Newborn GV

So in the last post I think I got the point across that despite all the concerns that labor and delivery itself went well and that as of 10:12 AM on November 27 HB and I have a daughter.  Yes? Okay then, moving on!

Once she was out, the nurses began their typical new born checks and double checks and successfully reported that GV scored highly on her APGAR and has ten fingers and ten toes (which after 21 sonograms was redundant, but still good news).  But seeing as I am not a normal mother, they had to run atypical checks on her as well to make sure she was healthy diabetes impact wise.  Course I knew that was coming and had worked hard to mitigate the worst case scenario with tight glucose regulation during labor (see my "Induction Begins Tonight" blog post for an explanation), but checking her blood sugar regardless of my control was just the responsible medical thing to do.

Pricking her little heel, the nurse applied the Accucheck test strip to the blood and reported a bg reading of 41 mg/dL for newborn GV.  While I would consider that number dangerously low for me, any number above 40 mg/dL is considered to be normal for newborn babies; in other words, she was borderline and verging on hypoglycemic despite my efforts to ensure her glucose would be in a safe range.  Hoping her sugars would go up on their own, the nurse handed her back to me for skin-to-skin time, immediate nursing and explained they'd need to check her sugars again in 30 minutes.

Holding that little baby and keeping her safe in my arms after so many months of worrying felt phenomenal... but in what felt like mere seconds after handing her to me the nurse was back to check GV's sugars again.   With HB supervising and being my emotional proxy, the nurse started the whole process again and pricked her heel.  The meter read 32 mg/dL.

Shit.  (Pardon my french).

Asking the pediatrician for a call on whether she needed to go directly to the NICU, the nurse reported back that GV's hypoglycemia wasn't "bad enough" to warrant a trip to the second floor but that we'd need to get her on formula right away.  Because a new mother's breast milk doesn't come in for two to three days after delivery and colostrum doesn't contain much in the way of glucose, we grabbed our Nutramigen formula and I tried to get at least an ounce into her before the next bg check in 45 minutes.  Warning that if her bg wasn't up by then we'd need to take "alternative measures" (aka the NICU), the nurse wished us luck and left us to it.

Fortunately, if there is one thing this kid does well, it's eat!  By the time the next check came around she'd gone up to 53 mg/dL!!  Unfortunately, they had to have a minimum of three readings over 70 mg/dL so even though her sugars were in the right range, the nurses on the "Family Centered Care" floor had to prick her several more times over the next 12 hours for record purposes -- all of which, thank the Lord, were in the perfect range.

But would that be the end of it?  Heck no -- that would be far too easy of an ending to an otherwise medically stressful pregnancy.

So we get up to the 7th floor recovery unit and we learn that GV's bilirubin levels are excessively high for a few hour old baby at 6.8.   The pediatrician initially said that they'd just keep an eye on it and see how she responded to simply being fed, but if the levels weren't better the following morning that they'd need to put her under the ultra violet lights for 24 or more hours.  I tried my darnedest to feed her  and combat the onset of jaundice (at 38 weeks, really?!), but the next morning her bilirubin levels had risen to 8.4 and the pediatrician made the call to get her under the lights.

I know even "normal mothers" have to put their babies in the grow box sometimes - heck even my husband had to go in it when he was born - but after everything this complication was simply one I hadn't emotionally prepared myself for.  I braced myself for all the plausible diabetes and abruption complications, but jaundice? It hadn't even crossed my mind.

Only able to take her out every three hours for a brief feeding, we sat up the entire night on Wednesday watching her tiny little chest rise and fall with each breath.  Feeling helpless to fix the problem, we waited for five o'clock Thursday evening to roll around and the defining bilirubin levels check to be completed.  If the labs showed that her levels were still high, I'd be discharged and sent home while she'd remain hospitalized in that incubator, but if her levels were low "enough" we'd be able to bring her home with us.  Needless to say we were praying and risking to hope for the second of those outcomes.

So with bated breath, we watched the clock until 6:00 PM on Thursday, November 29 when the nurse finally came in and gave us the verdict... GV could go home!!  Her bilirubin levels were still elevated higher than they ought to be, but not so high that at two days old she'd be in any risk by going home.

Thank God.

Labor & Delivery

On Monday, November 26 at 8 PM we wandered into the Fairfax INOVA Women's and Children's Hospital in exceedingly high spirits.  After months and months of worrying about how the hour long drive along I-95 and the Beltway would go it was a relief to calmly pull up and saunter in without traffic or fear of imminent baby delivery on the lobby floor.  But, with major relief, I was suited up in an oh-so-glamourous hospital gown and lying in a hospital bed well before Baby made her debut into the world.

