23 wks, 5 days: The Brethine Pump and Star Trek Crap

So I see my doctor on the Monday morning that is to mark the 23rd week of pregnancy. And he is starting me on the brethine pump. I am a little nervous about this. The brethine I have been taking by mouth has at times had me having such bad palpitations that I have to focus on my breathing, feeling short of breath from the tachycardia. He, on the other hand, doesn't seem nervous at all, but rather excited by the idea. He is sure this is going to solve my problem. Whether or not he is truly happy about it, or whether this is his way of keeping me upbeat remains to be seen. Whatever. I will try anything that has the slimmest chance of giving me a healthy, closer-to-term baby while leaving my life intact.

After a brief visit, I leave the office expecting a call from the home health company that is handling my P17 injections. And it comes about 2 hours later.

They tell me a courier will be bringing the medicine, and the nurse plans to be there by about 3:30 that afternoon. Sure enough, by about 3:00, these boxes start arriving at my home, via a courier who looks like a disgruntled grandpa, angry at having to trudge through the snow to deliver the packages. I am wondering how in blue hell my doctor pulled this off so quickly until I see the garish fluorescent-orange "STAT" labels on each box. A-ha! I know exactly how he did it now, and am picturing his nurse on the phone with the company, making it sound like delivery of this baby is imminent if they don't get the supplies here yesterday!

Shortly thereafter, my nurse is here, looking kind of frazzled too, and I start thinking I may be the rudest person of all: the massive snow we got last week is still accumulated on the front sidewalk, as we use the back door to come and go from the house. In my fight to keep working, I have to get J to do everything, and it is all I can do to get him to do the laundry and keep the three of us in clean undies and socks. The front sidewalk was not at the top of my list. I mentally take note to get him to handle it, while apologizing to the nurse, who is bringing even more boxes into the house. It really does stink not being able to do anything by myself, and having to rely on others, when I am truly used to handling everything.

So we get started. First is the home uterine monitoring. What? The huh???? I had no idea this was even coming, but apparently my doctor wanted it. So she shows me how to strap myself up to a monitor like they use in the hospital to track contractions. And explains that I am to do these recordings for one hour, twice a day. She plugs this huge contraption to the outlet by my kitchen table, extends this antenna, and plugs the monitor box into it. After a series of beeps and flashing lights, it says that data has been sent, and ten minutes later, someone from Columbus, Ohio calls my home to let me know they got it, and it looks great. I am utterly amazed. My amazement turns to the thought, "Wow, I am old!". While pregnant with E and having contractions, the only way to tell the doctor that they were truly contractions was to schlep to the hospital. It was such a pain. Now I can do this from home, and a team of OB nurses will interpret what is going on and call my doctor for me. Fancy Star Trek crap!

Next comes the dreaded brethine pump. I am really nervous now. I guess I had pictured trudging around my house with an IV pole. My doctor had tried to explain it to me, and said it would be more like a fanny pack attached to a little catheter. I remember him laughing when I sarcastically commented on how hot that would look with scrubs. But this is even better than what he explained. It's smaller than a cell phone, and goes in this pouch the size of a large wallet, which can either clip to my waist or fit in a largish pocket. Cool. And the needle is tiny, and not an IV or even intramuscular catheter, but rather a small subcutaneous one. It actually looks like a large thumbtack.

So the nurse is ready to show me how to insert the catheter to start delivery of the medicine, and this is when I start to kind of freak out. My profession has me driving needles into peoples' arteries (which I am quite good at, by the way) without the teensiest bit of squeamishness. But this? This little needle the size of a large thumbtack??? Going into me??? I can't do it. My heart is pounding and my respiratory rate goes through the roof as my hand hovers, frozen in space, above the prepped area of my upper thigh. I cannot do it, until she places her hand on mine and does it for me. And it doesn't hurt, and I feel reallyreallyreally silly. But there it is, attached to this thin blue tubing that snakes its way to the tiny pump. Viola! Continuous brethine infusion, with a bolus every four hours.

I cannot wait to see if it works. I will find out the next night when I return to work.

(Image Credit: Smiths Medical, not mine. )

22 wks 5 days: Put Yourself in My Shoes

So I report for my weekly cervical length,and I am having contractions about every 6 minutes or so. They have my cervix on the screen and know I am not dilated. Yet the ultrasound tech still insists that she tell the doctor, who makes me go to labor and delivery at the hospital. I go, but I don't like it one bit.

