Lingering Symptoms... Lasting Fear.

It has been a long, long night.  I know that FG will continue to demonstrate symptoms of RSV and bronchiolitis as his lungs recuperate from the infection that had him hospitalized, but around seven o'clock last night his symptoms changed and scared me half to death. 

While standing in the kitchen holding a sleeping FG to my chest while chit-chatting with HB and Grandmama, I noticed his breathing become much more audible than it has been previously.  Going from the occasional wheeze and sputter to a constant deep grumbling, I placed my hand on his back to better see his face and alter his neck angle in case his position was causing the change or inhibiting his "normal" rate of breathing.  But as my hand came to rest upon his back, I felt it: vibration in his chest that corresponded with the rhythm of his inhale and exhale.  

Calling the pediatrician immediately, the on-call nurse's line promptly said "given his history and the severity of his symptoms, I need to contact the on-call physician to assess the situation."  Within a matter of minutes (rather than the typical 45 to 60 minute lag time I am used to), the doctor was on the phone instructing me to get him into the bathroom with the hot water running and to count his respiratory rate.  Knowing full well that anything over 60 breaths a minute is considered "rapid" and therefore dangerous in these little guys, I wasn't necessarily comforted that his rate of breathing was 54 breaths a minute.   Concerned by this but not "get to the ER right now" kind of worried, the doctor talked me through the process of giving FG respiratory physical therapy by banging on his back - harder than typical of a burping motion - to move whatever mucus was causing the obstruction and, therefore, his new symptoms.  

So sitting on the bathroom floor with my back to the bathtub and the scalding hot water rising into steam behind me, I pulled FG upright on my chest and began to pound on his back.  Within a few minutes, his vibrations and grumbling stopped.  Expecting this to be a temporary solution, the doctor then instructed me to continue this PT process as long as it continues to resolve the symptoms as they reoccur.  "BUT," she says, "if these symptoms return and the PT does not change them, you need to bring him to the ER immediately for evaluation." 

Thanking her and hanging up the phone, I glanced at the clock which now read 8:30 PM and knew it was going to be a long night.  Agreeing with HB that we should pull shifts to watch over him throughout the evening, we set up several humidifiers in the nursery and I settled into my Grandmother's old blue chair for the first shift.   With FG propped upright against my chest, I had to place my book down every few pages to administer another PT session but, thank the Lord, they continued to work.  But four o'clock this morning I couldn't maintain my vigil with confidence in my care so I woke HB who brewed a few cups of coffee, grabbed his work bag and relieved me to sleep until the family went to Mass in a handful of hours (which, admittedly, I have missed since going to the hospital for fear of the crowds).  

So far today, FG appears to be in good spirits and is continuing to respond well to this new routine of respiratory physical therapy.  In talking briefly with the doctor again this afternoon, she indicated that as long as we can keep the mucus moving and prevent the onset of additional lung infections brought about by mucus build-up, he should be fine and shouldn't need to be seen between now and his one month post-RSV follow-up appointments next Monday.  I'll obviously keep them on speed dial just in case, but I feel reassured (albeit thoroughly exhausted and still quite a bit terrified) by the fact that there is something we can actually do to help keep FG safe at this point.  He doesn't seem to mind all the adamant back-patting he's been getting, so from a comfort stand point he seems to be doing alright.  

I truly wish that this waking nightmare of infant respiratory issues would end and we could go back to a normal state of parenting.  I feel like we must be the only third-time parents out there who are treating their third born as if he were the first -- "Don't use that blanket, it touched the floor!" "Wash your hands before saying hello to the baby!" "No, I'm sorry, you may not meet the baby. Maybe by the time he is four." "You want me to take him where? The grocery store? Sorry, I'd rather starve." -- but after the scare we've had I can't begin to justify the risks of laxity and complaisance with any of these children, regardless of their ages.  Obviously I cannot hold GW out of school for fear of germs and GV is at that thoroughly difficult fingers-to-mouth phase, but I unapologetically feel that any unnecessary exposure that we can proactively guard against isn't worth the cost of ER admission.  I am grateful that FG "only" needs constant PT at this point, but I pray to never, ever again be in this same position. 

Food restrictions

So just when I thought life was getting a little bit easier and my pregnancy diet of eggs, eggs and more eggs was beginning to fade from memory, the follow-up appointments we've had for FG at the pediatricians have constricted my reality to a new level.   While things post-RSV wise are going well for our little angel boy, the antibiotics that he was given at the ER and over the first several days of his stay in the PICU have proven to be so strong as to thoroughly kill off the good gut-bacteria along with whatever other bad bugs may have been lingering. And although this is a minor complaint compared to the risk of facing bacterial meningitis (and therefore a call I would gladly make again), the knock on effects of this complete zeroing of the "pro" biotic scale is enough to both pity his sensitive little tummy and to rant at my rotten luck. 

