Week 20: Fetal Echo

One of the challenges I'm finding about having a baby when you already have a child, or two in my case, is that working the baby's fetal schedule into the already complicated, busy family day is actually harder than it sounds.  With 19 weeks to go until baby #3 truly requires his own car seat, planned dinner and established bath routine (remember, I'm not allowed to go past week 39 without induction), his doctor appointments are already clashing with GW's school hours and GV's nap schedule.  Granted, it's pre-school for big brother and nap time can still happen pretty much any where for little miss, but the fact that I'm starting to get a taste of what juggling activities is going to be like and baby bump isn't even baby yet is somewhat comical

As the pre-ramble suggests, I had to move some things around today to get up to a doctors appointment in NOVA.  Due to the elevated AFP levels that we've been seeing over the last several weeks, my MFM is requiring that I see a pediatric cardiologist to examine baby's heart thoroughly with a fetal echo to rule out heart defects as the source of the abnormal numbers.  Given that diabetics with poor glucose control during the first trimester, notably the first seven weeks of gestation, can directly impact the formation of the baby's heart as a result of untreated hyperglycemia it is a logical concern of theirs (and, rightly so, one of mine) that is easily confirmed or ruled out with this exam.  So, taking the first availability we could to see the MFM's  preferred fetal cardiologist, we scrambled our selves and our typical Monday schedule to find out what we could: HB took the morning off of work, GW forfeited his morning school and romp session, GV resigned herself to a reclined rather than prone daily siesta and I held my breath for the ride north in extreme hope that the morning would prove an exercise in multi-child parenting, aka flaming-hoop jumping, rather than necessity.

We arrived at the Child Cardiologist Associates office with just enough time to fill out all necessary forms and initiate a sibling fight over the best child sized chair and waiting room toy before we were directed back to an exam room.  Finding the room to be exactly what you'd expect of a cardiologist, HB immediately began to field four-year old questions about "what's this?""can I touch that?" "do I have one of those?" about the various posters, replicas and kid-friendly props scattered about the counters adjacent to the table on which I impatiently perched.  Showing the kids the "foramen ovale" and various chambers of the heart from his inexplicable daddy-memory, HB kept the kids occupied just long enough for the doctor to come in, squirt the goo on my belly and begin our exam.

whub-whub-whub-whub... click, click, click, click... whub-whub-whub... click...

If you didn't know this already, it's torture watching someone who knows what they are looking at look at something important, like your baby, without commenting about it is they are seeing.  Giving the medical student with him a chance to drive the echocardiogram, two two white coats began to quietly discuss what parts are what, why they conduct sonograms in particular ways and how to check for this, that and the other malformation...  all of which, I then found out, were fortunately not present in my belly and therefore very ho-hum vanilla as teaching-aids.  I would have apologized to the poor student if I actually felt such disappointment were warranted, but frankly my boring belly and I were more than happy to be a non-noteworthy case study and deprive her for one more appointment of something to call home about. THANK GOD!

So, wiping my belly off, bundling the feisty siblings in their coats and scooting HB towards the door, we emerged from this high-stress, directly relevant to my self-/baby-care appointment with a sense of relief.   We're pretty much up-a-creek with the high AFP levels at this point as we've ruled out the main complications it could be leaving it as a likely indication of a prematurely aging placenta, but as I went through this process with GV I at least know what this could imply and the knock on affects we could see with baby #3s development.  The MFM will keep a very close eye on the placenta from this point forward to check for calcification and will monitor baby's growth to ensure we aren't seeing significant growth restriction due to inadequate function of the placenta, neither of which I can change or impact out of sheer will power.

All in all, it was a hectic morning that'll take the remainder of the day to recover from, but I'm happy we were all there.  I know we'll each need to sacrifice things as the kids get bigger to be there for each other's big moments - soccer games, piano recitals, science fairs - so the fact that we're starting it now is kind of nice.  We care about you, baby #3, and wish you nothing but congratulations on your big win today - just keep in mind that I'd prefer your next family togetherness moment be for something far less pressure filled than an fetal echo... like birth! Well, maybe not the labor process, but the clean baby snuggling right after doesn't sound half shabby to me.

