Wednesday, January 21, 2015

Week 35: Right now, right now? Maybe later, later?

Well, my 35 week check up was yesterday morning and I can’t even begin to understand where my head is today as things are just all jumbled.  Going into the appointment, I was anticipating all sorts of doom and gloom due to my weight gain this past week, a four-day headache that acetaminophen just wouldn’t shake and the knowledge that we’d be repeating fetal measurements (in other words, just how huge are we talking? And is vaginal delivery even still an option?);  but having hopped in the car almost two hours early to learn that the inner-loop of the Capital Beltway was closed due to a turned over vehicle blocking both the two Hot Lanes as well as all four of the regular lanes, I began to think my pessimistic expectations of the morning’s happenings were a bit too cheery for what was actually in store…  

Taking just shy of those two hours to get to the hospital due to knock-on accidents and residual area-wise back ups, I arrived just on time to go straight from the ATC reception into the ultrasound room for my exam.   Running a biophysical profile, checking my amniotic fluid index levels and measuring Baby’s overall growth, Tamara - the wonderful sonographer I’ve worked with through both of my pregnancies with this doctor’s office - was comforting, yet frank about where things currently stand: 
Biophysical Profile: 8/8
Amniotic Fluid Index: 29.6 
Estimated baby weight:  7 lbs 3 oz (85% percentile)
Abdominal Circumference:  34.2 cm (+18 days)
Head Circumference: 34.1 cm (+19 days)

Showing me the 3D pictures of his (practically identical to GW and GV) face, Tamara and I couldn’t help but notice the chubby cherub cheeks that Baby’s acquired in the last few weeks.  Suggesting that I cut even more carbs than I already have (okay, I’ve been cheating on my protein only diet some, but not terribly excessively… I’m dreading the idea of three more weeks of omelets…) to ensure that Baby doesn’t continue to put on excessive weight and break through that magical 9 lb 4 oz threshold that would ensure a doctor mandated delivery by cesarian, she encouragingly said that things were by and large looking good before sending me down to another nurse, Kaye, for my weekly NST. 

Delivering me to my reclining blue chair with waiting goo, padded belly straps and monitor, Tamara provided a report summary of the ultrasound which I promptly scrutinized for the twenty minutes Baby's heart accelerations and movement were monitored.  Passing this go around with no-prompting (thank you!) I was relieved to hear that, in spite of his large size, the NST and ultrasound were exactly what the doctor would be glad to see.  Setting my pessimism aside, but not out of reach, my meeting with the perinatologist was all that remained of the morning's flaming hoop session. 

Surprised not to be seeing Doctor Bronsky as he's typically the go-to in office practitioner at the ATC on Tusesdays (apparently Doctor Nies, along with everyone else in NOVA, is down with the flu so he was off covering for her on the L&D floor), Doctor Khoury called me back to his office in a flourish of compliments: "look at that belly!" -- "you look wonderful!" -- "it's so great to see you, dear!" Having dreaded my next appointment with him since my early November given the zero tolerance, minimal wiggle room estimation he made of me, my weight and my macrocosmic baby I acknowledged his praise with a half-hearted "thank you" and began throwing up as many emotional barriers as possible to handle whatever read he'd make of my test results.  

Stating that he didn't feel like a c-section is required at this point, he began by stating that the issue with diabetics with large babies - regardless of previously successful delivery histories - is that even if the baby doesn't measure above the weight threshold requiring surgical assistance for delivery, there is a significant risk for shoulder dysplasia that we'll need to  address mindfully.  Moving on to look at my AFI numbers and wishing to alieviate his concern with the possibility of preterm labor, he called down to the nurse practitioner, Laura, to have her check for effacement and dilation before sending me on my way for the week.   Running the Group B Strep test while at it, Laura made the ambiguous comment "oh yeah, you're super soft" before returning to her other patients.  Knowing that this generally meant things were heading in the correct direction for delivery, I gathered my things and began to walk out to reception with the intent of asking "anything else?" when Doctor Khoury practically tackled me in the hallway preventing my hasty exit. 

"Sit, please!"   (Uh oh...)

"You're moving quite a long - 80% effaced, 1 CM dilated and baby is at -2 station - so really he could come at any time.  I want to see you sooner than seven days, come in next Monday for your next appointment and we'll check you again.  In the mean time, if things progress at all - even if you aren't sure - get to the hospital immediately... subsequent babies tend to come quickly, but with the higher risk his size presents for delivery, we really can't afford to have you have this baby in the car.  Okay, dear?" 

Knowing that the numbers he rattled off are definitely a sign delivery is coming (but not necessarily imminently - darn AFI levels making "any minute" something that could last from right now-right now through induction in February), all I could do was nod my head and attempt to process the morning's events.  So I am looking at a large baby.  I am looking at a large baby that may or may not be premature.  I am looking at a large baby that may or may not be premature and is potentially going to be ill effected by my diabetes (sugar level or lung development wise). I remember with GV we did the amniocentesis at week 37 to determine if she could be delivered that week or would require more time for lung maturity, so being mid-week 35 with a large baby that may or may not be premature and is potentially ill effected by my diabetes has me freaked by "what-ifs" of his sooner rather than later arrival.   I mean even with waiting for 38 weeks to induce her, GV still wound up in the grow-box for a few days due to her jaundice and she suffered from post-birth hypoglycemia even though my sugars were tighter than the jeans on any one of those Hollywood film stars (at least they're wearing jeans, right?).  

Feeling excited, anxious, nervous, terrified and completely unsure of what is to come, I am flat out overwhelmed by yesterday's appointment.  On one hand, GW was a 36 week 5 day baby and he was just fine with a mild case of home-treatable jaundice... but he was born well over a year before I became a diabetic.  On the other hand, GV was born over a year and a half after I went on the insulin pump and, despite all of the terrible placentra-related complications of that pregnancy, was considered a perfectly healthy, completely normal newborn within four or five days following delivery - no NICU or micro-management required by the pediatricians.  So, optimistically speaking, things could go well even if Baby decided to come early...  would things be better if he arrived following induction the week of February 9th?  Yeah!  He'd get more lung development time, he wouldn't run the risk of being delivered on the side of I-95 in a traffic jam and I'd have another few weeks to button up the house into the home it's supposed to be.   Of course, he'll likely be so huge by then that that adds more cons to the mix, but hey, there is no one perfect way to have a baby and only God knows what's actually in store. 

On that note, I'll end my weekly blathering and hope that the next update I have for you is a clear-headed one.  Fingers crossed. 

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