Now, I'm sure miscarrying at almost 6 weeks is completely different emotionally than miscarrying further on, but difficult nonetheless. That baby was still my second child, Monkey is still my third, even if I don't say it that way out loud when they are both standing next to me someday. 

All that to say... Monkey.. I'm sorry you've been neglected in the documentation department.

Really, it's been such an easy pregnancy there isn't much to say. Other than some nausea early on because I was using progesterone (in case that was the cause of my miscarriage with my second pregnancy). After that went away at 16 weeks I had the same light headed issues from low blood pressure that I had with Emerson, and I have had braxton hicks contractions but not nearly as bad as with Emerson (because now I now about the miracle of magnesium lotion). At about 30 weeks I was starting to feel like I was a whale and tired of being pregnant already but once I figured out a better pillow set up I started sleeping better and that helped. 

It's funny that I started this pregnancy almost 15 lbs lighter than with Emerson and I eat crazy healthier given that I can't eat refined sugar or gluten.. but still I've gain basically the same amount of weight, just at different rates (gained very little with Emerson at first, more later; more with Monkey at first, less later). 

I also crave similar things, with my general craving being fruit, fruit, fruit, just like with Emerson. I've had other shorter term cravings too like biscuits or gyros, but some of the things I ate a lot with Emerson I just don't eat now so there's no point in craving them! Biscuits is one of those things but it was pretty strong.. so I found a gluten free recipe that has made my heart happy. (And now I want a biscuit.)

Monkey barely ever gets hiccups. Like maybe once a day, only a few times a week. Emerson got them like clockwork four times a day. Emerson was always spot on where she was supposed to be growth wise and Monkey has been a little big since about 20 weeks (mostly by uterus size measurements). Emerson was always perfectly positioned with her head down (you know, until just before she was born!) and Monkey gave us some worry by being transverse for awhile and then we weren't sure if he was head down or up. At my last midwife appt we confirmed he was securely head down but there was a little worry there for awhile! 

At 33 weeks we're just getting ready to have a baby shower and then it's time to get real and get ready for him. I have things set aside and I've picked out some of the gender neutral things and put away the baby girl things but I haven't really made the changing table/dresser his yet. It still has miscellaneous Emerson and diaper stuff. Soon though! Once I get all the fun boy clothes I think I'll feel like I can get organized. 

I may not have taken lots of pictures to write little notes to you on, but Monkey, we love you just the same! We are pretty sure we have your name picked out and we wonder if you'll have red hair like your sister. Speaking of your sister, she pretty much thinks you're awesome, and she also thinks that maybe you are my belly button. She loves to 'lay on baby brother' and talk to you. She laughs when you go kick her and go 'bump bump' and she's always checking in to see if you're awake or sleeping. She's been reading books and learning all the ins and outs of being a big sister, like how she can't pick you up or feed you but is excited to hold your hand, sing you twinkle twinkle and kiss your forehead. 

Monkey, you are my little kicker, always moving and wiggling! I'm excited to see what you'll be like on the outside and if your wiggle worm tendencies will mean you're going to be full of energy or if you'll be mellow like your sister (she was a wiggle worm too but not quite as much as you!). We love you either way!

Babies

It's not too surprising given our life circumstances and her age but Emerson is pretty into her babies lately. She's gone through a few spurts of packing around a baby, a day or two at the most but this time she's going on weeks. It's. Adorable. 

She'll stop mid-activity and exclaim that her baby has woken up, needs a nap/bottle/diaper etc., rushing off to take care of it. She comes back and reports how baby is doing or brings baby to me to hold or help. 

She's so sweet with them, so gentle and tender. She kisses their tiniest owies, wraps them in blankets, talks to them in her high-pitched sweet voice. You can tell she's been around a few baby lovers ;). She's similar with real babies save for a slightly shorter attention span when they wiggle and kick. 

It's no surprise that she takes good care of her babies, she's my little helper. She brings me the broom and holds the dustpan, sprays the cleaner while I mop, stirs when we bake and sits next to me 'helping' anytime I'm cooking. She's such a little mother and nurturer. When I hurt myself she rushes over to blow it kisses and bring me oil. She'll say, "Oh momma, owie? I sorry momma. Where your owie? Here? {air kiss} {air kiss} {air kiss} All better now momma." (She air kisses her own owies too with a similar narrative). That's just one example that comes to mind, she's always rushing off saying "I go get it momma (I do det it)" if I mention I need something, laughing with me if I forgot something, "ha, silly momma!" and randomly encouraging me when I do anything from go to the bathroom to find her missing toy or say that I've finished a task, "Nice job momma!! Nice Job!" In general, she just keeps life sweet with her little supportive or obvious comments as she narrates our day. How I adore her. 

Anyway, back to the babies. On Monday, she brought one of her babies to me and told me how baby was crying. She was hungry. "Baby need milt, momma. Poor baby." and then you could see this lightbulb go on in her head. "Oh!" She said, "I have Ma ma ma!" (Ma ma ma is what she said for mama milk or nursing) and she lifted up her dress and nursed her baby. "I nursing baby, momma!! I have ma ma ma!" 

I figured at some point she'd nurse her babies, but up until now she'd always given them bottles, which struck me as funny since she nursed for so long. But then she mostly saw other babies getting bottles (you don't really *see* babies nursing as much because most moms wear a cover). I thought for sure once she saw me nursing baby brother she'd start nursing her babies. I didn't expect it Monday but it was priceless to see her revelation. She sat down and asked for a pillow for baby as she explained how hungry baby was, "baby need yots of milt, mommy". 

I'm not saying she'll be perfect when baby brother comes but I'm sure she'll be sweet (mostly) and I look forward to watching her with him. 

I'm sure she'll love this in 12 years. ;)