Week 34: Not so much.

I am completely drained.  Yes, I have been staying up until well after midnight every night for the past few weeks.  Yes, I have been getting up early and fight the good fight to have two fully dressed children at the breakfast table by no later than 7:20 each morning.  Yes, I am eight and a half months pregnant and being tired is just a way of life.  But, no, these reasons have nothing whatsoever to do with the bottom of the barrel, running on empty, complete exhaustion that my day today introduced.

For the second week in a row, HB couldn't make it to my perinatal appointment at the hospital due to his looming work deadline.  Having overcome the oddity of this mommy-only situation last week, I pouted momentarily this morning when looking at the traffic reports before leaving just early enough to arrive twenty minutes prior to my "we don't actually have appointments available, but we'll schedule you for 8:45 and least know you'll be seen" time.   Skipping the waiting room in favor of the conveniently located bathroom at the nurses station, the nurse I bumped into on my way out decided to have me start my non-stress test immediately since I was already back in the exam room and it didn't matter scheduling wise where I was fit in so long as my NST occurred.  Reassured by my old-hand-at-this attitude toward the procedure, she quickly took my weight (down 1 lb from last week) and my blood pressure (118/79) before hooking my belly up to the various monitors and letting Baby, my book and me be for the twenty minutes of monitoring.

About 15 minutes later, she came in with a concerned look upon her face.  Looking at Baby's heart rate on the chart, she asked me to roll to my left side and down a large cup of ice chips to encourage him to show proper heart accelerations.   As I have previously explained with GV's pregnancy, a non-stress test is a way for a MFM to look at the fetal heart rate to see if it increases to a certain level for at least 15 seconds for a minimum of two times over the course of twenty minutes.   When this kind of acceleration is seen, the baby is considered to be "reactive" and in good health; but when this acceleration criteria isn't met within the appropriate time window, the baby presents "non-reactive" concerns that require additional testing.  Well, today, my coffee didn't rial him up, my movements didn't change his agenda and the ice bath I gave him must have been soothing because Baby wasn't having any of it.   Much to the concern of my nurse who continually went back and forth from my monitor to Doctor Bronsky's office, Baby showed marginal accelerations within a thirty minute window - reactive enough for Dr. Bronksy to take me off that particular monitor, but non-reactive enough to require a previously unplanned biophysical profile to be completed on Baby.

Sent back to the waiting room to fret over the "I guess you passed" (aka "I'm trying not to say you failed") results of the NST, it was only a brief moment before the extremely informative sonographer, Sandra, came out to collect me for my ultrasound.  Explaining every little thing she was looking at as she clicked with the mouse and slid across my swollen belly with the probe, Sandra went out of her way to praised the "precious/adorable/sweet baby" each step of the way through the 8 part biophysical exam as if trying to boost his ego and put my parental concerns at ease.  Stating that "it's no wonder why you guys failed the NST with how squirmy he is and how much fluid you have," my heart sank as she reported my amniotic fluid index levels had increased to 29.6 cm.  Reassuringly trying to indicate that this increase should be "no problem, as long as ..." she ended her pick-me-up speech with a rushed "but, the doctor will talk with you more about that...  Want to see the baby in 3D and color?" 

Nice try to distract me, honey, I'm still going to obsess about it. But, yes (duh), I want to see him in 3D and color.  

Left: 01/13/2015 Baby #3 at 34 weeks gestation.  Right:  10/31/2012 GV at 34 weeks gestation.
I think they'll likely look alike.  

Ushered directly from that non-sequitur into see Dr. Bronsky, I sat down and immediately noticed the oddly stiff straightness of my posture - there was absolutely no denying my concern about the changes from last weeks glowing reports to this week's failure to respond and abnormal AFI levels.  Looking over my chart - and once again not providing me with a take-home copy of the ultrasound report - he automatically launched down the "how are your sugars?" worm hole.  Explaining that my A1C is slightly elevated, but likely more as a result of fewer hypoglycemic episodes than otherwise, I braced myself for what I assumed would be a sink-hole of criticism to engulf my chair and self-esteem. 

