Showing posts with label Non-Stress Test. Show all posts
Showing posts with label Non-Stress Test. Show all posts

Wednesday, January 7, 2015

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!

Tuesday, December 30, 2014

Week 32

Squeezing just one more appointment into 2014, today marks the beginning of my incessant trips up and down I-95 for perinatal appointments.  Starting weekly appointments, soon to be bi-weekly appointments, I went into today with my fingers crossed that we'd be able to receive more complete information about Baby #3 than we did just two weeks ago from Doctor Bronsky.  It's not that I've been worried - okay, maybe it's more accurate to say that I am no more worried than normal - since we received jack-squat in hard-fact updates, but with how hard I've been working to keep my glucose on target and my weight (and the eggs...) down all while enduring near constant Braxton Hicks contractions leaves me feeling like knowing something - knowing ANYTHING - more than last time would at least give me a context within which to frame my insomnia and compulsive (aka distracting) fiction reading.  

Having received a reminder call yesterday about my "appointment with Dr. Bronsky tomorrow at 10:00 AM," I became more anxious for answers as we walked into the, once again, full waiting room.    Realizing something must have changed with their scheduling procedures, I said a quick thank you to God that we brought GV along for the day given her compact-sized entertainment value package. While waiting... and waiting... and waiting... and waiting to be called back for my lab work, sonogram or first non-stress test (NST) of this pregnancy, GV took it upon herself to wish everyone in the room an individual "Happy New Year!" in her best Shirley Temple attempting to be Santa Claus voice.  Noting the several holiday decorations around the room, she also began a ruckus round of who's on first with me, much to the delight of the other couples and staff witnessing the conversation: 

GV: "Look Mama! My found a Christmas tree!"
Me:  "No, GV, say 'I found a Christmas tree."
GV: "You found a Christmas tree, Mama?"
Me:  "No, I didn't find a Christmas tree.  GV found the Christmas tree. Can you say, 'I found a Christmas tree'?"
GV:  "My found a Christmas tree!"
Me: "No, say 'I found a Christmas tree.'"
GV: "You found a Christmas Tree?" 
Me:  "AGH!"

You get the gist...

Anyway, eventually I am called back by the quiet Chinese sonographer and we traipse our way back to the exam room (where GV promptly insists we should look at baby via her belly button).  Knowing it's now or maybe never that we get our answers about Baby #3 for the day, we promptly start to hound her with questions about my AFI levels, his weight and size.  Happy to please, she not only provided us with another set of 3D pictures of the little one, but the cold hard facts I was craving: 

Amniotic fluid index: 30.0  (99%)
Fetal weight: 5 lbs 2 oz (74%) 
Head circumference:  32.2 CM (84% or 36 wks 3 days)
Abdominal circumference: 30.0 CM (88% or 34 wks) 
Femur length: 6.3 CM (38% or 33 wks 4 days) (huh...)

Thanking her profusely for her assistance, I head back out to the waiting room where GV and I inevitably continue our two-year old pronoun reindeer games until I'm called back for my basic biophysical profile check.  Finding my weight to be up one pound since my appointment two weeks ago and my blood pressure to be perfectly within my normal range (114/63), the nurse sticks a gigantic pink sticky note to the front of my chart reading "KETONES (++)" before sending me back to wait for Dr. Bronsky's patient que to call my number.  Another fifteen or so minutes later, we're finally shown in to his office where we sit down and I automatically tense from nerves and HB puts on his "drill the doctor" face.

"So between his weight and the AFI levels, are we looking at scheduling the induction shortly?" HB asks in a leading manner.  

"The hospital won't allow for us to schedule an induction farther than 3 weeks out," Dr. Bronsky responds barely looking away from my electronic chart. 

"Even with him measuring several weeks ahead and her amniotic fluid levels so high?"

"Well, his weight and the AFI levels are all high because you're diabetic," he explained. "We won't let you go past 38 weeks anyway." 

Feeling stung by this last comment given my stellar HgA1C, I chose this moment to chime in that my glucose is under tight control. 

"So why are you spilling ketones?" he asks over his glasses.  

Having gone hyperglycemic over night (peaked at 178 mg/dL) due to changing basal requirements and still coming down post morning coffee (sample taken while at 148 mg/dL), I showed him my glucose monitor and the absolutely minimal out of range fluctuations I've had for the past 24 hours.   Knowing his threat with GV that "if you don't get your postprandials under control, you're going off the pump and onto injections," I shouldn't have been surprised by his expression of curiosity and confusion upon seeing my CGM monitor but his limited understanding of it spewed forth in his following comments: 

"Your glucose still swings dramatically, so these complications are directly relevant to your glucose control."

OUCH.  

Even with a HgA1C in the solidly normal, non-diabetic range of 4.1 to 5.9 (currently sitting at 5.5), this comment hit me like a ton of bricks: there is absolutely nothing more I can actively do to protect this baby from my diabetes.  Regardless of my locked down diet, my minimalist insulin usage and my target glucose range of 70 to 140 mg/dL, my limited tolerance of glucose is impacting Baby's glucose  ranges (aka his macrosomia), urine output (aka my AFI levels) and delivery options (induction or c-section, here I come).   It's honestly no wonder that my irritable uterus went into an encore round of Braxton Hicks just in time for my non-stress test to start - gee, thanks doc, for the pep talk.  Fortunately, Baby showed the proper accelerations and decelerations of his heart rate so at least I have that one shred of silver lining for the day that his heart, at least, isn't screwed up because of me! 

Information wise, the appointment was a major success. Emotionally speaking, however, I'd be lying if I said that I didn't feel like I've been run over by a bus.  I so try to put everything into taking care of this little one (and the older two, of course), but today left me with this feeling of unavoidable inadequacy and, it's knock-on effect, a dreaded sense of hopelessness that I am finding difficult to curtail when faced with yet another omelet dinner...  I realize it's only another handful of weeks (GW arrived at 36 wks and GV at 38, so that puts us anywhere from four to six weeks away from show time) until we're at the finish line and fumbling now isn't worth the cost of admission, so I won't, but dang it I'm exhausted and hurt and ... 

Until next week, I guess. 

Saturday, November 24, 2012

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.