The Amnio And the End

I went for my amnio, and which perinatologist should walk in the room but Dr. Big Shot. Dr. Big Shot is the head of obstetrics and maternal-fetal medicine at OB Mecca. He is also the doctor who took care of me when I was pregnant with E. Talk about a blast from the past. They did the amnio, and I didn't look. I had my requisite monitoring afterwards and waited the 2 hours for the result. Hospital employees can take their badge and get the results. So I tried to, but they wouldn't let me. They said we could only do that after 48 hours. But the ultrasound tech had told me that they would do the entire test in-house unless the lungs were immature, and then they would send those to OB Mecca for further analysis and testing to determine how immature. So I didn't have my results, but I did know that the test was completed, which meant lungs were mature.

I called my doctor when I got home to make sure, just in case, so I could give J's mom the go-ahead to start her trip here tomorrow. The high risk nurse told me what I wanted to hear, and when I asked for a ballpark time for Friday, she couldn't tell me. As it turns out, they never put me on the schedule officially for Friday, and have since booked up. She told me to be ready and just not eat anything after midnight tonight, but she would try to get me an answer tonight. About 30 minutes later, she called to tell me to be at the hospital at 10:30 tomorrow morning for delivery.

I cannot quit crying for some reason. It is all over: the pain, the misery, the anticipation, the worry, the paralyzing fear. I cannot believe I have survived this. I cannot believe it has gone on this long, that I have carried him to almost full-term. That this is my last night of pregnancy...ever.

I will hold my baby boy tomorrow and it will all be okay. I will never forget this. The time in my life where the bottom almost dropped out. The time in my life where career, education, and everything else I held dear was put on hold while I prayed and suffered and worried for someone I have yet to meet. One day Zachary may read what I have written about this pregnancy, and I hope that instead of seeing the negative this has brought to my life, he will see just how much I love him. I did it all for him. My precious gift of a child I never even knew I wanted or needed until he was here. A child I have given my life over to, even though I may have griped and complained through it.

I may post something in the wee hours of the morning like usual. I doubt I will sleep much tonight. But regardless, I will be absent for a few days. I will return with the story of his birth and, I am sure, some pictures. With that, this journey will end and a new one will begin as I go on with my life with my beautiful and amazing miracles.

34 Wks, 4 Days: A Little More Freedom

One More Week. (Is this getting annoying or what?)

Yesterday I did my monitoring as required. It really is futile, as they do nothing about the contractions anymore. The nurse called back and told me that the strip looked like any other of mine, and actually told me to stop monitoring. I don't know how many contractions I had, but it must have been bad. How can I not know? Well, I don't count anymore, and it has gotten to the point where my uterus is in a state of relaxation less than it is a state of contracting. One after the other after the other. The scariest ones for me are the ones that seem to build on top of each other: I'll be having a contraction, and before anything has had a chance to relax, another one starts and builds on top of the last one. Here lately, Zachary hs started flailing his little appendages in there with the contractions, which hurts like hell. I think he is getting tired of being squeezed. Sometimes, just having the monitor on my belly is enough to set him off, as if to say, "Hey! Something is pressing on me!"

So anyhow, I am now free from the monitor. Unless something feels different, then I can do it as needed. So the 17P shots are done and the monitoring is done. Now I just have to lose the brethine pump. I think that is happening Thursday when I go in to get my amnio results and pre-op instructions. Since a c-section bypasses nature and the uterus doesn't contract down to size on its own like in a vaginal delivery, they give you pitocin afterwards. I cannot imagine they would want me on a tocolytic before they do the deed. Which means Thursday night, if they do stop the pump, is going to be awful for me. I doubt the contractions can get any more frequent, but they can get stronger without the brethine infusion my body has been getting all along. Ugh!

Which leads me to the dreading of the pitocin. That was by far the worst part of E's delivery. I cannot even remember how long it was that they kept me on it, but that was very painful. Imagine contracting against a fresh wound, when your muscle is completely worn out from all of the contracting done beforehand. I didn't rely on pain meds a lot after having E, but I do remember that I spent those hours in a narcotic-induced fog.

But regardless, today starts my official last week of pregnancy. It's very surreal knowing when it will all end. It has its advantages and disadvantages. I can be completely ready, with bags packed, nursery ready, and more. But I also have time beforehand to think about what is going to happen, to dread the bad parts. And while having a plan made me feel better at first, now it is having the opposite effect. When the pain gets to be too much, I can't help but think that it is just a week away, and wish for them to just do it already. And it is frustrating not knowing a time, but they won't give me one yet. They are worried that the amnio on Wednesday will do me in. I have a high level of fluid, a big baby, and a worn-out uterus that is distended beyond where it should be. Inserting a needle in there at this point could have the same effect as putting one in a balloon overly-filled with water. If that is the case, I will be having him Wednesday. Or Thursday. Thus, no official time planned. Just a date.

My Nightmare

Yesterday morning, I was awakened at 3 AM by a nightmare I had. I've been thinking about it ever since. Aren't dreams supposed to you subconscious in action? I'm wondering what this says about me.

In the dream, I was at the hospital, in the OR, having Zachary. The surgical drape was in place, and I had been given my anesthetic. My lower body was numb, so I couldn't move. My doctor was starting the c-section when he got a call to a laboring woman in another area of L&D. And he left, telling me he would be back in a few minutes. The entire OR team followed him, leaving me alone, strapped to the table and unable to move. Whether from panic or anesthetic, I had an asthma attack. I thought I was going to die. I screamed for help and nobody came to my rescue. I didn't have an inhaler. Then I thought: epinephrine. We used to give epinephrine as an asthma drug, before they came up with safer options. And I knew that epinephrine is kept in the top drawer of our crash carts. There was a crash cart next to the anesthesiologist's area, right by my head, so I broke the little plastic lock on the cart and self-administered the epi. While I waited for it to work, I grabbed the Ambu bag from the anesthesiologist's cart. I knew it would be attached to oxygen and going, in preparation for it's emergent need. We always do that so it is ready should a patient crash on us. I held the mask loosely to my face, inhaling the oxygen, and praying someone would show up to help me.