Frankly stating that he wasn't pleased to see that my amniotic fluid levels increasing at this point, Dr. Bronsky used the magical word "however" when reviewing Baby's biophysical profile results: 8/8.   Indicating that this doesn't necessarily replace the non-responsive NST but provides him with significant more confidence that Baby is still looking good, he requested that I begin daily kick-counts and expect a more comprehensive work up next week rather than the week after. 

Feeling quite a bit battered around the head by the appointment, I took one final emotional blow as I left the hospital:  as I walked over the catwalk from the Women's & Children's Hospital to the parking garage a friendly hospital volunteer handed me a flier about the campus' new visitation policies.   Taking a gander over the bold face type as I approached the car, I stopped dead in my tracks and had to actively fight back tears as I read that "all children under the age of 16 (including siblings) are not permitted as visitors on hospital premises for the duration of flu season."  In other words, when baby comes and we're left in the maternity ward for hopefully a brief stay of two to three days, GW and GV will not be permitted to come see me or to meet their new baby brother as GW did when GV was only an hour old.  Granted, I understand the medical necessity of trying to decrease the spread of infection and control the rampant spread of the flu across the DC metro area, but they've had their flu shots and we know better than to take a sick child to a place full of depressed and/or brand new immune systems!  I just... I just was really looking forward to that moment when we could all share the newness of Baby together.   

What a freaking emotional roller coaster.  Let's just hope next week brings better news. 

Week 33: All Alone.

It felt absolutely bizarre to walk into the Antenatal Testing Clinic by myself today.  Finding the waiting room set up completely different than it was the last time I was here in 2012 (back then all of the chairs sat in rigid rows facing away from the door toward the television; now the chairs sit in four sections with two rows facing the door, one row directly opposite those two that faces the center of the room and one row adjacent to the door that still faces the television), I was startled by the collective curiosity that hit me as I walked into the crowded room and became immediately aware of all the couples… Every single chair, but one, was composed of a matched set of mothers- and fathers-to-be and all of them looked up in some sport-like synchronized motion when the door opened and I stepped into view.  In an ideal world, I am sure that would have elicited a walking on water kind of feeling from me or anyone else who was noticed by everyone when walking into the room, but the odd man out, something’s not quite right feeling that stuck with me as I took that last chair in the corner under the surveillance of the paired off parents was enough to make me wonder if I had spinach in my teeth or forgot my appointment was supposed to be black-tie attire required rather than pregnant mommy comfy.   

I realize that this might seem overly self-conscious of me to write about or perhaps entirely too trivial to even mention, but the strange thing about that moment wasn’t so much the receipt of these people’s innocuous attention as it was the fact that I’d never before noticed that pregnant mom’s rarely arrive at the ATC alone and when they - I guess I should say “we” - do it’s enough to distractedly drop People magazine to wonder what’s her story.  I mean, as a high risk clinic it makes sense to have someone there with you to endure whatever bad news awaits or to confirm that whatever medical phrase the doctor just said is actually a positive thing, heck that’s how I’ve been operating up until today, but to realize in such black-and-white, seriously look at your surroundings that, yep, it’s completely strange to be here without HB today was a whole new level of surreal.  Maybe I’m applying too much weight to the shift, but I’ve heard tell that going from two to three kids is the hardest transition for parents to learn and this might just be the first taste of that difference I’ve noticed. 

