We made it to the 30's!!! Feeling very good about this. Now I have two week goals from here out: 32 is better than 30 and 34 is better than 32 and 36 is better than 34 and after that I'm good to go.
I had an ultrasound on Wednesday that I thought was supposed to be a biophysical and growth check because the peri had said we needed to check out growth every two weeks due to the placenta and cord issues. When I got in there the US tech only had me down for a bio. For those who don't know, this looks at heart rate, amniotic fluid level, gross and fine movements and practice breathing that the baby should be doing. They give the baby a score and I'm not sure how the points are broken down but each baby has to get 8 out of 8 or further monitoring and intervention is needed if they don't. Last week at 29 weeks I had to ask the US tech to look at the placentas and cord flow and tell her why I was concerned about it. My OB had been on vacation the previous two weeks while I was in the hospital and had just gotten back that day so I just figured she hadn't seen my report yet and didn't order anything extra in the ultrasound.
So then I had my appt with her and discussed what the perinatologist had said and I thought we were on the same page as far as concern level goes because she talked about delivery at 34 weeks.
But then this week the US tech once again only had me down for a bio. I told her the peri wanted to look at growth every two weeks and the on call OB in the hospital said we would look at placentas and cords weekly.
Well this week the tech said normally they do growth monthly because two weeks won't show much change and that my doctor hadn't ordered to look at those things but she would do it just this one time for me.
I was very frustrated with this because I'm getting different messages from different doctors. I was looking at my appt schedule and after next week, I didn't have any US ordered until 34 weeks. Ummmm how are we supposed to decide if it's necessary to deliver at 34 weeks if we don't have any US to check on things up to that point?! I called the peri to see if I was supposed to follow up with her and the nurse said that no, they had just sent recommendations to my OB and that I would just continue to see her and that's who I should speak with.
So I called my OB and they got me scheduled for weekly bios but said once again that growth will only be checked monthly but that they would review the notes from the peri and see exactly what her recommendation was and may or may not change the orders based on the report. Ugh. Then I asked about the placentas and cords and the nurse said "I thought that was part of a bio anyway". Well, I have no idea but it sure seemed like I had to really convince the techs to look at those things. I asked if she could please make sure of this and if not, make sure it is ordered for my remaining ultrasounds.
I don't know if I'm just overreacting or what, but I get the feeling my OB is not taking this issue as seriously as myself or the peri. The peri acted like it was definitely something to pay close attention to and I sure as hell want to check it out every week. Heck, I'd prefer to check on it every day if I could.
We'll see what happens next week and see how big of a fit I'll have to throw. Hopefully they'll get it together and just do what I'm asking.
But for this week their growth had greatly improved! Owen was 3lb 5oz/ 58th percentile and Eden was 3lb 3oz/ 54th percentile. Last week they were in the 44th and 40th percentiles so all this bed rest has given them a lot more energy to draw from and they grew like crazy!
Eden passed her bio right away but it took Owen awhile because he was not moving or doing practice breathing at all. The tech kept pushing on my belly trying to wake him up but he was not budging. It was starting to freak me out but then finally at the end and passed his test.
Owens placenta is looking very old and calcified but his cord flow was fine.
Edens placenta looked only slightly aged but her cord flow was mildly concerning. They measure the systolic to diastolic ratio and like to see it be less than three. The tech measured it three different times and got 3.1-3.7 but then came back at the end and was able to get two more readings of 2.8. She went to tell the OB (not mine) about it and after a minute she came back in and said that the doctor was ok with those numbers because she passed her bio, her growth is good and we did get a reading below 3 so the higher readings could have just been her position or activity level at the time.
I'm glad the doctor wasn't concerned but at the same time I'm freaking worried out of my mind and kind of wish someone with authority would be to. In a way I wish I could just be monitored continuously in the hospital until they're born. I'm so afraid I'm going to lose one or both of them because of lack of attention.
I've had thoughts cross my mind that it would be better to just deliver early and get them out here where we can have more control and for a second I thought about taking myself off bed rest and just allowing myself to go into labor. But I would feel horrible if something happened to them due to prematurity. My biggest concern at this gestation would be NEC (a life threatening intestinal infection) I just don't know what to think. My main motivation for staying on bed rest is for their cord flow and growth. I want to give them everything I have. My concern for preterm labor, although important is less of a factor in my mind. At this point if they're born early I will feel like it's because it was the best thing for them.