Once at labor and delivery, they hook me up to the monitor, and I am indeed contracting. and the nurse I have is one I don't know. By this time, I am frustrated and am scheduled for my big return to work in a mere 5 hours. I want out of there!

I tell the nurse that I don't want to go on the brethine pump, and I know that is what they are going to do next. She starts her "what is best for the baby" spiel. "You want a healthy baby, don't you?", she asks. Grrrrrr! Seriously? I give J a look at this point, and he knows I am about to lose it. Yes! Yes, I want a healthy baby. Yes, I know what I am up against. But I want to have a healthy baby with my job and finances intact, without having E and J fall through the cracks in my life. So I cannot help it: I get downright snippy with her, and look at J and say "Well, I can just refuse it, I guess!" Meaning the brethine pump, not the subcutaneous brethine injection they give at the hospital to stop the labor. What I want is for the nurse to try to understand. My frustration at my situation should in no way reflect on whether or not I want a healthy baby. I should be allowed to vent and cry a little without feeling less than adequate as a mother. I want her to put herself in my shoes: to be proud and independent and tough, to have worked to overcome multiple obstacles in life successfully, only later to be victim to random circumstance. Yes, I want a healthy baby. But I also want to be like all of the pregnant women I have known: working, smiling, glowing, and free of bruises and needle marks and pain that seem to mark my pregnancies.

One of the doctors from my OB practice whom I like is already at the hospital for a delivery, and he makes an appearance at my bedside. The nurse must have told him I had an attitude, because he looks at me and tells me I am contracting, yet again, and asks me if I want the sub q injection. I tell him yes, I want it, that I want the labor to stop, but don't want the pump. He asks me why, and I explain that another doctor in the practice told me I would be on strict bedrest until delivery if they had to go that route. Instead, I like it the way it is: playing it by ear and only being off of work when needed, instead of having to be off all of the time. He tells me he is going to call her and see what the thought process was behind that statement, and disappears, dialing her on his iPhone as he walks away.

Minutes later, he is back and tells me he wants me in the office on Monday, and that they are going to put me on the pump then. I can continue the way things are now with work, and I am allowed to leave, but no work tonight.

22 wks: Is This About A Horse???

This is funny now. It wasn't then.

There is something that has become commonplace since I had E. Progesterone injections to prevent preterm labor. And my doctor wants me to have them. I say whatever works! But I know nothing about these. I google some, and hear they are all the rage. I call the contact number to get the ball rolling. I call my insurance, and some dumb rep tells me they aren't covered. Then the OB nurse tells me they are. I am beyond frustrated. I do some reading to discover they may be contraindicated in asthma. I call the pharmacy to ask, and am reassured.

Finally the OB nurse calls and gives me a number to call. These people are supposed to get me set up. The meds will come to my house, and I will get the injection at my doctor's appointments weekly. Okay. I call. I'm supposed to ask for Bob. No last name, no extension number. Just. Bob.

The first thing I hear when I call is a recording asking me if I am a veterinarian. Ummmmm. No. But before I can hang up, a female comes on the line. I tell her my name, that I was told to ask for Bob, that I am pregnant and trying to set up progesterone injections.

"Is this about a horse?", she asks. No. It's not. I'm human, and so is my baby. "Oh ok", she says. Bob gets on the line before my mind can stop reeling. And before he says hello or anything, he tells me he needs my credit card info. What? Just a second ago, someone asked me if I was a horse!

"Wait a minute! I have insurance!" I tell Bob.
"We don't DO insurance here", he tells me, rather rudely. He says he needs my debit card info so he can ship the supplies and meds to me.

"Okay, whatever, how much is it?", I ask.

" One thousand, five hundred and sixty-two dollars."

I tell Bob I will call him back and hang up. I am not about to give someone Cart blanche with my bank account when just a second earlier, I was being questioned about my species. And I call the OB nurse from my insurance company.

Somehow they pulled it off for me, and they arranged it so a home health nurse will come to the house to give me my shot once a week to the tune of $135 weekly. Okay. But I at least I know it is medication designed for a human.

J comes home from class to find me sitting in the floor, crying hysterically. Of course he asks what is wrong, and I tell him the story. My new nickname, as a result, is Seabiscuit.

21 wks, 3 days: Labor and Delivery is a Cruel Place

21 weeks, 3 days pregnant. The contractions start at 5 AM. I don't wake J. I take my brethine. I wait a couple of hours and take more, even though I probably shouldn't. I am supposed to go back to work today. Please, God, make them stop!