Causing him to suffer from a constant case of reflux and a smattering of rashes and diarrhea, the doctors have recommended that I assist his recovery from the antibiotics by beginning a series of food restrictions to help his little stomach get back to normal.  As my diet directly impacts the nourishment he gets through breast milk, I am placed in the position of doing what he needs at the expense of my palate or forfeiting the opportunity to breast feed -- which I can flat out tell you is not going to happen.   So, starting the restrictions with all things containing dairy at last week's  appointment, the pediatrician handed me a sheet of paper with all the dietary vocabulary that, until further notice, I need to be leery of: 

Unfortunately, at the follow-up appointment we had yesterday, the pediatrician agreed with me that his symptoms of rash and copious spitting up warrant the escalation of my dietary restrictions to include soy and nuts as well.   Hoping that the combination of these three usual suspects enables his skin to clear up, his spitting up to diminish and his diapers to be more predictable, I have my fingers crossed that some combination of the three will be the key to making tummy wobbles disappear for our quickly growing little one.  

The thing that is surprising me, however, is that as straight forward as it seems like it should be to avoid all things with dairy, soy and nuts, it's a lot harder to find ready made food or ingredients that don't include these in some form or another.  Who knew that soy is in canned tuna, most breads, mayonnaise and cereals?  What's a diabetic to exercise if my go-to quick carbs of chocolate, yogurt and milk are all off limits? How the heck is a girl supposed to attack the world in the morning without a cup of coffee (the "proper" way to make a cuppa in my opinion: two scoops sugar, one part coffee, three parts milk)?  I am sure that I'll figure this out the further we get into this, but daggnabbit! 

I guess on the up side, all the proteins, vegetables, fruits and grains I can eat should be able to help me shed the rest of my baby weight, but with GW and GV sitting here next to me eating pb&j on store bought bread it's hard to see any of my own benefit from this scenario.  For the little man, of course, it makes total sense and I'm not about to cheat, but were this just for me, I'd be off the bandwagon before hitting the doctor's office parking lot! 

FG, may you never doubt how much I love you... 

Discharged home!

HB loading FG into his
carseat for the drive home. 

At just over a week on the regular pediatric unit and two weeks for this hospital stay in total, FG is finally being discharged home!  Having worked with the Pediatric Pulmonologist closely over the past few days, FG has successfully been taken off of his oxygen cannula and we know with confidence that he is now officially in what is being described as the "post-bronchiolitic" phase of this illness.  Essentially meaning that he's no longer actively fighting off infection despite the continuation of persistent visible symptoms, we are leaving the hospital feeling confident that this bout with RSV is behind us and that we know what to expect of the new normal.  He'll likely go on bobbing his head, wheezing and occasionally retracting, but unless things dramatically worsen, this is - for better and for worse - how it's going to be for the foreseeable future.  Warranting a few follow-up appointments, a serious amount of hand sanitizer to be stationed around the house and a complete bar on all visitors, we're heading home with our precious baby boy. 

Despite our homeward bound jubilation, I think HB and I are finding this experience to be a lot more sobering upon reflection than it necessarily was while we were slogging through the worst of it.  The realization that we. almost. lost. him. is weighing incredibly heavily on our minds and the commentary from our pediatricians over the past twenty-four hours has only solidified our terror rather than pacifying our in-the-moment fears:  

* Yesterday we overheard one of our doctors brief the group of rounding residents about FG's progress before she came in to fully remove him from the cannula.  As the oldest practitioner in the office, Dr Clapp has seen her fair share of RSV cases in her forty years of practical experience.  "But," she says with stern authority as she points to FG's room, "this is the worst case of RSV in a two week old that I have ever seen."  

* Then this afternoon, upon finishing his final exam and just before signing the release papers, Dr. Fox - the same practitioner who initially saw FG before calling 911 on February 26th - was bantering happily with HB when he casually expressed his sincere relief and surprise that FG made it through the first night at the hospital.  Not having realized how close to death our health care providers considered our son to be, those initial hours of overwhelming ignorance and shock feel all the more painful in hindsight despite the distance we're placing between ourselves and that time and place.   

