PreOp and Neonatologist Visit

As of 12:15 this afternoon, I'm officially on maternity leave!  I spent the afternoon in various medical appointments, which was exciting and exhausting.  I had my last prenatal OB visit first, complete with a nonstress test and then a visit with the doctor who will be delivering Chimi.  As I checked out, the receptionist told me I was the best patient, "You've been on time for all your appointments, and that never happens with physicians."  My parents would be shocked to hear I was never late.

From there I went over to the hospital and had my preop labs done, and completed everything for registration, and got my final pre-op instructions.  I then met with a neonatologist.

I think I've neglected to mention that they've been following something with Chimi on all these ultrasounds I've had, something that's probably nothing, but is enough of a something that neonatology is now involved.

At about 20 weeks, they noticed a few little calcifications in the liver.  This is usually a benign and isolated finding, but sometimes associated with trisomies or congenital CMV.  So I had the Materniti21 test done, which was normal, and had my CMV titers rechecked (I was positive before, but they double checked my IgM to be sure I hadn't had a reinfection, and it was negative.)  They've stayed the same the entire pregnancy, and no other ultrasound findings have popped up to raise suspicion for either CMV or an undetected trisomy.  Then with Finn's history, there's always the concern for a mass, even though both the genetic counselor and Finn's oncologist have both said there's not a genetic link with neuroblastoma, and Finn and Chimi only share 50% DNA, and neuroblastoma would not be expected to show up as a primary tumor in the liver.

But, they still want to be sure that everything is ok. So neonatology saw me today, and talked about what they would do - plans for a full physical exam, a blood count and an abdominal ultrasound. If all those are fine, then there's no other worries.  But worse case scenario - he may need more evaluation such as an MRI, a CT or other interventions.

We also talked about the stuff that all c-section babies may face, mainly respiratory issues, and of course possible issues like low blood sugars because of my gestational diabetes, that might lead to a NICU stay.

After all that, the neonatologist (who had a wonderful dry sense of humor and was just wonderful) suggested that I take a NICU tour to familiarize myself with it, and "to ward off evil spirits" he then looked me straight in the eye and said, "and I really believe that."

So once we were done, I got a tour of the NICU, which is just amazing.  It's ALL private rooms, and each room has a comfy chair, a bed, and a breast pump, so that parents can actually stay with their babies day and night, and they encourage this, no matter how sick the baby is.  It was a lovely, calm place.  And I hope I never set foot in there again.

Both my perinatologist and the neonatologist reassured me that they don't think I should worry too much, but "if there wasn't anything to worry about, we wouldn't be sitting here having this conversation."

I'm scheduled to arrive at the hospital at 5:45am on Friday morning, and will have another nonstress test, and get prepped for surgery, then am expected to be in the OR at 7:15.  The c-section probably won't actually happen until around 8, and then if all goes well, we should be in our room by 10 or 11am.  I'm hoping to be eating a hamburger and a chocolate shake with Reese's cups in it by around 1pm  (yes, food ranks up there as one of my biggest priorities!), and updating my blog at some point in the afternoon  The nurses told me today that the OB group I'm with has a great standing protocol for getting patients up and moving, and for pain management, so most of their patients do great with pain control, better than the other groups' patients.  Which was very reassuring to hear, and has me feeling more confident that this recovery will be better than my last.

I'm so ready for this baby to be born, and really hoping that all his tests are normal.  It would be lovely to have a child with no major health issues.  Amazingly lovely.

Crazily, Wonderfully, Exhaustingly Busy!

Busy seems to be the theme of my life this year, but right now it's a wonderful kind of busy.  It helps, I think, that earlier in the year the busy was unpleasant and stressful - it puts the craziness of right now in perspective.  It's nice, having a lot going on, but feeling full of anticipation and excitement about it, instead of soul-eating anxiety.

So, for the updates.  First - I found out this week that I passed my boards!  Such a huge relief!  I could not get the thought out of my mind that I'd failed and that I'd have to do the studying all over again, but this time with a toddler and an infant.  It's an amazing weight off my shoulder to know that I don't have to worry about boards again for another 10 years.