I feel so fortunate for every day that I wake up and still feel them moving. I feel like I'm just waiting for something horrible to happen and I keep wanting to control the situation in some way but the only thing I can really do is give the control to God and keep praying.
The other thing bed rest has done was amazingly allowed Owen to disengage his head from the birth canal. His head was no longer resting on my cervix which everyone thought was impossible because of how low he was but because I've been laying down and never standing, he was able to come back out. This is great because it means I probably am not anymore dilated and decreases my chance of preterm labor.
The bad side is that he is now breech again AND his sister decided to follow him and they are BOTH breech. Little turds. This is ok for now, but they better get their heads back down where they belong for delivery.
Friday, July 13, 2012
Monday, July 9, 2012
baby sprinkle and rest
Saturday was my baby sprinkle thrown by my younger sister Jannel. I was so excited to celebrate these lives. It really had nothing to do with getting gifts. The only thing I really needed was new cloth diapers and I got a TON so that's great, but what I really wanted was just to have family there to celebrate these miracles inside me. That morning I felt the babies moving and just thought to myself "we made it to the sprinkle". I was just so amazed and grateful that they were still alive at 29.3 weeks. When my sister and I decided on July 7 way back in like Feb or March I remember thinking "if we make it that far". And we did! I'm so grateful to still be pregnant with TWO living babies!
Everything was done in blue and pink and was so picture perfect like a scene right out of pinterest!
I was so glad my doctor let me go. I sat the whole time and had people bring me my food, drink and gifts. It was great to get out of my house and my same old recliner I ALWAYS sit in. I decided to stay at my moms for several hours after the sprinkle was over just so I could talk to some people for awhile and have a change of scenery from my living room. It was really nice, but by the end of the night I was very uncomfortable and couldn't seem to get comfortable in any of their furniture so I was ready to get back to my recliner and was starting to get some contractions so I took a prn muscle relaxer as well. Being up and moving even just a little bit kinda made me appreciate the bed rest status because I had kind of forgotten how much pain I was in trying to simply walk around. As bored as I get, I realize how wonderful the rest is and how much my body needs it. I'm very grateful to not be working right now. I need the time off WAY more right now than I will after the babies are born. I really only need about six weeks for full recovery after babies anyway and the rest of maternity leave is just fun time with my babies. I remember thinking after six weeks with Corynn that there really wasn't any reason I COULDN'T work, I just liked being home with my baby for a few more weeks.
Whereas right now I CAN'T work. Right now is when I really am "disabled" and NEED that short term disability check.
Another thing I noticed the day of the sprinkles was that the babies didn't move much. They moved enough to let me know everything was ok but they were small rare movements. They move WAY more when I'm home kicked back in my recliner. The day the perinatologist saw the problem with Eden's cord and placenta she said the best thing for it would be strict bed rest to keep my pressure down and allow them optimal flow and they can get all the energy they need because I'm not using it to move around and man, I could really tell the difference on saturday! Sunday they were back to moving around like crazy.
I feel a greater need to be on strict bed rest for this reason than I do for the preterm labor. Not that I'm not worried about preterm labor, but I'm more worried about simply keeping them alive.
Everything was done in blue and pink and was so picture perfect like a scene right out of pinterest!
I was so glad my doctor let me go. I sat the whole time and had people bring me my food, drink and gifts. It was great to get out of my house and my same old recliner I ALWAYS sit in. I decided to stay at my moms for several hours after the sprinkle was over just so I could talk to some people for awhile and have a change of scenery from my living room. It was really nice, but by the end of the night I was very uncomfortable and couldn't seem to get comfortable in any of their furniture so I was ready to get back to my recliner and was starting to get some contractions so I took a prn muscle relaxer as well. Being up and moving even just a little bit kinda made me appreciate the bed rest status because I had kind of forgotten how much pain I was in trying to simply walk around. As bored as I get, I realize how wonderful the rest is and how much my body needs it. I'm very grateful to not be working right now. I need the time off WAY more right now than I will after the babies are born. I really only need about six weeks for full recovery after babies anyway and the rest of maternity leave is just fun time with my babies. I remember thinking after six weeks with Corynn that there really wasn't any reason I COULDN'T work, I just liked being home with my baby for a few more weeks.
Whereas right now I CAN'T work. Right now is when I really am "disabled" and NEED that short term disability check.