It's only now that I am sitting here in the living room watching FG peacefully sleep in his baby swing that I have begun to comprehend what those words mean and the implications of their occurrence.  Heck, it's only now that I am fully processing the meaning of the repeat question we'd received about  altering his baptism schedule. The little life of my newly one month old could have been taken from him and the glue that his presence is that my life together could have vanished.  I do not know the soul-consuming grief that it must feel to loose one's child, but the empathy I have from this near death experience for those who have... leaves me breathless and at a loss for words.   

There is no fiber of my being that I wouldn't trade to save him were I to choose him or me.  There is no amount of holding and hugging and kissing of this baby that will be enough to satisfy the physical manifestation of my love for him.  There is nothing in my life that is more important nor is there anything else that I have or will contribute to the world that I am as proud of than him and his siblings.  I cannot bring myself to the mental brink of disaster that the "what if" question presents, but, thanks be to God, today is not a day that I need to find out the answer to such a horrific question.  

Resting post hospitalization.

Transferred to Peds

HEAR YE, HEAR YE!  We have great news!! After six days in the PICU, FG was finally considered stable enough to be transferred to the regular Pediatric Unit of the hospital two evenings ago.   Having reduced his oxygen levels down to 4 Liters and 21% - which is equivalent to what we're breathing plus a slight puff of humidified pressure to ease his work of breathing - the Intensivists took out his feeding tube, allowed me to nurse and decreed his stats no longer warranted intensive care.  

THANK GOD!

Now that we are over on the regular floor, FG is back under the care of his regular pediatrician's office and one of the attending physicians will be visiting him daily until they decide that he is ready to be discharged.  Finding that he is still having some difficulty breathing - he is continuing to bob his head, retract around his clavicle and in between his ribs, work quite hard to nurse and gasp or wheeze when his oxygen is reduced too much - the main doctor following his case has prescribed a reduction of 0.25 liters of oxygen per day to ensure a slow and smooth return to unsupported respiration.  We understand this is exceptionally slow and, as such, we've been battling the residents who continue to aggressively come in and attempt to fully remove his oxygen, but with understanding nurses, a gigantic "DO NOT TOUCH HIS OXYGEN!" note on his file and a respiratory therapist visiting two times daily he continues to get the care that he requires despite the occasional treatment plan battle.

One of the respiratory therapists has submitted a request for us to receive a specialized consultation with a pediatric pulmonologist in the next few days, so that examination will provide quite a bit of comfort and insight into what we're still dealing with and what we have to look forward to upon returning home.  It is my understanding that this lung specialist is one who is quite familiar with our pediatrician's office, so I am relieved to be broadening our long term health care team for the better.  We shall see what comes of his visit.

The final bit of good news to share is that, since we're no longer in the PICU and barred from receiving visitors under the age of 12 years, FG and I are finally able to see and hug his siblings.  Having only seen them over Skype (I still haven't left the hospital and likely won't), GW, GV and Grandmama were a very welcome addition to our otherwise monotonous environment.  They were quite curious about the medical gadgets, how to "order" toys via the call button, what cookies were deliverable with our dining trays and that allusive magical question of "when can he come home?"  We've assured them that discharge will happen and that it looks like it will be sometime next week . Quite adorably, they reassured us that homecoming can't happen soon enough to suit their tastes as they miss their (their emphasis, not mine) baby brother.

Me too, kids, me too.

So what is RSV?

I’ve been writing about it for a while now, but what exactly is RSV?  Have you heard of it? No? Not surprised, neither had I.  

Respiratory Syncytial Virus, or RSV, is as common as the common cold — in fact, it’s so common that most of us get it each year and merely acknowledge it as a prolonged, miserable cold rather than by name.  But while RSV can be dismissed with a few tissue boxes and a degree of annoyance by us adults, little guys with little airways are at a greater risk of complication and may require hospitalization due to the severity of its symptoms.  What makes it all the more terrifying, in my opinion, is that most of us aren’t even aware of RSV as an illness until we’re standing in the ER confronted with it in it’s full severity despite the fact that the CDC reports that all children - and therefore all parents - will have had at least one RSV infection by their second birthday. 

