Week 38 Appointment: Induction TONIGHT

Well, it's finally February 10th and that means no more guessing and no more waiting: Baby will be here and in my arms by tomorrow.  

The appointment at the Antenatal Testing Center this morning showed a reactive NST and that it'd be necessary for the doctors to administer several doses of Cytotec tonight before beginning Pitocin and actual, active labor tomorrow morning.   I'm excited and glad to have answers to all of my "what if," "when," and "how" questions.  

We're heading home now to have an afternoon full of GW and GV before we head back up to the hospital at 6 PM tonight.  Not sure how long it will take me to get updates up after delivery, but it'll happen :) 

Wish me luck!

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 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 34, part one

As an exciting post-Hurricane Sandy and Halloween outing, the whole family came along with me to the perinatologist office today for my week 34 non-stress test (NST), amniotic fluid index (AFI) reading and check up.  HB, who is the most wonderful, involved father I know, always comes but today was a bit of a treat because my Mom came along totting a very sharply dressed snowman.  I was quite flattered that GW received as many compliments on his home made costume as he did, but given the fact he is such a dang cute kid in the first place I give him all the credit for wearing the outfit with such success... course wearing a jumpsuit of 100% polar fleece inside a warm doctors office for two hours turned out to be a bit tricky (especially since he skipped his nap today), but he managed just fine and put smiles on several many faces.  Particularly mine.  

 

 

So... the appointment.    Tam, the sonographer, did a partial sonogram for a basic biophysical profile (BPP) reading since they comprehensively looked at the baby's weight and my cervix thickness last week.  It is my general understanding that the doctors only do a full sonogram examination of the baby every three weeks because so many things can vary from one week to the next that it's not worth the extra stress if something may be a simple "water weight" change.   Any way, Tam spent the sonogram focusing on Baby's heart rate, her breathing patterns, her muscle tone, her movement and amniotic fluid levels (22.3) - to which I am happy to report Baby got the perfect score of 8/8.  She also did another 3D ultrasound and, for the third time this pregnancy, we got to see our little angel's face... granted she stuck her tongue out at the camera today, but hey she's supposed to be practicing that - she's got a big brother to contend with after all!
 

After the sonogram, the nurses had me do my second weekly NST.  Since she was more active after I downed Starburst last week to correct for a low, I checked my blood sugar before starting, noted I was trending low and did the same this week to try to save time.  Unfortunately Baby was set and determined to sleep through the Mommy-provided stimulus and after sitting there strapped by a belly band to a loud "wubba-wubba" machine for 45 minutes the nurse came in and gave her a vibroacoustic prod... Having never experienced this before, I must say it's kind of startled me when the nurse first pulled out this wand thing because I didn't know if I should expect a shock or what.  But essentially a vibroacoustic stimulator is a hand held machine that sends vibrating sound stimulus into the uterus to invoke a fetal heart rate acceleration - which is the whole point of the NST in the first place. After that the baby responded within the limits they look for at this stage in the game and I was taken off the machine after another 15 minutes.  

Bored out of his mind, GW requested to go read a toy book (pregnancy magazine) in the lobby with Grandma and so HB and I went back just the two of us for our meeting with the one and only Dr. Bronsky.  I gave him my blood sugar logs and for a matter of several minutes (which felt like several hours) he was dead silent as he looked at my numbers and began strategically flipping through my chart.   As I've previously shared here and outwardly complained about at all of my recent appointments, my blood sugar has been continuing to drop into hypoglycemic ranges that aren't normal or ideal for this point in the pregnancy. Since my last blog post where I indicated that my basal rate was decreased to the "low" daily total of 15.3 units I've had to further decrease it to 13.9 units - and I am still seeing numbers in the 40s and 50s! So, finally, he spoke up and said with a voice of mixed relief and concern that the results of my AFI and NST today are fantastic but that the lows in my blood sugar logs likely indicates a problem they're not seeing with the placenta.  As the implications of this can be dangerous and my diabetes is "very serious" (his words, not mine), these numbers warrant the doctors to be even more cautious as we finish out the pregnancy and Dr. Bronksy requested that I come in twice a week to the hospital for my testing so that they can monitor Baby more closely and "retrieve" her immediately as necessary.  

So as of this Friday morning at 8:30 AM, I begin my new routine of every Tuesday and Friday doctors appointments for the next several weeks of third trimester fun.  With any luck there wont be reason to justify more frequent appointments than that between now and delivery, but we'll see if we actually make it to the induction date - which YES we did set today. 

Drum roll please... 

If for whatever reason I do not go into spontaneous labor before week 38, the doctors have scheduled Baby to be born on Tuesday, November 27!  Dr. Bronsky explained that he'll have me come in the night before to be put on Cervidil and, depending on how things went with that, the morning of Nov 27 he'd would start Pitocin and artificially rupture the amniotic sac.  If things progress slowly, he said that we could expect to have Baby mid afternoon that day; but when HB mentioned how quick active labor was for my first birth, Dr. Bronsky said it could be much quicker than that.  

As I'd rather go into labor spontaneously than wait for this little whumpus to come out on a specifically circled date on the calendar (yes, I think that is weird), I am somewhat hopeful that she'll decide to pleasantly surprise me between now and then with an awkward gush and sharp twinge of pain.  Regardless, even if I don't go into labor on my own before then, it sounds like the docs are confident that I'll be able to have the vaginal birth that I've been hoping for and for that I thank God!  With how complicated things have been it's at least nice to know that Plan A is what I wanted all along and that Plan B is there as needed... 

Since my hands are shaking and my bg is probably low that is all for now. I'll be back again on Friday with another update from the land of the overly poked and prodded.  

Love, 

Diabetic Mommy of One, soon to be Two