Another thing I noticed the day of the sprinkles was that the babies didn't move much. They moved enough to let me know everything was ok but they were small rare movements. They move WAY more when I'm home kicked back in my recliner. The day the perinatologist saw the problem with Eden's cord and placenta she said the best thing for it would be strict bed rest to keep my pressure down and allow them optimal flow and they can get all the energy they need because I'm not using it to move around and man, I could really tell the difference on saturday! Sunday they were back to moving around like crazy.
I feel a greater need to be on strict bed rest for this reason than I do for the preterm labor. Not that I'm not worried about preterm labor, but I'm more worried about simply keeping them alive.
Tuesday, July 3, 2012
aging placentas
had an ultrasound and OB appointment today. Both placentas now appear to be aging/ calcifying, actually Owen's looks more aged than Eden's BUT both of their cord flows looked normal today!! That made me very happy. They both were doing a lot of practice breathing and moving.
Based on the way my placentas looked, my doctor is thinking that we will deliver them at 34 weeks. While I don't want them to have any NICU time, I know they will need a short stay if born at 34 weeks and I'm ok with that if it's what's safest and the alternative is death from non- functioning placentas! I think especially knowing ahead of time that that's what's going to happen, I can prepare myself for not having them in my room with me and giving up on that idea.
Good news is that both babies are now head down so hopefully they stay that way and I won't need a csection!!
My doctor checked me again and was blown away by how much pressure Owen was putting on my cervix and how far down his head was. She said "I'm pretty sure you're still 2cm, but I'm not gonna do a thorough check because he's so low, I'm afraid I'm going to stir something up". She emphasized that I need to stay off my feet and be on strict bed rest as much as possible but did give me permission for the baby sprinkle on saturday :-)
Based on the way my placentas looked, my doctor is thinking that we will deliver them at 34 weeks. While I don't want them to have any NICU time, I know they will need a short stay if born at 34 weeks and I'm ok with that if it's what's safest and the alternative is death from non- functioning placentas! I think especially knowing ahead of time that that's what's going to happen, I can prepare myself for not having them in my room with me and giving up on that idea.
Good news is that both babies are now head down so hopefully they stay that way and I won't need a csection!!
My doctor checked me again and was blown away by how much pressure Owen was putting on my cervix and how far down his head was. She said "I'm pretty sure you're still 2cm, but I'm not gonna do a thorough check because he's so low, I'm afraid I'm going to stir something up". She emphasized that I need to stay off my feet and be on strict bed rest as much as possible but did give me permission for the baby sprinkle on saturday :-)
L&D 5
yesterday afternoon I lost a bunch of nasty bloody mucus plug so I called my OB just to let her know what was happening and she decided I should go back to L&D just to check my cervix and make sure I wasn't dilating more. I wasn't!! Still 2cm.
So they were just gonna watch me on the monitor for a bit and send me home. Thanks to the pericardia, I only had a contraction about every 15-20 minutes! Just as they were going to release me I had a contraction that made Owens heart rate drop to 80, so they decided to keep me another hour to watch him. He didn't do it again but it still made me very nervous. The nurse was like "oh he probably just pinched his cord" and I'm thinking that is the worst thing she could say to me. People treat cord compression like it's no big thing, and I guess maybe it's not most of the time but when you've lost a baby to a cord accident, ANY cord compression is a major deal!
I went home after a couple hours
Saturday, June 30, 2012
Keflex and Glyburide
Keflex- after my last trip to L&D which was thursday night June 14th, I had decided not to take the oral abx prescribed to me because I didn't really have any symptoms and the last "UTI" was actually negative anyway.
So Monday morning I called my OB office to see what the results of the urine culture were and they were in fact negative so I decided not to fill my script. But then Wednesday night June 20th I started getting horrible bladder spasms. It was the only symptom I had and knew it could've just been Owen kicking my bladder but decided to just fill my already written Keflex script after all instead of going back to L&D AGAIN. By the next day the spasms were better and it may or may not have been due to the Keflex, but I figure it can't hurt too much either way.
Glyburiede- Thursday June 21 I called my OB to report that my blood sugars had been really hard to control ever since I was placed on modified bed rest. I assumed it was because I wasn't getting any exercise at all. My OB wants my fasting blood sugars in the mornings to be 60-90 but mine were running about 100-110 which was making it difficult to control the rest of the days sugars as well.
I was already taking glyburide which makes your body secrete more insulin. I started out a few weeks ago taking 2.5mg at night, then increased to 5mg at night to control my fasting sugars.