When a child is exposed to the virus, it takes 3 to 6 days of incubation before symptoms really begin to appear.  Initial symptoms of RSV are consistent with a minor cold:  runny nose, decreased appetite, cough, sleepiness and irritability.  Although this is sometimes all that occurs, in premature babies and infants under the age of six months the virus’ mucus begins to build up in their tiny airways and inhibits their ability to breath. So as the virus keeps escalating in severity until day 5 to 7 after symptoms first appear, it isn't surprising that the CDC reports as many as 25 to 40 of every 100 cases progress into full on respiratory infections such bronchiolitis or pneumonia with additional symptoms of fever, wheezing, rapid or difficult breathing and a blue-gray “dusky” tinge to their skin due to a lack of oxygen.  And seeing as infants are unable to adequately move mucus from their lungs on their own and home suctioning techniques have a limited scope of efficacy after a certain point in the virus’ intensification, it is estimated that there are over 125,000 infant hospitalizations for RSV in the United States on an annual basis.  And out of these acute cases, as many as 25 out of every 10,000 cases result in the death of babies under the age of 12 months. 

For those children who survive the average 1 to 3 week hospital stay for RSV(+), the long term consequences for such early exposure to it leaves them vulnerable to repeat infection and additional medical complications later in life, particularly asthma.   Unfortunately because RSV is a persistent virus that is contractable at any time of year there is no slack time for these little ones to develop their lungs and airways without risk of exposure — HOWEVER, there is a much lesser likelihood for those babies born between the months of May and September to become infected as newborns (defined as birth to 3 months of age) whereas those babies born in “peak season” are not only more likely to become infected but to suffer from repeat infections within the October to April timeframe.  For late RSV season babies like FG, the risk of infection does diminish for the summer months, but as they’re still infants for the majority of the subsequent RSV season and their respiratory systems are left vulnerable from the first infection, their risk for another severe infection is again heightened and worthy of professional concern.  

So, what can we do about RSV? 

Treatment wise, you’ve seen pretty much what there is to offer with the support FG is currently receiving:  external oxygen, breathing treatments and suction.  Premature babies under the gestational age of 32 weeks may be able to receive a drug by the name of palivizumab that can help prevent the development of serious RSV, but it does not outright prevent infection with RSV and it cannot cure or treat children already suffering from RSV.  It is also good to know that for the majority of older babies insurances do not cover the palivizumab and it is, unfortunately, largely cost prohibitive without their financial aid.  Prevention is then the only thing we as caregivers and responsible communities can address.  

So how do we prevent RSV?

* Avoid exposure. Limit your contact with people with fevers or colds, this is especially important for premature babies and all infants in the first two months of life.  Indirect or direct contact with infected nasal or oral secretions (i.e. through kisses, shared drinking glasses or “high touch” objects) causes avoidable transmission. 

* Avoid transmission.  People infected with RSV are contagious for 3 to 8 days, however, some babies with weakened immune systems can be contagious for as long as 4 weeks.  If possible, children and adults demonstrating infectious behavior should refrain from participation in group environments and contact with high risk populations: infants, children with compromised immune systems and the elderly. Techniques to avoid transmission include: 

* Wash your hands frequently.  Do so particularly before coming into contact with babies, before and after exposure to large groups of children in a school or day care environment, and teach your children the importance of hand hygiene.  It is also a good idea to avoid touching your face between opportunities to wash your hands. 

* Cover with your elbow when coughing and sneezing. RSV can be spread when an infected person coughs or sneezes into the air, spreading virus-containing droplets that linger in the air and contaminate surrounding surfaces.  Other people become infected when the droplet particles contact their nose, mouth or eyes.  

* Keep things clean.  Make sure that all “high touch” surfaces in your home are regularly disinfected; such surfaces include kitchen and bathroom countertops, sink faucets, doorknobs, stair railings, toys and phones.  Also ensure that all used tissues are properly discarded right away. 

* Further proactive prevention techniques include avoidance of crowds, consistent disinfection of children’s toys, regular washing of bedding and clothing, distinction between “outside” clothes and “home” clothes for older siblings.  Also enforce zero tolerance for smoking in your home and around your baby as infants who are exposed to tobacco smoke are at a higher risk of contracting RSV and more severe respiratory infections. 

So what?

At this point in our crash course education on RSV, HB and I are feeling thoroughly flummoxed that something so common and universally applicable could be so utterly foreign to us as parents and as self-identifiying educated, health conscientious Americans.  I mean we pay close attention to what preservatives and chemicals go into the food we purchase, we know the difference between a carbohydrate and sugar, we use sunscreen, we model healthy exercise behavior for our children, and they regularly wash behind their ears... and yet, the sniffles have completely taken us out at the knees.  The post-traumatic correlation between ignorance and guilt that is besieging my conscience as I stand here watching FG breath in his sleep is enough to bring out the white flag of surrender and promise this little guy a lifetimes supply of cartoons and chocolate to make up for what, I feel, is an unacceptable oversight on my part.  Instead of feeling retrospectively slothful, I could have done more of the preventative steps to ensure his safety... and instead of being blind sided, I could - should - have known what we were up against and recognized the signs of danger sooner than the eleventh hour.

