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 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.