Anyway, so there I am (no shit) all by my lonesome at my first unaccompanied perinatal appointment dreading whatever gloom and doom report of fetal complications, maternal weight gain or what-have-you when I’m called back for the NST which, much to my shock, Baby passed within the first five minutes of being monitored.  Required to remain on the machine for a minimum of twenty minutes, the nurses let me be and read the final chapters of Lisa See’s Red Princess Mystery series (thanks for sending that AS! Loved it.) in relative peace and quiet with only the constant background noise of little one’s wub-wub-wub heart rate to distract me.  Feeling skeptically hopeful that the appointment might not be such a disaster, I went back to the waiting room (alone) and began my next book (okay, Mom, I’ll read the Eragon series… you happy?).  

Shortly there after, Lin, the Chinese sonographer who works part time at the ATC and part time at the main doctor’s office called my name.  Seeming a bit shocked to see me (alone) at the hospital rather than in the normal office environment (with husband and kids in tow), she was quite a bit more eager to chit-chat while checking on Baby.  Covering the weather, the older kids and what we can only assume is the adorable face of this Baby (he’s shy and keeps his hands in front of his face for the 3D sonograms), she could feel me tense when she began measuring the four amniotic fluid pockets around his body.  

“What were you last week?”  she asked. 

“30.0,” I responded. 

“Oh… well you’re down to 26.8!” she announced with a note of triumph.  

Taking that emotional leap of faith from tentative hope to actual happiness as a result of the appointment’s exams, I couldn’t help but smile with relief at the positive turn of numbers this measurement indicates.  See, the thing about AFI levels is that they are supposed to peak between week 32 and 36 before gradually beginning to decrease as full term approaches - so the concern for the past several weeks has been whether or not this decrease would occur or if, Heaven forbid, the AFI levels would continue to rise making for higher risk complications at the onset of birth (namely premature rupture of membranes or placental cord prolapse).  Given that this 3.2 cm reduction would indicate that Baby and I are actually headed in the right direction… holy smokes! What a weight off the world!

Practically floating into my appointment with the doctor, it was such a pleasant surprise to find the soft spoken, kiddie-gloved Dr. Nies waiting behind the desk with her welcoming smile and perpetual encouragement.  Looking over the NST and AFI results, she announced that they wouldn’t need to see me twice a week at this stage of the game as they had initially anticipated and that, if I had no questions, I was free to schedule a once weekly NST for the upcoming three weeks.  Explaining that we’d be repeating fetal measurements week 36 when we’d also be looking to go-ahead and schedule induction (did you see that?!  She said “INDUCTION!” NOT C-SECTION!) for the second week of February…  what A-W-E-S-O-M-E news. 

You can imagine the unrestrained pregnancy glow that emanated from my being as I reentered that couples-only waiting room a full five inches taller than I had when first arriving earlier in the morning.   Soaking-up the five seconds of “single-mom” fame that repeated itself in the group stare as I began to check out, there was no second-round of doubt going through my head about my vegetable-free teeth or my chic mommy-comfy outfit because, yeah, I am the third-time mom that came alone to the hospital’s high risk clinic and you know what I just did? I had a kick-butt appointment.  All by myself!

Dexcom Down!

I am feeling like the biggest idiot on the planet.  About four days ago, my Dexcom monitor began to doo-da-loo at me with an error message I'd never seen before: "Transmitter Battery Low.  Order Replacement."  Thoroughly confused by this message as I'd just replaced the monitor this past September, I plugged in my CGM to it's USB port and rolled on with life.

Then, at about one o'clock in the morning this past Sunday, it hit me.  The error message was so darn clear, the transmitter battery is low, not my monitor battery -- in other words, the gray piece I attach to my new sensor on a weekly basis needs to be replaced.  So no matter how well charged my blue CGM monitor is or how fresh my sensor is, with a dead battery in my transmitter my CGM is about as useful as when trash day falls on a national holiday (yes, we were hit three times recently thanks to Thanksgiving, Christmas and New Years Day all falling on Thursdays... no, I am not annoyed...).