But, all self deprecation and guilt-assuaging aside, I know the enemy now and I sincerely want to take this opportunity to get the word out to you brave souls resiliently reading my rambling because, Lord help me, RSV is the worst thing I've endured -- and I'm not even the one who is sick!  RSV is no joke and, even if you aren't around a little guy on a daily basis, I guarantee someone you come into contact with is and they - we - cannot afford to see something as seemingly harmless as a "cold" rip our world asunder with the loss of that which is most important: our children.  Please educate yourselves and those around you about the Respiratory Syncytial Virus and, as a village, help keep these little innocents safe from this all too real, all too prevalent boogieman.

To learn more about RSV please check out these additional resources: 

        * The CDC website for RSV prevention and treatment as well as their Podcast by Dr. Eileen Schneider

        * The comprehensive RSV Protection website for premature babies and infants

        * The Mayo Clinic definition and explanation of RSV symptoms, risk factors, complications and treatments

PICU Update

Last Thursday evening, FG was admitted to the hospital with RSV, bronchiolitis, a partially collapsed lung and a whole list of "could be, so we'll treat for it to be on the safe side" illnesses.  Initially put in an isolation room on the regular Pediatrics floor, the first several hours of treatment and attempted stabilization demonstrated that FG had a greater need for external support than the wing could provide and necessitated that he be transferred to the Pediatric Intensive Care Unit.  Moving over here first thing Friday morning, we've been camped out here ever since watching his little chest rise and fall.  I have yet to leave his side for more than the occasional trip to the bathroom (which is soberingly located over on the Pediatric Oncology Unit) while HB has made the long trek home a few times to check on Grandmama, GW and GV.  They, thank God, are hanging in tough with support from some wonderful local families (SP, you are an angel), but it's tough explaining to them what's happening here as things with FG are still quite tenuous. 

Beginning his treatment with 8 Liters of heated, humidified High Flow Therapy at 40% FiO2, the PICU Intensivists have explained that it's still too early to know where FG is in the 10 to 14 day life span of the Respiratory Syncytial Virus.   Knowing the worst symptoms typically come between days 5 and 7, the doctors are unsure if he's past the peak and will remain as he is for a few more days before progressively getting better or if the worst is yet to come...  as he is currently maxing the High Flow treatment option, we're playing the high stakes game of wait-and-see if escalation to the CPAP (Continuous Positive Airway Pressure) mask or intubation becomes necessary over the coming days. In the mean time, the doctors have started an EZPap therapy that uses positive airway pressure to force lung expansion and reinflate his collapsed lung as well as an almost constant routine of nasal and deep suction to remove excess mucus. You can imagine how miserable both of these treatments make FG... poor little guy.

We're also struggling to keep his feeding tube accurately placed in his stomach.  His many leads prevent him from wearing the hospital's mitten-onsies and, with his fingers exposed, his comfort position of his fists near his cheeks enables his ninja-like paddy paws to pull both the cannula from his nose and the feeding tube from his stomach.  And while I'm concerned about the bright red, raw color of his cheeks from the abrasion of his cannula's adhesive, the constant delivery of oxygen and his ability to stay hydrated and nourished trump the superficial irritation and have required some ingenuity with socks and careful use of A & D Ointment to address all of these concerns.  I'm sincerely hoping that the socks will at the very least save him from the unnecessary discomfort and additional radiation needed to insert the feeding tube for the fourth time.

One bit of good news at this point is that the final results of the spinal tap culture came in earlier today and the doctors now know that he is not sick with bacterial meningitis as they initially feared.  As illnesses of this kind of severity move incredibly quickly in babies this young, the ER doctors didn't want to loose critical days waiting for the results if the tests had been positive so they'd placed him on a multi-day course of a broad spectrum antibiotic that would kill any and everything that could possibly be making him sick.  As we're now certain the cause of all of this is viral, I'm thrilled he'll be skipping the next couple doses of medication as only time will tell how his body and the good bacterial will respond to such strong antibiotics.   

More to follow.  