Echo Results

Halfway through the drive back from Burlington tonight, we stopped at this mom-pop type bakery on Route 7 called "The Love Shack."  Having spent a good portion of the day whining about wanting a cookie, HB graciously stopped to pacify my craving and we scoured the baked goods for the perfect selection...  Ultimately purchasing a bakers dozen of cookies out of sheer indecision, we taste tested a few on the drive home and - ironically - determined that the "Motherly Love" cookie is better than either the "Puppy Love" or "Summer's Love" cookies.

Why, you might ask, is this cookie better than the others? Made with dried cranberries and white chocolate morsels, this "Motherly Love" had the right blend of sweetness and acidity to make the perfect cookie bite (not to mention a valid parenting suggestion).  So flavor wise, the cookie was more complex and more foodie-palate-satisfying than either the chocolate and peanut butter chip cookie or the chocolate chip oatmeal cookie.  But that's not all... the "Motherly Love" cookie was better than the others because of the name and the outcome of my day.

The fetal echocardiogram went beautifully.  After spelling out the likely complications that diabetes can cause for fetal heart development, the neonatal cardiologist said that Baby's heart couldn't look more normal and that based on what he saw there is no need to do additional testing to confirm his findings.  In other words, Baby's heart is developing in the best case non-diabetic pregnancy kind of way - thanks be to God!  He was also very pleased with my weight gain thus far and the simplicity that my body-type creates for diagnosing complications in the baby - thanks be to Sean T for helping get me in the best pre-pregnancy shape possible!  

So what does this mean? It means that my BG control has rocked and that any of the complications my diabetes could cause for the baby thus far aren't an issue.  Granted, it's a bit early to straight out celebrate as BG control directly correlates to baby size/weight (that will only be determined in the final weeks of pregnancy through ultrasounds), but I'm feeling pretty good about things and we're very relieved that diabetes:Baby::baseball:daisies - completely irrelevant!

Obviously there are other issues that we still need to keep an eye on - where the placenta is, any possible issues with fetal growth and how my blood pressure is doing for preclampsia purposes (98/50 today btw) - but all of that is fortunately non-diabetes related and out of my hands.  I know and so do my doctors that I am doing everything I possibly can for a healthy baby and, at the end of the day, that helps me sleep at night.

Thanks for the support. I'll let you know how the next prenatal appointment goes when I get back to VA and can touch base thoroughly with my MFM down there. :)

Fetal Echocardiogram Today in Burlington

As I mentioned in one of my last pregnancy related posts, the fetal echocardiogram is the next big hurdle for me to clear in the pregnancy.  In all pregnancies the doctors will look at the development of the baby's heart to make sure that it is healthy and not showing malformations or irregular operations. With insulin-dependent pregnancies, they do a higher resolution more careful screening of the baby's heart because problems with heart development are more likely to happen with diabetics because of the impact abnormal blood sugar ranges have on fetal formation.

So with non-diabetic people in general, typical blood glucose ranges are between 70 and 100 mg/dl.  With diabetics, this range is very difficult to achieve and requires full attention to get even close to such "tight" control, which is why our optimal range is slightly higher between 70 and 120 mg/dl to account for this difficulty. Now, consistent blood sugars above 120 mg/dl prior to conception and during the first trimester of pregnancy can cause birth defects - specifically in the cardiac system - because of the delicacy of the fetus' system development.  Obviously this means it is completely on the mother (aka me) to give the baby a healthy heart from the get-go.  No pressure.

Wanting to give baby the best shot possible at a healthy life, I worked very hard to have tight sugar control before conception and I've had my sugars on lock down since the beginning of the pregnancy for fear that I might do something to Baby.  Today is kind of the culmination of that... whatever happens in the coming months with my placenta previa, my higher risk for preclampsia and issues with fetal growth are all irrelevant to my diabetes control and out of my hands.  But today, the fetal echo, is a direct measure of my blood sugar control and its impact on the pregnancy.  Again, no pressure.

I'll report back how it goes as soon as I get a chance...  until then, please keep your fingers crossed and us in your prayers.  We'll take whatever help and positive vibes we can get!