Having contacted my Dexcom customer service rep first thing on Monday morning, I learned that it will take 3 to 5 business days to arrive here at the house.  So with a possible arrival time of this Thursday at the earliest or next Monday at the latest, I have been crossing my fingers that the low battery holds out until the earliest possible time that my replacement transmitter can arrive.  Unfortunately, however, as I was going about the morning routine today my monitor stopped reporting my glucose trends and indicated my transmitter is out of range.  As I'd seen this error message before it didn't initially register that my CGM needs more than my sticking the monitor in my pocket for a while... so you can imagine how dumb I felt after carrying this thing around for an hour to no avail when it hit me that, yet again, I'm being completely dense.

My transmitter battery is d-e-a-d, DEAD.  I have yet to receive shipment notification from my supplier that my new transmitter is on it's way.   I've officially thrown myself back to the Stone Age of diabetes management as, for the second time this pregnancy, I'm back to finger sticks to track my blood glucose.  As my insulin requirements continue to change over the course of the third trimester with the placenta making my body increasingly insulin resistant and with baby and me being incredibly sensitive to glucose swings - him and my AFI levels, apparently, responding to my in-range 70-140 mg/dL blood sugar variations; me responding emotionally to the mere suggestion of my diabetes incompetence or a potential c-section - this is NOT the ideal time to have my high tech gismo go out on me.

Keep your fingers crossed that my new transmitter arrives soon and that the mean time doesn't somehow manage to make my head explode.  I head to the perinatologist later today (solo... boo hiss) and it's my first appointment at the hospital's Antenatal Testing Center, so I'll report back sooner rather than later on how things are going... so, seriously, all the fingers you can spare to crossed are appreciated!

Week 37, part two

Thankful for a labor free and turkey full Thanksgiving holiday, I was positively giddy to go into my last perinatal appointment at the Antenatal Testing Center on Friday.  Knowing that Baby's lungs aren't mature and that there wouldn't be a change in plans for what we'd do after this particular appointment ended, I felt like the day was going to be predictable pregnancy-wise for the first time in weeks.   Considering how worried I've been about the stability of my blood sugar, the occurrence of another abruption or whatever else could go wrong, it was a relief to walk in expecting a "simple" a non-stress test, my last sonogram (#20) and a quick conversation with the doc.

Being the day after a holiday, the testing center was ridiculously busy with two days worth of appointments -- there were 16 pregnant women and their spouses in the waiting room when we arrived -- we had a bit of a wait, but it was actually quite a pleasant wait because a 28 week pregnant woman came up and introduced herself to me because she saw my pump clip in my jeans pocket.  As it turned out, she has been a T1 diabetic for almost twenty years, she uses the same pump that I do and, as this is her first baby, she was glad to meet another insulin dependent mom juggling a kid and a baby.  Course I didn't have the heart to tell her that GW wasn't a diabetic baby, but it was nice none the less to swap battle stories and commiserate over the difficulty of our current circumstances... while it sounded like her diabetes gets along much better with her pregnancy than mine has, I really appreciate how this charming woman made me feel far less alone and stranded by my beta cells than I've felt in the last nine months.  So Erin, wherever you are, thank you for that!

Having seen me twice a week for what feels like months, the nurses called my family back to the NSTing area by asking GW to bring his mommy back.   While they're perfectly professional and good at their jobs, I must admit it is the personal touch these nurses give to patients like me that make me absolutely love them...  they put up with my family's quirks and a few of them have even let GW help with the testing process by allowing him to squirt the goo, place the fetal doppler and even help steer the sonogram wand.  Since things were going smoothly today and nothing was abnormal with the sono or NST, they had nothing but nice things to say and well wishes to our family upon my "graduation" from routine testing. It'll be kinda sad not to see them all the time, especially Tam and Sandy, but Lord knows there's always the next pregnancy, right?