After debriefing my nurse and getting fully checked in to their new computer system, the MFM resident came in to check Baby's position via sonogram one last time (#21) and to evaluate the condition of my cervix.  At about 70% effaced, 3 CM dilated and -3 vertex station, he decided to hold off on the Cervidil until 2 AM to make sure that things didn't progress too quickly over night -- which given the last quick delivery made HB and I very happy because, let's face it, we didn't work with Perinatal Associates of NOVA all this time to wind up being delivered by some random resident.  So the resident (to give at least this one credit, he was a nice, competent guy) put in the orders, requested that my blood sugars to be checked every four hours and instructed the nurse to start Pitocin at 6:30 Tuesday morning.  Completely on board with the Cervidil and Pitocin plan (what the heck do I know about that to have an opinion on it?), HB and I decided to blatantly blew off the blood sugar instructions and checked my bgs every hour to make sure they were tight for delivery... Needless to say that kind of ate away at our last night of sleep with out an infant, but we kept my sugars in between 70 and 80 mg/dL from the first time I sat down on that bed to the time I was being wheeled to a recovery room baby in hand.  

Go me!

So with irregular Braxton Hicks, the nurse put me on Cervidil from 2 AM to 6 AM -- which initially was no big deal, but after a few hours caused the start of real, regular contractions at just under 5 minutes apart.  Having spent the past nine weeks of merely uncomfortable contractions wondering if I wanted an epidural this time, when the nurse asked me if I wanted one I politely said "HELL YEAH" and got my name on the first slot of the sign up sheet for the day.  Needing 30 minutes between Cervidil and Pitocin, the nurse got fluids hooked up and into my system so that by the time the anesthesiologist got there somewhere between 7:30 or 8 o'clock (or by every 3 minute contractions on my watch) I was ready to get the show on the road.  The epidural was no big deal (the iodine scrub brush was the worst part of it) and once the magic meds kicked in, HB and I agreed that this was the perfect opportunity for him to get himself breakfast before he collapsed from hunger exacerbated excitement. 

But, really folks, is sending your husband off during labor a good idea?   NO! 

He wasn't gone more than three minutes when the nurse came rushing in to flip me on my side, stop the Pitocin and put me on oxygen.  Baby's heart rate was dropping well below the acceptable range of 110 to 160 after each contraction (now spaced every 2 minutes) and that kind of fetal distress this "early" is very worrisome given the intensity of active labor.  So by 8:30 my new day-shift nurse paged Perinatal Associates and - much much to my surprise - a different doctor from the practice assigned herself to my case and within minutes arrived to evaluate the situation.  Seeing the progression of contractions and the baby's positive response to oxygen, Dr. Al-Kouatley (who, I must say is the nicest woman in the world) decided to manually break my water, restart Pitocin and asked me to turn off my pump before the real exercise of labor began.  Since I wasn't having any issues with my blood sugars and I could afford to go higher by another 20 mg/dL, I thought this made sense and we moved forward. 

While all of this was happening, I'd been texting HB to let him know what was going on and that he might want to get his butt back to the delivery room sooner rather than later.  Since he didn't respond I guessed he'd missed the messages, which by the look of absolute horror on his face when he came back at 8:45 to my much altered appearance, was confirmed.  The nurse and I explained what was happening and that there was no longer a big need to worry, but I've got to give the guy a lot of credit because even with that reassurance he didn't let go of my hand after that and he was johnny on the spot for all of what happened over the next hour.   

Side bar:  It is a really regular occurrence for me that women at random places like doctors offices, the grocery store or  the play ground pull me aside and comment about how wonderful my husband is for being so supportive and involved.  While I can't explain how I got so lucky to have him be  my other half, I can with 100% authority say that I know how good I've got it and that I appreciate every one of the little things that you do, HB.  Thank you for being there with me each step of the way, for blessing me with your love and making my world better by simply being in it.  

Now this whole time, as the endocrinologist had warned us to do, HB and I were explaining to the nursing staff that my first delivery went quickly, that my blood glucose control has been fantastic throughout the pregnancy and that this baby was last measured at over a pound less than GW was at birth.  But, seeing as the typical experience with diabetic mothers involves wanton neglect of sugar control resulting in gigantic babies and hours of pushing, my nurses apparently didn't believe us and ignored our hints that a) they should be ready and b) things were progressing:

At 9:15, much to my previously drugged surprise, I began to feel some serious contractions again and HB went to tell the nurse something was changing either with the contractions or the epidural (before the epidural my contraction pain was at about a six on a one to ten scale, now it was about at a seven or eight).  Saying she'd be there in a minute, we waited and I attempted to breath through the every 45 second contraction pain I was now experiencing...

At 9:30, HB went back out to the nursing station to tell them that the pain was seriously much worse (about a nine) and that I was feeling "pressure" - which if you haven't had a baby means that the baby is ready to exit.

Finally, at 9:45 a nurse came in and checked the baby's position - which HELLO, was right there at +1 station (typically you don't start pushing until +3 station, but waiting for that was seriously not going to happen) and frantically tried to get the completely unprepared room prepped for delivery.  She called the Dr. Al-kouatly, who needed about ten minutes to change into scrubs and come up from the testing center, so low and behold look who walked in to check on me but my worst nightmare Dougie Howser... at this point I was without any pain meds (we don't know what happened to the epidural) and doing everything I possibly could mentally to not push until a doctor - a real doctor - was there and ready to catch.  But before I had a chance to slap him for his horribly arrogant, "I haven't read the chart" bed side manner and instructions to do practice pushes (seriously?! BAD IDEA KID!), my prayers were answered... It was at this point that a Hollywood director would have flooded the room with white lights, used slow motion camera effects and some sort of "halleljah" music because Dr. Bronsky just happened to walk in ready for action.  Ridiculously unhappy with the lack of preparedness, my MIA pain plan and his not having been paged for "his case," he barked orders at the nurses to get their act together and, within ten minutes of sitting down, delivered my beautiful daughter, GV at 10:12 AM.  