Emergency Hospitalization

As the mother of three, I came out of the delivery room onto the maternity wing of the hospital as a well seasoned, veteran parent.  Treated far more deferentially than a first time mom by the nursing staff, I was given space to do my thing with our newborn and, right from the get go, I felt confident and comfortable with my knowledge, skills and the idea of introducing our latest addition to the wide world.  And given all of the experience his active, outgoing and curious older siblings have provided us over the past five years, I doubted there was anything that would surprise me as we brought home our perfectly healthy, full term baby boy.  

Unfortunately, I was wrong. Horribly, horribly wrong. 

GV circa 02/2013

While we were at the hospital for the induction and post-delivery day, our oldest boy came home from his Valentine’s Day party with a bit of extra pre-school love in the form of a cold. Congested and occasionally coughing, it didn’t raise any significant red flags when he shared his germs with our daughter (sure, they fight over the train, but this they share) and she too came down with a case of the sniffles.  Knowing it’d be unpleasant for the baby to need aspiration, we asked the big kids to wear masks and wash their hands, but despite our best efforts to contain their symptoms, their excitement about the baby resulted in not only the introduction of them, but of their congestion to FG as well. Starting the sick-little-guy routine, we turned on our humidifiers, administered saline and sucked the increasingly green mucus from his tiny nose with the notorious, yet incredibly handy NoseFrita (and, for the record, the poor kid does not like aspiration the way GV did).  So already sick for the first time going into his two week well-baby appointment, the pediatrician discovered that FG had a nasty ear infection to which she prescribed an antibiotic and instructed us that “if he’s not better after 24 hours or if he develops new symptoms, call back.”

Later that afternoon, HB and I found ourselves independently looking at FG thinking that his color wasn't quite right - he seemed almost grey.  Finding a change in position to resolve the issue or that the artificial lighting from one room to the next was largely to blame, we administered his first dose of antibiotics in hopes that the medicine would diminish his symptoms by the morning thus calming our overtired nerves and trigger-happy fears.  Sharing our concerns briefly before bed, we agreed that FG wasn't demonstrating other red flag behaviors - poor nursing, infrequent diapers, difficulty waking up and ferver - and that we'd keep a close eye on him if and when things changed.

The following day, I attempted to nurse FG every so often but found his latch to be weak (he'd had a frenulectomy at his well baby appointment the day before, so I wasn't terribly concerned) and his general demeanor to be sleepy.  Given that he's still quite new and supposed to be sleeping a lot, I didn't begin to aggressively attempt to rouse him until early afternoon.  Using our typical wake-'em-up tickle up the spine or diaper change tricks to no avail, I told myself not to panic and I began to escalate my pestering techniques - ultimately putting his head directly under running ice cold water - only to have eye lids flutter in minimal response before returning to a deep sleep.  When HB walked through the door shortly there after, I presented FG to him and, while difficult to be sure given the overcast, grey light of the day, we agreed that his color was off again and that the confluence of symptoms he was presenting warranted a follow up call to our doctor. 

With a "come directly here or get to an ER if things get worse" response from the triage nurse, HB hastily buckled our baby into his car seat as I scrambled to get our oldest to tell Grandmama we were leaving - immediately.  Sitting in the back seat of our car watching for any change to his breathing patterns, HB ignored the speed limit on I-95 and got us to the doctors office in about two thirds of the time it usually takes to get to NOVA.  Dropping me at the front door with the car seat, I bit back tears of fear as I impatiently rode the elevator to the right floor.  Walking in, the receptionists didn't ask who I was but quickly glanced at FG and said to "let the doctor know he's here." 

Escorting me back to an exam room, the nurse began to run through the typical baby appointment routine: "Okay, let's have you take off his outfit and get down to a dry dia..."  But she cut herself off mid-sentence and dashed from the room.  Seconds later three other nurses and the pediatrician were entering the tiny room with muddled looks of it's-okay-mommy/holy-shit on their faces.  Ordering for oxygen, a nebulizer and a pulse oximeter, Dr Fox held a stethoscope to FG's chest as HB joined me in the exam room.  

Directing his comment to a nurse "His pulse-ox is 61.  Call 911."

The next several minutes were a blur as firefighters and paramedics streamed into the room with what seemed to be an endless repetition of questions as they loaded FG back into his carseat and prepared to take him by ambulance to Fairfax INOVA.

The last time I rode in an ambulance was when I had the placental abruption during my second pregnancy and, while that was scary, this trip was far worse.  As the patient, all you can do is lie there, watch the lights and attempt to remain stable with whatever willpower you can muster; but as the caregiver who is, literally, along for the ride it is the most helpless, terrifying experience ever.  Just listening to the sirens blare and watching the other vehicles through the back window as they jockeyed to regain their spots on the road made me realize the preciousness of time and unleashed a torrent of regret and what if's... regret about not bringing him back to the doctor the previous day and not going directly to the Emergency Room... and what if... if... if...    