After 3 hours, I call the doctor. Take a hot bath, he recommends. I do. The water turns cold, and I shiver as I empty the tub and let it fill again with hot water. It turns cold again, and I empty it to fill it again. No more hot water. I wait for the water heater to do its job, and fill it yet again. Please, just stop. The contractions don't, but now I am having palpitations from all of the brethine. They do go from every five minutes to every seven minutes, to every ten minutes. I dry off and curl up in a warm bed, and sleep.

I wake up. It is 11 AM. I am still having contractions. Every seven minutes again. More brethine, and now my heartrate is in the 130's. I call the doctor's office, just to hear them tell me what I already know: go to labor and delivery. I do.

No they don't hurt. They don't physically hurt. The contractions are uncomfortable, andI know they are there. But my heart hurts. I was foolishly holding onto the idea that this time would be different, that the episode at 20 weeks would be the last. The doctor comes in, and we devise a plan. Meds. More brethine, this time intramuscular injections. An ultrasound to check baby. A cervical length. What's that? I didn't have that with E. Must be new. Turns out they jam this rod that looks like a torture device into places you don't want anything jammed when you are contracting. But the cervix looks good.

I get 3 doses of brethine before all is said and done. The doctor is threatening to send me to Good Sam, the OB mecca I stayed in for a month when pregnant with E. Not that place. I don't want to go. J calls my boss while I cry. And listen to the sounds of an OB unit of a hospital, which is where the title of this post comes into play.

I listen. I listen to the woman in the bed next to me as she is sent to her room to deliver her healthy full-term baby. I watch smiling loved ones as they stroll down the hall, clutching pink and baby blue teddy bears, holding aloft the "It's a BOY!" or "It's A GIRL!" balloons. I am wheeled to a hallway where I am to wait for my ultrasound, wearing a thin, flimsy hospital gown. Pregnant women come and go for outpatient stress tests and ultrasounds. They glow as they stroke their bellies. And me? I'm just tying to hold on. And I sit in my gown, in a wheelchair. Contractions five minutes apart. A woman in the room across the hall asks if I am okay. No, I tell her. I work here. This is my place of business, and I am only 21 weeks. I am heartbroken,embarrassed, ashamed. She puts me in a bed, puts me on a monitor and alarm paralyzes her face as she sees the waves of contractions on the monitor. She calls my nurse, who brings more brethine.

Somewhere in all of this, the contractions stop. I ask about work, and my doctor asks me if I'm crazy. I feel weak and can barely hold the pen as I sign the discharge papers. We leave, and by now J has picked up E from school. E is upset with me because there is a book fair at school. He wants to go, but there is no way to explain why mommy can't. He doesn't understand, and I don't want to force the issue for fear of raising resentment toward the new brother who has already rocked his little world. I have failed him, too.

20 wks: What You Aren't Supposed to Say

The contractions started while I was at work. I felt them. I knew they were there,but I didn't want to be a burden to coworkers. I remember feeling fear. Fear for my unborn baby. Fear that this, combined with my history with E's pregnancy, would end my ability to work. Which spawned fear for the financial well-being of my little family. Fear.

But we, as pregnant women, are not supposed to think of anything but the baby. After coworkers convinced me to go to L&D to get checked, all I could think is "this is it: there goes my life right before my eyes". All of the overtime worked to keep on top of bills. All of the hours of study-time logged to get me closer to my goal. My job. My house. My car. My ability to provide for E. All of it. Whoosh! There it goes.

They stopped the contractions and I was able to go home after a few hours. Home to bedrest until I could see my OB in the office. But something happened to me that night. I left the hospital feeling less adequate and faulty. What was wrong with me? I was supposed to be the selfless mother, concerned only with her baby. Who thinks of work, school, or others at a time like that? The answer is ME. I do.

Because what they DON'T tell you while you are laying there, strapped to monitors that are recording your body's dysfunction is that you are only human. And that while I have an obligation to be selfless for this baby that still needs to grow, I also have obligations to others in my life. E is young, and he needs me. J needs me. My coworkers rely on me to be there when scheduled. And my family relies on me to work to provide, to get my education to provide more in the future.

But I'm not supposed to say that. There is no "self" and there is noone else when you are pregnant. The world is supposed to stop. For the baby.

Hmmmm, I Should Start at the Beginning

I guess our fight to become parents began with E. eight years ago. E was the little boy we were sure was to be our daughter, and we found out we were expecting him almost one month to the day after we were married. I remember J's excitement, after having told me he, like I, wanted a girl, and then we saw the telltale image on the ultrasound screen to show us it was not our daughter after all, but rather a son. "That's my BOY!", he exclaimed!