Now she wanted to increase me to 7.5mg at night and 5mg in the morning. WOW. This seemed like a lot to me. I was worried I would get too much insulin overnight and not wake up or something. I took the 5mg friday morning June 22nd and got so sick! By lunch time I was shaking and weak and felt really low blood sugar. I was at my sisters house so that she could help me with Corynn, and of course I forgot my glucose monitor at home so I don't know how low I got.
I felt bad most of the day and did not feel the babies moving hardly at all so I called my OB and went in for an NST and the babies started moving and acting totally fine. She thinks it was just that my sugar got too low, so she said to try and take the same dose again the next day while I actually have my glucose machine so I can check and actually see what my blood sugar is and that if it gets low to call the on call doc and that maybe I should decrease my morning dose if it happens again.
I took the 5mg the next day and this time felt fine. Sugars were great and had no symptoms of hypoglycemia and then it dawned on me.... I had drank caffeine friday morning. I really wanted a frapuccino which has 34grams of carbs so I knew I couldn't have much carbs with breakfast if I also wanted to indulge in that treat (I'm allowed 45g in a meal). I had 13g of carbs from a whole wheat waffle with PB on it and an hour later went to get my frap and drank 2/3 of it. Well, I think the lack of food mixed with the caffeine is actually what the problem was, so I decided I better skip caffeine while I'm taking the glyburide or at least make sure I also have plenty of food to go with it.
After hesitating for a few days, I took the 7.5mg at night for the first time on sunday night June 24th but had a snack by my bed and my glucose monitor ready just in case and I had emergency orange juice in the fridge. I set my alarm for 1am just to check and make sure I was alive and sure enough, my sugar was just fine and my fasting the next morning was a beautiful 76! So, this new dosing is actually working out pretty good for now. Hopefully it stays that way. Seems like having two placentas has made GD a little more difficult to manage than in my pregnancy with Corynn. With Corynn I never went above 2.5mg at night of glyburide and I didn't have to be quite as strict with counting my carbs. I could go over by 10g or so and still be fine, but not this time!
So Monday morning I called my OB office to see what the results of the urine culture were and they were in fact negative so I decided not to fill my script. But then Wednesday night June 20th I started getting horrible bladder spasms. It was the only symptom I had and knew it could've just been Owen kicking my bladder but decided to just fill my already written Keflex script after all instead of going back to L&D AGAIN. By the next day the spasms were better and it may or may not have been due to the Keflex, but I figure it can't hurt too much either way.
Glyburiede- Thursday June 21 I called my OB to report that my blood sugars had been really hard to control ever since I was placed on modified bed rest. I assumed it was because I wasn't getting any exercise at all. My OB wants my fasting blood sugars in the mornings to be 60-90 but mine were running about 100-110 which was making it difficult to control the rest of the days sugars as well.
I was already taking glyburide which makes your body secrete more insulin. I started out a few weeks ago taking 2.5mg at night, then increased to 5mg at night to control my fasting sugars.
Now she wanted to increase me to 7.5mg at night and 5mg in the morning. WOW. This seemed like a lot to me. I was worried I would get too much insulin overnight and not wake up or something. I took the 5mg friday morning June 22nd and got so sick! By lunch time I was shaking and weak and felt really low blood sugar. I was at my sisters house so that she could help me with Corynn, and of course I forgot my glucose monitor at home so I don't know how low I got.
I felt bad most of the day and did not feel the babies moving hardly at all so I called my OB and went in for an NST and the babies started moving and acting totally fine. She thinks it was just that my sugar got too low, so she said to try and take the same dose again the next day while I actually have my glucose machine so I can check and actually see what my blood sugar is and that if it gets low to call the on call doc and that maybe I should decrease my morning dose if it happens again.
I took the 5mg the next day and this time felt fine. Sugars were great and had no symptoms of hypoglycemia and then it dawned on me.... I had drank caffeine friday morning. I really wanted a frapuccino which has 34grams of carbs so I knew I couldn't have much carbs with breakfast if I also wanted to indulge in that treat (I'm allowed 45g in a meal). I had 13g of carbs from a whole wheat waffle with PB on it and an hour later went to get my frap and drank 2/3 of it. Well, I think the lack of food mixed with the caffeine is actually what the problem was, so I decided I better skip caffeine while I'm taking the glyburide or at least make sure I also have plenty of food to go with it.