I was there for what seemed like hours. The spinal wore off, and I could move my legs. I freed myself from the table, and felt around on my belly to see how far the doctor was into the surgery before he abandoned me. My belly was flayed open, and I had surgical retractors protruding from my abdomen. He got that far. My uterus was cut too, and you could see Zachary in the transparent balloon of amniotic fluid. I wailed as I tried to decide whether to leave him be or take him out. I knew I was trained in neonatal resuscitation, but did I know enough to save my own son? I am trusted with the loved ones of others, but do I trust myself with my own?

Finally, one of the night shift OB nurses showed up in the OR. I don't know why it was her. I'm not even that close with her. We are just acquaintances at work. But she told me there had been drama in L&D, that everyone was gone except for her, that they all got fired. I asked about my doctor, and she said he was gone, too. She told me one of his partners was on his way to finish me up. I asked her if anyone was on standby for the baby: "Is Children's on the way?" (When we have a baby that needs help beyond our abilities at my hospital, we call in a transport team from Children's Hospital. If we know before the delivery that there will be problems, we call so they are there and ready.)

She said yes, that I was only 31 weeks, so they are coming. And then I woke up.

I never have dreams that I can recall with such detail. Never.

So what does it mean???? First of all, my doctors are consummate professionals and would never do anything like this. To anyone. But is it because I am afraid of them not considering me? That just because I cannot dilate, they consider me to be second-class, coming behind women who do? And the details of work? J says I just need to go back, that I miss it even more than I realize. I think he's right.

26 Wks, 1 Day: Perfect?

On Monday, I had my 26-week appointment. Other than losing 12 pounds last month, the pregnancy got a perfect bill of health: perfect blood pressure, perfect 3-hour glucose tolereance test results, perfect little heartbeat, perfect height of fundus. Perfect, other than the contractions and preterm labor that plague me.

By some pregnancy books, have started the last trimester and by others, it will not start until 2 weeks from now, at the 28-week mark. But either way, wow!!! At times, it seems like this pregnancy has lasted forever. At other times, it seems like the time has flown. And other than being on bedrest and having the preterm labor issues, I feel great. My body has adapted to the brethine pump, so I no longer feel the insane tachycardia and jitteriness that goes with it, even after they increased my dosages this past weekend. I'm not nauseated, don't have crazy heartburn, am not as sore as I was in the first trimester. Other than some pain in my left hip, which is sure to be nothing more than pregnancy-induced sciatica, and Zachary's wonderful kicks and punches, I wouldn't even tell you I feel pregnant. I do feel fat, but I have this great baby belly. With E, I just looked horribly obese, to the point that people couldn't even tell I was pregnant. But this time? Ummmm......not the case.

I am starting to get a little apprehensive about the delivery. My doctors tell me they are going to stop everything at 34 weeks, which is when I had E. I am having a repeat c-section and am not even given the option of a VBAC, but they won't even schedule it. One of the joys of having a scheduled c-section is that you know, without a doubt, when your child will be born. You literally get to pick their birthday. But they know that as soon as the brethine pump and progesterone shots are stopped, I am going to go into labor on my own, making any attempt at planning null and void. And I know that, after the prenatal care I have had, the close watch they have kept on Zachary, the steroids, and more, that they will deliver him then. But do I want them to?

This brings up a question of how truly lucky were we with E? I have learned in my line of work that a 34-week preemie can be perfectly healthy or they can have problems. It can go either way. E was perfect: over 6 pounds, which is big for a 34-weeker, but still small. I'm not sure, but even if he would have been full-term, he may not have even been considered low-birth-weight at that weight. He may have tottered on the edge of that line, but I don't think he crossed it. I remember him as baby: he was pefect. Petite features, pefectly proportioned. He was a little on the long side for his gestational age, making him even skinnier as his 6 pounds was distributed over more body length. And I didn't see him immediately after delivery, but I know he didn't even need suctioning, which is so commonly needed for c-section babies, as the trip through the birth canal doesn't occur to squeeze the fluid from the little airway. My mother-in-law was there, taking pictures of him, and I remember her telling me that he cried and screamed when someone would pick him up, but as soon as they laid him in warmer, he would be quiet and still and just look around, as if to say "leave me alone, people, and let me check out my new world". When I was finally taken to the recovery room, and got to hold him, he was perfectly quiet and still, laying there wrapped in his little bundle, on my chest. The only negative thought I could have about his birth is that he couldn't latch on, making our attempt at nursing in recovery awkward and leading to bottle feeding instead of breastfeeding as I had intended. That had as much to do with me as it did with him. Neither of us were in it at the time.

So back to Zachary: If I let them deliver him at 34 weeks from horrific contactions that aren't producing cervical changes, am I taking too big a risk? Because delivery at that stage would be for me, not him. And doctors can tell me what they think the odds are, but even if I were to deliver at a perfect 40-week mark, no one can guaruntee a healthy baby. In this cruel world, babies that seem perfectly healthy in utero can emerge with anomalies no one could have predicted. I am saying all of this now, but at 26 weeks, I can already tell that the contractions are getting more frequent, are harder to make go away, and are more and more painful with each passing week. How bad will they be at 34 weeks? How much will I be able to take? Is the gamble too great a risk?