While things didn't go 100% smoothly communication-wise for delivery at INOVA Fairfax, HB and I are incredibly pleased with Dr. Bronsky's phenomenal care for me as an individual patient and I must say that I am grateful for his Hail-Mary reception of GV.  I am sure that Dr. Al-Kouatly would have done a wonderful job as well, perhaps even Dougie too (gag), but Dr. Bronsky helped get me from pre-conception nerves to post-delivery beautiful baby... Assuming that there aren't complications or reasons I've yet to learn (the placenta has been sent to pathology), I am really looking forward to working with him again for future pregnancies because we have a battle rhythm and positive relationship that I wouldn't trade for the world.  

Alright, all for now, the little one has been peacefully sleeping in my lap for all these paragraphs and now wants to be fed... Consider this post one of a few on the diabetes and L&D topic, I'll fill in the post delivery blanks soon. Thanks again for the support and love -- it is appreciated like always!

Induction begins tonight

Well, today is the day.

I go into the hospital tonight to begin fetal monitoring, receive a dose of Cervidil and then bright and early tomorrow morning we'll begin Pitocin to really get things started.  Based on my past pregnancy history and the dosing amounts he's planning, Dr. Bronsky expects that we'll have the baby by sometime tomorrow afternoon.  On one hand I am absolutely relieved to know that there is a definitive plan and an end to the pregnancy in sight, but I conversely find it a bit weird to know for a fact when the baby is arriving after so many weeks of uncertainty.

Hopefully my body will be responsive to the drugs and things will go smoothly with the induction, but seeing as I've been struggling with my blood sugar in hypERglycemic ranges the last couple days I'm a bit concerned about what this means for Baby.  I'm not sure where the high numbers are coming from exactly, but I'm trying to do whatever I can to get the numbers back down into normal ranges as soon as possible because if my sugars are high when she is born Baby will be required to go to the NICU to correct her hypoglycemia.

I think I've explained this before, but just in case I haven't or simply for review, when a fetus is in utero it's pancreas creates extra insulin to balance the excess glucose that is transmitted via the placenta from the Mom if her blood glucose is too high.  But when the baby is born and the external sugar source is cut off (literally), the insulin the newborn's pancreas is putting out becomes excessive and leads to their blood glucose dropping into dangerously low ranges.  Since the only way to correct hypoglycemia is to ingest more carbohydrates and colostrum does not contain much beyond antibodies, the NICU needs to feed the baby supplementally with sugar or formula and monitor his/her blood sugar until the baby is stable on its own.  Once the blood glucose balances out, the baby shouldn't need to stay in the NICU longer unless there are other complications that require additional intensive care... knock on wood.

I'm doing everything I can to keep things were they need to be, but if the placenta makes a last ditch effort to screw with my blood glucose then it's kind of out of my hands since hormones are simply unpredictable.  The reality is that Dr. Rogacz told me to expect Baby to go to the NICU and since we don't know with 100% certainty that her lungs will be fully developed by tonight I've kind of resigned myself to the fact that she might need more help than vitamin D like GW did when he was born.  Of course HB and I have prepared ourselves emotionally and medically for this and we're as ready as we can get...  At the most basic level, instead of using what basic brand the hospital provides, we've decided to bring our own hypoallergenic formula if Baby needs supplementation because research studies have indicated there may be a link between cow protein based formulas, type 1 mom's and babies developing autoimmune diseases later in life.  I can explain more about this research later since this topic goes hand in hand with the breast feeding post I still need to write (good thing we're not quite there yet), but we've decided not to take any chances and we're covering down on every detail we possibly can to keep her as healthy as we are able to.

Anyway, we'll see how things play out over the next two days.  I keep sending up prayers that the increased risks for infection and slower healing time because of diabetes will be of no concern coming out of this, but like I said, we'll see.  There's nothing about diabetes that makes life easy and it effects everything that involves the body -- much like carrying a baby, go figure.  I've somehow managed to avoid the swollen ankles and several other unpleasant side effects of pregnancy this go around, so here's hoping that some of the diabetes and delivery complications will be irrelevant as well.

I expect this will be my last blog post for a while since the hospital has spotty internet connectivity and I'm planning to be very busy with our TWO wonderful kids for a while...  But I'll be sure to put up an update when we get home and we're all settled (please don't call while we're at the hospital since we're not out of the woods yet).  Until then, thank you so much for reading my posts and giving me your support and encouragement over the past many months.  Writing about what is going on is a great outlet for me and, although things have been rough with the pregnancy, knowing people out there care is appreciated more than you know.

Talk soon :)

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!