Upon getting to the Pediatric ER at Fairfax INOVA, a team of nurses and physicians swarmed our son.  Informing us that they were completing a full respiratory work-up and beginning worst-case scenario treatments to stem any serious illnesses before they have a chance to gain a leg up on treatment options, we could only stand by and attempt to comfort our baby as the doctors took x-rays, ran an EKG, took blood samples and drew a spinal tap.  

With cables and cannulas, needles and vials, cuffs and Lord knows what else coming and going from the room with various scrub-clad personnel, HB and I were in an overwhelmed trance when a sort of celebratory "whoop!" went up as a nurse reported some results to the team attending FG:  "RSV POSITIVE!" 

Taking us aside, one of the two pediatric trauma physicians in the room explained:  "So what we're looking at here with Baby F is a case of RSV - Respiratory Syncytial Virus - which is pretty serious, but the best answer we could hope for; okay? From what we can see on his x-rays, he has a partially collapsed lung which is typical with this disease and, since this is viral, there really isn't anything more than oxygen that we can do to get him through this. We're ordering him a bed upstairs right now and, hopefully, you'll be able to go home sometime next week." 

... processing... processing... processing...  

Our two week old has a virus that just caused one of his lungs to collapse, to loose almost 40% of normal oxygen saturation and to require a cannula to keep him breathing until it passes?  Right, gotcha. 

He's been upstairs in the Pediatric Intensive Care Unit (PICU) for a day now and, while he appears to be stable, I can't help but perpetually rationalize to myself that the ICU isn't some place they send patients as place holders... The reality is he's sick.  Very, very sick.  He needs oxygen via cannula to breathe which, preventing him from nursing, requires a feeding tube  into his stomach.  He is on a one nurse to two pediatric patient ratio and is visited at least four times a day by an intensivist attending or resident... in other words, he's exactly where he needs to be, getting the exact care that he requires and all we can do is wait for the worst to be over.

We simply pray that is soon. 

3 Minutes. 9 Pounds. No tearing.

So I have someone simply wonderful and absolutely perfect to introduce to the word: FG!

Born on Wednesday, February 11 at 3:55 AM, he surprised everyone on the labor and delivery floor by coming hours earlier than we anticipated.  Starting the Cytotec, a cervix ripening drug, at 9:00 PM, the nurse briefed the treatment plan that I would receive another dose every three hours until 6:00 AM when I'd have the option of an epidural before starting Pitocin at roughly 7:00 in the morning. Not having decided if I wanted an epidural this go around or not, HB and I nodded in acknowledgment of the schedule as we followed the nurse out into the hall way to begin our ritual of walking the baby out.  

Getting a bit too crampy and too tired to continue our laps by 11:30, we went back to our room where the nurse began to encourage me to take a dose of Ambien and Tylonal so I'd be able to sleep comfortably after receiving my next dose of Cytotec.  Decline both of these medications, the nurse administered the second dose of Cytotec and reported that I was slowly progressing and only 1 cm dilated before turning out the lights and leaving HB and I to a) stew about my lack of progress and b)  sleep.  

A little after 1:30 in the morning, the contractions changed and I couldn't sleep through their frequent and rising intensity.  Thwacking HB with my pillow to get him to wake up (did he take my Ambien?), he helped me to the bathroom and gradually began to look at me with consternation as I went from "me" to "cranky" (his words, not mine).  Attempting to breath my way through the pain, I finally asked HB to go ask the nurse for that dose of Tylonal she'd offered... finding that she was on break, the back-up nurse assigned to my room, Debbie, came in with the small pills and immediately asked if I wanted to consider that epidural. 

Feeling like a complete wimp for not having made it remotely close to 6:00 before giving in on the pain and accepting the drugs, HB translated my non-comprehensible grimace and whimper as an articulate "yes, please" and the nurse called for the anesthesiologist at 2:45.  Gathering supplies and bouncing back and forth from the hallway - before double checking my dilation - it was 3:30 by the time the back-up nurse began to register the look of concern on my face and  helplessness on HB's. 