My house is moving right along - I visited today with my friend LB and her kids, and was amazed at the progress.  The countertops for the bathroom and the upstairs carpet still need to go in, along with a lot of finishing touches, a coat of paint, and cleaning - but it's really starting to look like a real house.  The kids had a wonderful time, running through the house like maniacs, and I started to really visualize where furniture is going to go and what it will be like to move in.  A lot of people commented on how big my house is - and it is, it's double the size of the house I'm in now.  But it's also the smallest model in the entire development, which for some reason had me thinking it's smaller than it really is.  Walking through it I'm reminded again that it is huge.  I'm going to have a lot of empty space for awhile, but after living so cramped the past few years, I think empty space is a good thing.

Move in date is fast approaching - my final walk through is scheduled for Christmas Eve, and closing is scheduled for New Year's Eve!  I have movers booked to pack us up on January 9th, and to move on the 10th.  In the meantime, I'm getting a few boxes here and there packed - next on my list is to box up newborn essentials like nursing pillows, breast pump, and that sort of thing.  The more I can get packed, the cheaper the move will be, but my first choice moving company actually gave me a quote that was less than I'd budgeted for, so I'm not going to stress about it.

I have a list of things I need to do before moving - big purchases to make, projects (like landscaping and having blinds installed) to arrange for - but I've realized that it all doesn't have to be done now, and while it's going to be hard, I think I can get everything done that needs to be done before we move, and the rest will fall into place after that.  At least I hope it does!

I start my twice a week OB appointments tomorrow (I'll have a biophysical profile one day, and a non-stress test the other), which are another side effect of my gestational diabetes.  I was annoyed at first, because I'm going to have to take so much time off from work because of these appointments.  But then I decided to just bring a book and enjoy the rare downtime while I can.

My c-section is scheduled for just under 8 weeks from now - I got the date I really wanted: 2/7/14.  Of course, Chimichanga may decide to come before then, but if all goes as planned, we'll have 4 weeks in the new house before bringing a new baby home.

Reading back over this post, I'm realizing just how profoundly my life is about to change.  It's wonderful.  Terrifying, but wonderful.  My upcoming move date is exactly one year to the date that I got the BFN after my last failed IUI cycle.

What a difference a year makes.

(I feel like I need to add the disclaimer that I'm aware that a LOT could happen to derail these plans, but I've decided to stick my head in the sand and ignore those worries and just enjoy the craziness instead!)

Gestational Diabetes

My trusty Dexcom sensor

You may remember that I started myself on insulin back in July, before I'd even seen my OB, because my morning blood sugars were running high.  My sugars were weird from the very beginning, so I've intermittently been wearing a continuous glucose sensor to make sure I wasn't missing anything, and was lucky enough for the first two trimesters to be able to eat just about anything I wanted to.  But at 24 or so weeks that changed and I became very restricted with my diet. Last week I finally switched my insulin from NPH to the newer, longer acting Levemir - and wow has it made a difference.  I'm constantly wearing my sensor now, and am amazed at how much better my blood sugars look, and so happy that I've been able to add some things (like fruit) back into my diet.

Dealing with this for the past few months has given me such a different perspective on managing my patients with gestational diabetes, both from a diet and medication standpoint, as well as from a personal interaction standpoint.  We've been taught that the best way to manage diet is to follow what's known as the Jovanovic diet, and for many women that does work best. But I have discovered that my sugars do much better with following the similar 3 meals and 3 snacks a day regimen as is prescribed with the diet, but with less carbs at lunch and supper.  I have a better idea of when NPH insulin works, and when Levemir is better.  And I know firsthand what it's like to look a donut in the face and think, "Is this food worth the health of my baby?"

Damn, it's hard to follow this diet!  Intellectually I knew that, but it is so much different to live it.  And I'm lucky enough to really understand the diet and insulin before getting the diagnosis (or should I say, giving myself the diagnosis), so I didn't need lots of training. I have access to things like a continuous sensor (I now can't imagine having insulin requiring diabetes without having a sensor!), and other endocrinologists and diabetes educators to bounce ideas off as I've tried to manage my sugars the past few weeks.  I think it's much easier for me than it is the average patient, and yet it's still frustrating.  I hope that this experience makes it easier for me to help my patients; I know that it has already made it easier for my patients to accept my recommendations once I share with them that I also have GDM, and that I'm also taking insulin.

I haven't eaten Fruity Pebbles in years, and yet that's all I think about when someone asks me what I want to eat.  Fruity Pebbles, PopTarts, Oreos, donuts, Peeps, milkshakes (I had one almost every day of my 3rd trimester with Finn), bagels, pasta and pizza all dominate my daydreams.  I cannot wait to be able to eat whatever I want to once this baby boy is finally born.