After hesitating for a few days, I took the 7.5mg at night for the first time on sunday night June 24th but had a snack by my bed and my glucose monitor ready just in case and I had emergency orange juice in the fridge. I set my alarm for 1am just to check and make sure I was alive and sure enough, my sugar was just fine and my fasting the next morning was a beautiful 76! So, this new dosing is actually working out pretty good for now. Hopefully it stays that way. Seems like having two placentas has made GD a little more difficult to manage than in my pregnancy with Corynn. With Corynn I never went above 2.5mg at night of glyburide and I didn't have to be quite as strict with counting my carbs. I could go over by 10g or so and still be fine, but not this time!
Friday, June 29, 2012
L&D 4: early labor, Edens cord flow
On Monday night June 25th around 8pm I noticed that my braxton hicks felt pretty crampy and were coming pretty regularly about every 6 minutes. I had already been to L&D a couple times for the same situation and it never turned into much, so I thought I'd just try to drink more water and get some sleep and just see if they would go away on their own.
They woke me up occasionally throughout monday night. I wouldn't call them painful, just uncomfortable. By Tuesday morning they were still every 4-6 minutes so at 7am I called my OB who told me to go to L&D.
I arrived at about 8:30 and told my nurse that I was pretty sure these were just BH contractions and that it was probably nothing, but thought I'd better check. I really thought I'd be there a couple hours and then go home.
Contractions showed up every 4-6 minutes on the monitor so they gave me vistaril (muscle relaxer) and wanted to just watch me for a couple hours. The nurse checked my cervix and I was dilated to 1cm and she could feel the amniotic sac of baby A (Owen). At first the contractions slowed down with the vistaril and just as they were talking about sending me home, they picked back up to about every 2-5 minutes so the OB wanted to check my cervix again. I was 2cm.
With the cervical change, people started to get worried.
I was told I wouldn't be going home for a few days. They started me on a magnesium drip, did a gbs test, started IV antibiotics and steroid shots to prepare for an early delivery (28 weeks).
The goal was to keep me on magnesium until I could get a full 48 hours of steroids in my system for the babies lungs. For the first 12 hours of magnesium I was not allowed to eat or drink or get out of the bed. Apparently it is a central nervous system depressant and it often makes you lethargic, weak and have flu like symptoms and can decrease your gag reflex and cause choking and aspiration, so they wait to see what your alertness level is going to be before you can eat. I was SO HUNGRY. This is also why you can't get up. Not even to use the bathroom. I became familiar with bedpans and sponge baths for the first time and I have to say I'm not a fan.
The magnesium can also cause fluid retention, particularly in the lungs, so I was fluid restricted as well.
I actually had very minimal side effects compared to most on the magnesium. I got a little hot and flushed and at some points it became difficult to breath and felt like my chest was tight. I was a little sleepy but not totally out of it. I was determined to show the nurses how alert I was so by midnight they finally let me eat!
The mag wasn't as bad as I had thought it would be. The worst part was not being able to get out of bed.
WHile on magnesium, I really had MAYBE one contraction an hour. It worked like a charm! The steroids raised my blood sugar one time to 224, but it didn't last long so I never needed insulin.
On Wednesday they let me get out of the bed to sit in a chair and use a bedside commode instead of the bedpan. It's amazing how excited you can get about something like that! Those hospital beds KILL my back (not to mention peeing in your own bed).
On Wednesday I had a lot of spotting and think I began to lose my mucus plug. That night around 7pm, they decided to try to wean my magnesium from 2g/ hr to 1.5g/hr to slowly get my body adjusted to turning it off by noon on Thursday as planned. The contractions slowly started back up. First it was one every 20 minutes, then 10-15 and by the time they were every 6 minutes around 1am, they turned my magnesium back up to 2g/hr because it was most important that I got the full 48 hour effect of steroids before going into labor. I also got another vistaril at this time to slow things down. This worked and contractions went away.
At 9am on Thursday they turned the magnesium down again to 1g/hr but at the same time started me on an oral calcium channel clocker "procardia" which can be used to prevent muscle contractions just like the magnesium but without the side effects. It's less affective, but is good enough and I can go home on it.
It worked and I did not have any contractions during the weaning of magnesium or turning it off at noon.......... until 7pm. At this point they had allowed me to get up and use the restroom and take a shower. The contractions started to show up slowly again and progressively got closer and by 4am friday morning my nurse gave me an extra dose of vistaril which slowed them a little but not a lot and at 6am the OB ordered a fluid bolus and a cervix check.
On Tuesday my cervix was 2cm but had been very posterior and hard to reach (which was good). On Friday morning I was still two cm but no longer posterior at all. The nurse said that his head was very very low and engaged. She said she had to back off a bit because she was afraid she would break my water accidentally. She said she could feel his head squirming around and would be very surprised if they let me go home like that.