Reviewing all the little details, checking my cervix for progress (2 CM) and confirming the plan for my induction on Tuesday, Dr. Bronsky verbally walked HB and I through the last few days of pregnancy.   Knowing my interest in moving about for the sake of labor progression, he said to fly be free and have a nice weekend but to plan on being bed bound from 8 PM Monday until post delivery (boo, walking helped so much last time) on account of how "brittle" my diabetes is and how closely they'll need to monitor the baby because of it.  While I am not thrilled to hear that, I understand the priority and I value that he's concerned with/aware of how sensitive my body is because of my stinking pancreas.   All we can hope for is stable, low (but not hypo) numbers over the next several days and through delivery...

All that being said, I've got a couple days of pregnancy left and by Tuesday (at the latest) we'll go from a family of three to a family of four.  We're going to spend the next several days enjoying our time with just GW and, hopefully, we'll go into next week with minimal complications and confidence in the arrival of a happy, healthy baby girl.

Week 37, part one

I don't know how coherent or comprehensive this post will be, but I'm attempting to put something together before the complete emotional exhaustion of the past few days knocks me out.  That said, bear with me.

After writing my blog post Monday night, I had a bit of a melt down.  Caused in part by nerves for the amniocentesis and in part by simply being overwhelmed by the significant differences there have between this pregnancy and the first, I found myself as curled up as a nine month and one week pregnant woman can get in a heap of tears.  You see, with GW, the pregnancy couldn't have been smoother...  I didn't realize I was pregnant until week 12 so I "missed" the morning sickness phase (had it, but didn't know what it was), there weren't any medical complications and he came early and very quickly.  I wasn't restricted to bed, I was very physically active and we generally treated me like a normal woman rather than the delicate creature pregnant women actually are (I distinctly remember carrying a full size mattress from our trailer, across our lawn, into our house and upstairs by myself at 8 months because I felt I could).   Back then I didn't have a clue what I was signing up for or what I could lose if something happened to my fetus.  I didn't have the Mommy Gene, I didn't feel connected to the baby and I generally was waiting for labor to begin so that I could get my "skinny pants" figure back.

But this go around, there is nothing smooth and the stakes couldn't be higher.  Now that I fully comprehend what it means to be a Mom, just how much my son matters in my life and what extent I have given/would give or do anything for his well being and happiness, I am terrified of what a fine line I find myself walking with baby #2.  I knew things would be more complicated this go around with my diabetes, but I had no idea that things would be as hard as they actually have been.  While talking with my nurse at the Antenatal Testing Center Tuesday morning she said that "some people's bodies just don't do well with diabetes and pregnancy" and, unfortunately, that "some people" reference seems particularly relevant to me... which is why all of the complications of the past nine months culminated in a crumpled mess of weepy gooey blah that only marginally resembled me Monday night.

Ug.

So puffy eyed and physically drained, we piled into the truck and drove up to the hospital Tuesday for my amniocentesis and first week 37 prenatal check up.  It took a little while for the doctors, nursing staff and technicians to get things all sorted and settled, but after a quick sit down with Dr. Bronsky I was lying on my back repeating Hail Mary in my head and trying to remain calm for the procedure.  I'd done a bit of research on what to expect and depending on which medical website you look at the sensory explanation of an amnio ranges from a "slight, momentary burning sensation" to "pain worthy of local anesthetic" -- so really I had no clue what I'd signed myself up for as the needle and multiple syringes were laid out on my belly for quick accessibility. 

Taking deep breaths and working extremely hard to keep from contracting my core out of anxiety, Dr Bronsky did a second ultrasound of my uterus (the tech had already done the routine one -- AFI level dropped to 19.6) to locate the best place to insert the needle.  Unfortunately this turned out to be much more difficult than he anticipated because of my anterior placenta and Baby's position. So, if you remember, an anterior placenta means that it is attached to the front wall of the uterus and because I had a partial previa earlier in the pregnancy we know that it is attached quite low to the front wall.  Well, as the baby has grown, so has the placenta and now it covers the entire left half of my belly -- which made it impossible to insert the needle on that side.  Looking to the right side of my uterus, the doctor struggled to find a safe place to test because Baby is curled with her back to my right side and her feet, arms and head pointing to the left.  Since jabbing her with a needle is completely out of the question, that left little to no room for even the thinnest of needles. 