But on the bright side - I've eaten so much healthier this pregnancy than I did with Finn. I have a leafy green salad for lunch every day, I'm eating tons of veggies and a reasonable amount of fruit.  And I've actually lost two pounds in the past month.  I'm pretty sure that while I started out this pregnancy 10 pounds heavier than I did my last pregnancy, I'm now just a few pounds over where I was at this point with Finn.  While my stomach has gotten bigger, the rest of me has not, and that has been really lovely.

Is it wrong that one of the main reasons I hope I can exclusively breastfeed again this time is so that I can eat whatever I want and still lose weight?

The Plan

Thank you for all the wonderful, thoughtful and informative responses to my post yesterday.  I woke up this morning about 5am and had a mini-breakdown – and then I read the responses on my blog and was able to get myself back together and go back to sleep for another hour or two.  Anxiety and hormones are a bad combination – I’m so glad I can turn to all of you for support!

When I woke up again, this time to get ready for my OB appointment, I was thrilled to see a little pink spotting on the toilet tissue.  And then I had to laugh – the very thing that would have sent me into a tailspin 30 or so weeks ago made me very happy this morning.  Crazy.

Heidi (who has been so amazing to give up her life for the past two weeks and spend them with me instead of her cozy NYC apartment) and I drove to my appointment, and first went in for the ultrasound.  He passed the biophysical profile with flying colors, but, since he’s running out of room, we couldn’t really get any good pictures.  His cheeks were about all we could get a good view of, and they are HUGE!  So is he – he’s measuring 8lbs14oz!  The measurement could be off by a pound or so either way, of course – let’s hope it’s an overestimate. 

The good news is that there is a least a little action going on with my cervix.  I was dilated to a whopping one centimeter, and while he’s not fully engaged, he’s definitely down more than he was last week, and my OB is pretty confident that he’ll be able to continue to move down (which is something she wasn’t so sure of last week). I did ask her about an elective c-section, but she said based on the state of my cervix, she would recommend we try for a vaginal delivery.  Having her say that is such a huge relief.

She gave me two options – Cervadil to ripen the cervix, which means that I’d get admitted tonight and put on the fetal monitor, or using a foley catheter (the catheter that is usually put in the bladder to drain it) to ripen the cervix and staying at home tonight.  Of course, I chose the foley.  I’d never heard of this before, but basically what they do is insert a foley into the cervix, and then inflate the bulb in the cervix to manually dilate it.  It was actually a LOT less painful that I thought it would be, just some cramping when she got to the end of inflating the bulb.  I’ve now got a lovely rubber catheter hanging out of my hoo-hoo – it’s awesome.

I’ve had quite a few irregular but very painful contractions since she inserted the foley – which has me hopeful that I won’t need the induction in the morning because this will be enough to really get things going.  I had an acupucture session this afternoon that was just lovely and am now sitting on my bouncy ball to further help things along. 

And, while I was writing this, I had a liquid that is definitely not urine come out of my vajayjay.  It’s either the fluid in the bulb, or my water just broke! 

41 Weeks

As Kristina pointed out, Chiquitito has disappeared from my ticker, but he's still hanging out in my uterus!  I think that when even your ticker shows that the baby has been delivered, it's really time for Chiquitito to get with the program and come out already!

I have an OB appointment tomorrow, and we're going to talk induction.  But here's my concern - as of my appointment on Thursday, he wasn't even engaged in the pelvis, which means that the chance of induction failure is high.  I feel like my belly looks lower, and things down there feel different, but I can't say for sure that he's actually engaged at this point.  And if he's not engaged now, at 41 weeks, I really wonder if he's ever going to get there, and I wonder if it's wise to even consider induction when my risk of an emergency c-section is so incredibly high.

So my plan for tomorrow's appointment is to find out what my cervix is doing, and where Chiquitito is in there.  And if he's still not engaged, I'm going to have a serious conversation with my OB about skipping the whole induction thing and going straight to c-section.  I don't want to be induced.  I don't want a c-section.  I *really* want a normal, natural, healthy delivery.  But more than anything, I want a healthy baby in my arms.  And if that means scrapping my dreams of a natural childbirth, then that's what I'll have to do.

In the meantime, we can add the following things to the list of What Doesn't Induce Labor:

• Thai food
• good movies like Zombieland
• cheesy movies like Iron Eagle
• yoga
• spending an hour and a half at the DMV - half of which was spent waiting in line