Well, surprise, an hour later the on call OB came in and said that since I live 10min from the hospital, that I could go home on the medications but with STRICT bed rest. I can not drive or walk around the house. I can not get on the floor to play with Corynn or go outside etc... I am only allowed to use the bathroom and take one quick shower a day and I have to go back to the hospital if I have more than 6 contractions in an hour. She seemed a little hesitant to send me but I think they were very busy with deliveries and needed the bed to be honest.
So now I'm home and doing my best not to move, taking meds every 6 hours and trying to keep these babies in as long as possible.
So that's the labor side of things.
Now for the health of the babies.
On Wednesday, the perinatologist came into my room to scan for the babies sizes and positions. First they looked at Owen and this is when we realized that he had flipped (which I had suspected about a week ago) and his head was now in my cervix, low and engaged in the birth canal. They said that the chances of him coming back out of that position are low because of how far he was and that his head was likely the cause of all this preterm labor this week. Otherwise he was perfect and healthy and measuring in the 44th percentile at 2lb 8oz which was up 10 oz from his scan two weeks ago!
So then they moved on to Eden who was still in a breech position. The tech seemed more quiet while doing her scan and I noticed while she was looking at her cord blood flow, she was staring at the same thing for quite a while but not saying anything. I got that bad feeling that something was wrong. The tech left and came back with the perinatologist who did the scan again. The peri told me that there was an issue with the blood flow in baby B's cord. I immediately started bawling so hard that I couldn't talk or breathe. I was so worried we were going to have another cord accident and this was the last thing I wanted to hear.
Once I could collect myself to hear exactly what was wrong, the peri told me that her placenta was aging too fast and causing a reduced diastolic flow in her cord. Basically as I understand it, it is normal for the placenta to age at the same rate that the baby ages. As the placenta gets older it becomes tougher which makes blood flow tougher but normally the baby is just as strong as the placenta and can handle the changes. Eden's placenta seems to be about six weeks ahead of her age and is considered a grade 2 placenta with 1 being the best and 4 being the worst. The flow in the cord is measured by what is coming from the placenta to the baby (systolic) and what's coming back from the baby and out to the placenta (diastolic). Since her placenta is older than she is, her heart is having to work extra hard to pump blood back out against this resistant placenta. This is burning her energy quickly and causing slower growth than her brother. She measured in at 2lb 5oz which put her in the 40th percentile. This isn't too different from Owen except for the fact that at our last scan two weeks ago she had been slightly bigger than him and she has only gained 5oz in that time compared to his 10oz. The plan is to scan weekly to evaluate the placenta, the cord flow and her growth. If at any time the diastolic flow becomes absent or reversed or her growth has dropped off, we would deliver the babies early. The peri said the best thing for this is simply bed rest. She said that me relaxing as much as possible and keeping my blood pressure down will make her resistance less and easier for her to pump blood. She actually recommended that I go to a pool daily and rest my upper body on a floatation device while letting my body dangle in the pool to take all pressure off and reduce resistance. But the OB told me not to leave the house, so I need to clarify which of these is more important.
At this point I think I am more concerned about Eden's cord than i am about preterm labor.
Keep praying for healthy and as close to possible full term babies!
They woke me up occasionally throughout monday night. I wouldn't call them painful, just uncomfortable. By Tuesday morning they were still every 4-6 minutes so at 7am I called my OB who told me to go to L&D.
I arrived at about 8:30 and told my nurse that I was pretty sure these were just BH contractions and that it was probably nothing, but thought I'd better check. I really thought I'd be there a couple hours and then go home.
Contractions showed up every 4-6 minutes on the monitor so they gave me vistaril (muscle relaxer) and wanted to just watch me for a couple hours. The nurse checked my cervix and I was dilated to 1cm and she could feel the amniotic sac of baby A (Owen). At first the contractions slowed down with the vistaril and just as they were talking about sending me home, they picked back up to about every 2-5 minutes so the OB wanted to check my cervix again. I was 2cm.
With the cervical change, people started to get worried.
I was told I wouldn't be going home for a few days. They started me on a magnesium drip, did a gbs test, started IV antibiotics and steroid shots to prepare for an early delivery (28 weeks).