I will never forget the feeling of the tightening in my belly at eighteen weeks of pregnancy. It seemed so benign. But after a few minutes, it happened again, and I realized that I was having contractions. We reported to the hospital to be told what I already knew. But instead of saying I was in preterm labor, they said I was having a late miscarriage. No. No no no no no. Miscarriage is something that happens at the stage of pregnancy when everything is still so abstract. Not to ever belittle the loss of a baby, but this was OUR baby. Our son. Our E. Of course we cried.

The doctor agreed, since we were a young married couple, to try to stop the labor. Looking back now, I realize how arrogant this truly was. Who were they to "decide" which babies are worthy of saving? But they gave me a shot, and the contractions stopped. But the battle was far from over. I went into labor on average of once a week from that point on. That is, until it got to the point where I just didn't stop contracting. I spent a month in a local hospital, what was known as the mecca of obstetrical care in this region of the country. I toured their NICU, in preparation for what we would be facing. I was on every drug known to man: Brethine, Procardia, Sulindec, magnesium sulfate. I got the steroids, a course in each trimester, to be exact. I was on bedrest and couldn't work. My husband, having just started a new job, lost his from having to be absent so many times thinking "this is it, we're having a baby". We ended up living in my in-laws' basement from financial ruin.

But E held on. To know him now would explain it all: a spirited, gifted, spunky little boy who can have you enamored with him within five minutes of meeting him. He was born at 34 weeks gestation and came out screaming. I cried when he cried, from lungs that were to be underdeveloped. That is what we had prepared for, after all: the idea of immature lungs had been hammered into our head from 20 weeks of gestation. But he made it, and was a picture of health. He's now eight years old.

When E was a baby, if you asked me if he would be an only child, I would've told you no. While we were not eager to repeat the experience of his pregnancy, to test fate, we loved being parents. We had been so lucky, and our family had emerged, other than a few minor bruises, largely unscathed. Our boy was healthy and proving to be quite smart. And one day we would give him a brother or sister, but "not right now". After a few years of recovery, I didn't even think of birth control. If it happened, it happened. It never did.

I was always kind of sad about that, though I would never admit it. I didn't want to attempt fertility drugs because I didn't want to chance multiples. Not after having survived E's pregnancy. I would stifle my jealousy as others around me became pregnant. I knew I SHOULDN'T want another. We couldn't afford it. I couldn't risk it. And I had things I wanted to do with my life. I went back to school to become a health care professional, and began to earn a far-better salary. Then I turned to the idea of fulfilling a lifelong dream: I went back to school to work on the requirements for medical school.

As E got older and older, people started to ask when we would have another. "NEVER!" would be my cry. My life was crazy. A full-time healthcare provider, a full-time pre-med student, a wife, a mother. J had started nursing school so that he would be done in time for me to start medical school, so I could then slack off at work. We had plans. And they were coming to fruition. No. No more babies. Instead, we had given up the idea and filled our life together with other things.

But God had other plans for us. And after just "not feeling right", and years of no birth control, I discovered myself to be pregnant. Everyone around me judged me for thinking this, but I honestly thought it was a cruel joke. As in: " Now? Really, God? Are you serious?" And I was upset. All of the struggles we fought to bring E into this world came back to me. What if they happened again this time? How would we handle it? J was unemployed and a full-time student. E was thriving. And me? I was the sole breadwinner for the family. What if I couldn't work? What if it was worse this time? What if I just couldn't hang on again?

Gradually, I got used to the idea by telling myself this was finally my daughter. I was later devastated to discover it was to be another son. After all, this really is to be the LAST ONE. I am an obstetrical nightmare, and the odds of a complicated pregnancy increase with age. I am now 33 years old. I had to tell myself that this is it. I will never have a daughter.

But then something happened. I got over the shock. I got over the disappointment of a boy. I began to realize that this, just like E, is to be our baby. And we love him. I never thought I could love like I love E, but I do. I picked out clothes and furniture and bedding. We picked out a name. Zachary, because it means "God remembered", and Clifton, after J's grandfather, who passed away this past year.

I took comfort in the idea that every pregnancy is different and watched as the weeks ticked by on the calendar, each week thinking "so far, so good". I was waiting for the other shoe to drop. Finally it did, and I went into preterm labor on January 29 at 2o weeks gestation.