Finally selecting a tiny spot near her tush, Dr Bronsky meticulously threaded the needle between Baby, my rib cage and several many blood vessels through my abdominal wall and into my uterus.  Although I can definitively say that the needle going in wasn't so bad, the needle staying in and being tweaked this way and that to find a clear pocket of amniotic fluid hurt like freaking hell.  Back when I was hospitalized at GTU in 2010 I had to have an arterial blood draw from my wrist and, while that was the hardest blood draw I've ever had to endure, it seemed like a walk in the freaking park compared to this amnio.  OW.  It was all I could do to just keep my eyes closed, continue to breath normally and remind myself that it'd all be over soon...

After what felt like hours of torture (seriously, has anyone told DoD about this yet?) the needle was removed along with enough fluid to check on Baby's lung development and the smallest, dinkest bandaid ever was placed over my cramping, sore flesh wound.  Reminding myself this is all for Baby's own good, my minimal optimism flew out the window when Dr. Bronsky bluntly said that "you know, you can tell lung maturity based on the color of fluid and, from what I'm seeing here, we're definitely not there."  He said they'd still run the tests anyway to see if it'd be safe enough to move the induction date up, but unless things were at a certain level, he and the other doctors weren't confident enough to deliver Baby until next Tuesday -- at the earliest -- because she's just not physically ready to be outside the womb. 

So, not surprisingly, this afternoon we got the results back that confirm that Baby does not have mature lungs...  And although the docs are incredibly concerned about the perpetual drops in my blood sugar and the implications that has for placenta failure, they think it is worth the risk to leave her where she is for another week instead of guaranteeing her a trip to the NICU for breathing assistance.  This, unfortunately, is not to say that she'll have mature lungs by next Tuesday or that she'll be NICU free anyway but it's a calculated risk that the perinatologists think is the best case scenario for a high risk diabetic baby.  I guess this is a good thing that we know she's not ready to come out and that I've got another few days to try to kick this respiratory infection (still feel sick as ever and what's worse is GW caught it), but I'd be lying if I said that I wasn't distraught by the news that things are progressing like diabetes predicted.  I mean fortunately she's not a gigantic diabetes baby, but dang nabit why did my pancreas have to go and screw with her lungs when it has frankly screwed with me and Baby enough for a life time?!  I'm quite done being pregnant and I am completely over being diabetic... one is hard enough as is, but both of them? In the worst combination possible? Not cool.

With November being World Diabetes Awareness Month I feel a bit guilty at just under two years of affliction complaining about the lack of a cure, but you know what? This isn't like a prison sentence -- I didn't do something that made me deserve this disease and therefore the time of incarceration befitting my punishment.  I might not have the decades of frustration and illness that most T1s have, but I'm just as over this disease and the impact it has on my family as anyone else who needs artificial insulin...  How dare diabetes screw with my baby! How dare my pancreas give up on me when I never would have given up on it! How dare people treat me like I'm broken or, worse, like my disease is "not that bad."  This disease flat out sucks and I am frustrated about what it is putting me through and I am angry that my baby girl is being put through the wringer of every possible medical test because I'm stuck with failing beta cells.

AGG!

Since I'm still attached to my pump, still rocking my battle bandage from Tuesday and I still haven't gone into spontaneous labor, we're planning to go back into the testing center on Friday to check on Baby again.   Assuming all continues as is the doctors don't want to move back the induction from November 27, but if things change for the worse or if I go into labor on my own things may either be sooner or later than Tuesday depending on what exactly is going on.  I'll try to keep my update on Friday to something a bit less rant-ish and a bit more concise, but after months and months of high stress composure I was bound to break sometime...

Until then, have a great Thanksgiving folks!