The goal was to keep me on magnesium until I could get a full 48 hours of steroids in my system for the babies lungs. For the first 12 hours of magnesium I was not allowed to eat or drink or get out of the bed. Apparently it is a central nervous system depressant and it often makes you lethargic, weak and have flu like symptoms and can decrease your gag reflex and cause choking and aspiration, so they wait to see what your alertness level is going to be before you can eat. I was SO HUNGRY. This is also why you can't get up. Not even to use the bathroom. I became familiar with bedpans and sponge baths for the first time and I have to say I'm not a fan.
The magnesium can also cause fluid retention, particularly in the lungs, so I was fluid restricted as well.
I actually had very minimal side effects compared to most on the magnesium. I got a little hot and flushed and at some points it became difficult to breath and felt like my chest was tight. I was a little sleepy but not totally out of it. I was determined to show the nurses how alert I was so by midnight they finally let me eat!
The mag wasn't as bad as I had thought it would be. The worst part was not being able to get out of bed.
WHile on magnesium, I really had MAYBE one contraction an hour. It worked like a charm! The steroids raised my blood sugar one time to 224, but it didn't last long so I never needed insulin.
On Wednesday they let me get out of the bed to sit in a chair and use a bedside commode instead of the bedpan. It's amazing how excited you can get about something like that! Those hospital beds KILL my back (not to mention peeing in your own bed).
On Wednesday I had a lot of spotting and think I began to lose my mucus plug. That night around 7pm, they decided to try to wean my magnesium from 2g/ hr to 1.5g/hr to slowly get my body adjusted to turning it off by noon on Thursday as planned. The contractions slowly started back up. First it was one every 20 minutes, then 10-15 and by the time they were every 6 minutes around 1am, they turned my magnesium back up to 2g/hr because it was most important that I got the full 48 hour effect of steroids before going into labor. I also got another vistaril at this time to slow things down. This worked and contractions went away.
At 9am on Thursday they turned the magnesium down again to 1g/hr but at the same time started me on an oral calcium channel clocker "procardia" which can be used to prevent muscle contractions just like the magnesium but without the side effects. It's less affective, but is good enough and I can go home on it.
It worked and I did not have any contractions during the weaning of magnesium or turning it off at noon.......... until 7pm. At this point they had allowed me to get up and use the restroom and take a shower. The contractions started to show up slowly again and progressively got closer and by 4am friday morning my nurse gave me an extra dose of vistaril which slowed them a little but not a lot and at 6am the OB ordered a fluid bolus and a cervix check.
On Tuesday my cervix was 2cm but had been very posterior and hard to reach (which was good). On Friday morning I was still two cm but no longer posterior at all. The nurse said that his head was very very low and engaged. She said she had to back off a bit because she was afraid she would break my water accidentally. She said she could feel his head squirming around and would be very surprised if they let me go home like that.
Well, surprise, an hour later the on call OB came in and said that since I live 10min from the hospital, that I could go home on the medications but with STRICT bed rest. I can not drive or walk around the house. I can not get on the floor to play with Corynn or go outside etc... I am only allowed to use the bathroom and take one quick shower a day and I have to go back to the hospital if I have more than 6 contractions in an hour. She seemed a little hesitant to send me but I think they were very busy with deliveries and needed the bed to be honest.
So now I'm home and doing my best not to move, taking meds every 6 hours and trying to keep these babies in as long as possible.
So that's the labor side of things.
Now for the health of the babies.
On Wednesday, the perinatologist came into my room to scan for the babies sizes and positions. First they looked at Owen and this is when we realized that he had flipped (which I had suspected about a week ago) and his head was now in my cervix, low and engaged in the birth canal. They said that the chances of him coming back out of that position are low because of how far he was and that his head was likely the cause of all this preterm labor this week. Otherwise he was perfect and healthy and measuring in the 44th percentile at 2lb 8oz which was up 10 oz from his scan two weeks ago!
So then they moved on to Eden who was still in a breech position. The tech seemed more quiet while doing her scan and I noticed while she was looking at her cord blood flow, she was staring at the same thing for quite a while but not saying anything. I got that bad feeling that something was wrong. The tech left and came back with the perinatologist who did the scan again. The peri told me that there was an issue with the blood flow in baby B's cord. I immediately started bawling so hard that I couldn't talk or breathe. I was so worried we were going to have another cord accident and this was the last thing I wanted to hear.