So now, here we are. Fighting for Zachary. And I am starting this blog to document the struggle. It is not foreign territory to us, but I find myself wishing I would have documented something with E's pregnancy. Now is my chance.

(Image: E at 4 years old, on the front porch, and those chocolate-brown eyes that reel me in.)

From the Beginning Again: Looking Back

I should explain that while this is dated as the first post of this blog, it is not. I am currently 6 months beyond my pregnancy. Zachary is six months old.

I started this blog for several reasons. I endured a pregnancy much like my pregnancy with Zach with my oldest son, Evan. As the years passed, some memories of the ordeal seemed to stay almost palpable, while others softened and blurred around the edges. I remember wishing I would have kept a journal so that when I tell Evan he is a miracle, he will have tangible evidence as to why this is true.

I began my pregnancy with Zachary as being ignorantly hopeful that I would not have to endure the same experiences.The first trimester made this even more believable. Somewhere nearing the midpoint, as with Evan, I began to experience a sort of deja vu, and the battle with a dysfunctional uterus began. The names and faces, the times, and the treatments available changed with the passing of eight years. The experiences remained largely the same, all the way down to the boys' birth weights, which were only a few ounces off. So with this in mind, the blog became less about documenting the story of his birth for Zachary and more of a catharsis for me.

I was in my final year before entering medical school, a dream I have had since childhood and was finally making a reality for myself. I was a borderline workaholic. I was a complete control freak, type A, know-it all sort of person. And despite the fact that I had at one point wanted another child, after eight years without conceiving a little brother for Evan, my husband and I had given up. Suddenly, I was thrust from my life with a pregnancy that was unplanned and actually quite a shock to us.

I cannot put into words the place from which this was all written. It was my entertainment and my outlet for 4 months of bedrest. Four months of lost control, pain from both contactions and treatment for those contractions, fear for Zachary's well-being, and a deep sorrow for the life I had to give up. Add to that the financial burden of our family's sole breadwinner being grounded, the medical bills, and the guilt that was provoked from feeling anything but pure joy at the thought of my pregnancy, and you have a very deep, dark place. In fact, there was one particular phase where the only factor keeping me from suicide was Zachary's right to his life.

I try, many times over, to revisit this blog. To look back. I never can seem to do it. I would much rather spend my time moving forward with a little boy who is the greatest joy in my life. I don't miss the idea of medical school because it would diminish time with my baby. Where I surrounded myself with my job before the pregnancy, now it is simply something I have to do and that takes me away from Zach, which I deeply resent. Zach's presence in my life has had that much of an impact for me. When I first became pregnant, I remembered thinking God had horrible timing to wait for a point in my life where I had gotten past having babies. Now I know his timing was perfect.I needed to slow down in order to love and appreciate life with my amazing husband and my two miracles.

I am in the process of editing the blog. I had, on average, anywhere from 20 to 40 contractions an hour for the duration and, toward the end, did so with tachycardia, dyspnea, and a narcotic-induced fog. The fact that I was able to type all of this is still somewhat miraculous to me, but I did. And as a result, it is wrought with typographical errors and in need of some general corrections. Other than that, I plan to leave it largely untouched. Raw. Rough. To smooth anything over would defeat the whole purpose of me recording any of it.

The reason for the editing? I am having it made into a book for Zachary and myself. As if to say, "Look, kid! We made it through!" With that being said, I should say something to my angel of a baby boy:
Zachary, I love you more than words. There is no part of this that I would not do again just to have one tiny glimpse of you in my life. You are that worth it to me. Never doubt how loved and wanted you are.
And to my team of doctors, who have remained largely anonymous through this: I did this out of professional courtesy. but please know that each time I look into the gorgeous blue eyes of my perfectly healthy baby, I am reminded of you all. I hear your voices of reason. I see the art with which you knew what I wanted for my unborn child, even when my voice was saying something altogether. Of course I didn't want a grossly premature baby, even though I was begging you to end my misery. And I hear your voices, in the middle of the night, once again awakened by nurses who were staring at a recording of my contractions in panic. Ever calm, ever reassuring, ever reasonable, ever patient. Even when you had to be groaning on the inside at the mere mention of my name, I never felt this from any of you. Even when I was trying to refuse trips to the hospital or more drugs for the contractions. You guided me though some of the roughest waters of my life, thanklessly, and I will be eternally grateful. That your hands were the first to touch Zachary seems appropriate since his presence here is as much your work as it was mine.

So this is it. Zachary's story. My story. Zachary's journey into the world, and my fight to get him here. I am so glad I won.