Once I could collect myself to hear exactly what was wrong, the peri told me that her placenta was aging too fast and causing a reduced diastolic flow in her cord. Basically as I understand it, it is normal for the placenta to age at the same rate that the baby ages. As the placenta gets older it becomes tougher which makes blood flow tougher but normally the baby is just as strong as the placenta and can handle the changes. Eden's placenta seems to be about six weeks ahead of her age and is considered a grade 2 placenta with 1 being the best and 4 being the worst. The flow in the cord is measured by what is coming from the placenta to the baby (systolic) and what's coming back from the baby and out to the placenta (diastolic). Since her placenta is older than she is, her heart is having to work extra hard to pump blood back out against this resistant placenta. This is burning her energy quickly and causing slower growth than her brother. She measured in at 2lb 5oz which put her in the 40th percentile. This isn't too different from Owen except for the fact that at our last scan two weeks ago she had been slightly bigger than him and she has only gained 5oz in that time compared to his 10oz. The plan is to scan weekly to evaluate the placenta, the cord flow and her growth. If at any time the diastolic flow becomes absent or reversed or her growth has dropped off, we would deliver the babies early. The peri said the best thing for this is simply bed rest. She said that me relaxing as much as possible and keeping my blood pressure down will make her resistance less and easier for her to pump blood. She actually recommended that I go to a pool daily and rest my upper body on a floatation device while letting my body dangle in the pool to take all pressure off and reduce resistance. But the OB told me not to leave the house, so I need to clarify which of these is more important.
At this point I think I am more concerned about Eden's cord than i am about preterm labor.
Keep praying for healthy and as close to possible full term babies!
Monday, June 18, 2012
L&D take three
So on Thursday at 26 weeks, I started having some low down cramping that was a mix between menstrual cramps and bladder spasms. With the UTI I had supposedly just had a few weeks earlier, I called my OB office and asked if I could come in to test my urine just to make sure I didn't have a UTI and we could catch it early.
Instead of letting me do this, they decided to send me straight over to L&D because of my short cervix. I guess I understand but I was slightly frustrated because their office was still open and right next door and the hospital is way more expensive. Better safe than sorry I guess.
I had contractions showing up on the monitor every 5 minutes or so but they weren't painful, just my usual crampy tight BH. My cervix was closed thank GOD!
But they didn't like the way the monitor looked for 26 weeks, so they kept me for a few hours. My initial urine dip came up with only trace leukocytes (white blood cells that show infection). My nurse wasn't even gonna send it to the lab because she said trace is pretty much the same as a negative. But then she decided to send it last minute just to cover her bases.
The lab simply has a positive or negative result so of course it was positive.
The on call OB came in and said that although it was positive, she read my last lab report and the UTI they told me I had and gave me abx for ended up being a contaminate so I never even had a UTI at all but no one ever bothered to tell me. No wonder I didn't have any symptoms.
The OB decided to give me fluids, a muscle relaxer and IV abx "just in case" to stop my contractions. What did the trick was the muscle relaxer. As soon as I got a little sleepy, they slowed down quite a bit. She gave me a script for oral abx as well but I'm waiting to fill it until my culture comes back. I have no other UTI symptoms other than an irritable uterus and since the dip was only trace and my last one was a contaminate, I don't want to pump myself full of abx I don't need.
Instead of letting me do this, they decided to send me straight over to L&D because of my short cervix. I guess I understand but I was slightly frustrated because their office was still open and right next door and the hospital is way more expensive. Better safe than sorry I guess.
I had contractions showing up on the monitor every 5 minutes or so but they weren't painful, just my usual crampy tight BH. My cervix was closed thank GOD!
But they didn't like the way the monitor looked for 26 weeks, so they kept me for a few hours. My initial urine dip came up with only trace leukocytes (white blood cells that show infection). My nurse wasn't even gonna send it to the lab because she said trace is pretty much the same as a negative. But then she decided to send it last minute just to cover her bases.
The lab simply has a positive or negative result so of course it was positive.
The on call OB came in and said that although it was positive, she read my last lab report and the UTI they told me I had and gave me abx for ended up being a contaminate so I never even had a UTI at all but no one ever bothered to tell me. No wonder I didn't have any symptoms.
The OB decided to give me fluids, a muscle relaxer and IV abx "just in case" to stop my contractions. What did the trick was the muscle relaxer. As soon as I got a little sleepy, they slowed down quite a bit. She gave me a script for oral abx as well but I'm waiting to fill it until my culture comes back. I have no other UTI symptoms other than an irritable uterus and since the dip was only trace and my last one was a contaminate, I don't want to pump myself full of abx I don't need.
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