As the anesthesiologist began to prep by lumbar spine for the epidural placement, I was beyond my own abilities.  Unable move due to my own tension, HB and Debbie helped me sit up and breath calmly though the first series of needles. Looking at Debbie the whole time, I told her in no uncertain terms that "I feel like I need to push - I'm not - but I feel like I need to."  Having not checked my progress yet, she had no idea what we stage of labor we were actually looking at and could only respond by parroting that I not push.  Within a few seconds of the large gauge needle being inserted into my spine, however, I couldn't wait for the actual medication to be administered and I flat out said "I don't trust myself - I have to push NOW!" 

Helping my lie down, HB and Debbie found the baby fully crowning.  Sending the anesthesiologist into the hall for reinforcements, he returned a moment later with the closest thing he could find to my doctor: two random residents and my primary nurse.  With minor instructions and as much encouragement they could find amid the general shock of the unexpected, the baby's head, his shoulders and then his body along with ALL of my amniotic fluid were out within 3 minutes.  Without tearing. 

Unfortunately for the residents, it was only after my water broke following delivery that the nurse remembered to state: "Oh, yeah, she's poly."  

Collectively feeling like what just happened was completely surreal, the nurses quickly began working on the Baby - who didn't start crying immediately - as the residents cursed the late arriving polyhydramnios warning as they delivered the placenta and collected the pieces necessary for our cord blood kit.   

"Holy cow! He's nine pounds and sleeping!" laughed the nurses from the warming table.

Bringing him over to me, the nurse casually informed us of the NICU nurse lurking in the hallway due to FG's low blood sugar levels of 34 mg/dL.  Having talked with our nurse earlier in the evening about our intent to correct his hypoglycemia ourselves with nutramigen upon birth, she bought us some time as HB held our newborn skin-to-skin on his chest and dripped the formula drop by drop into the baby's mouth.

Requiring that FG's blood sugar above 50 mg/dL in order to prevent his admission to the Neonatal Intensive Care Unit, it was half an hour later that we anxiously watched the nurse prick his heel and apply his blood to the glucose strip.  Feeling like the resulting two seconds of processing was closer to two hours, there was a collective sigh of relief when the number 51 finally appeared upon the screen.  Happily dismissing the NICU nurse to return to her other charges, the labor and delivery team put our paperwork together and transferred our care to the maternity ward where we were generally left in peace by the staff given our "veteran" parent status.

Spending the following 24 hours going through the typical newborn routine, he received his first round of vaccinations, his hearing exam (which, unfortunately, he failed), bilirubin checks (slightly elevated) and his first pediatrician visit.  The pediatrician indicated some concern over his red color (likely a result of elevated hemoglobin levels) and his hips clicking (likely caused by his position while in utero), but indicated that the various abnormal results could be resolved with time or on an out-patient basis.  Otherwise granting a clean bill of health, the doctors found FG fit enough to  earn us a discharged ticket home.

Now that we're here... life with three kids will certainly take some time for us to get accustomed.  Upon walking in the door and introducing the baby to big brother GW and big sister GV, we found ourselves swimming in the deep end as FG promptly peed on the couch mid-diaper change as GV went into a full-on overtired two year old tantrum and GW raced about the house showing off his latest drawings and demonstrating his race car speed for his new brother (it was only on lap number three that he slipped on the hardwood in his socks and began to cry after careening into a cabinet).  I think things will be just fine when we develop our new rhythm, but for the mean time, I'm going to let the contentment of my post-delivery glow and a touch of mommy-brain carry me through.

Happy, happy, happy Mama!

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!

Breastfeeding in Virginia

So as one of three remaining states in the Union that does not outright protect the rights of breastfeeding mothers, the legislature of the Virginia Commonwealth took to voting yesterday to change state law to benefit lunch time.  As it currently stands, it is perfectly legal for mothers to breastfeed their infants on state-owned property in Virginia, but if she is breastfeeding - covered or otherwise - on privately owned property it is legal for the proprietor, employees, volunteers or whomever of that establishment to demand the mother stop nourishing her child or face enforceable eviction.   But the vote is in and that archaic law has changed!

Having largely become an issue due to uncomfortable individuals accusing mothers of introducing "biohazardous" materials in public venues,  it has long befuddled me how something so natural and completely innocent could be misconstrued as dangerous, lewd or "disgusting."  A baby needs to eat just as the rest of us do and I don't see non-closed mouth chewers facing the same social commentary about their preferred eating method despite the truly displeasing sight their public mastication presents.  But while it may, to some degree, be justifiable to politely ask such individuals to shut their faces, the difference I see between their choice to share their meal with others and breastfeeding in the public sphere is that a mother doesn't choose when her child must feed or where God made her milk come from.  I cannot tell you how infinitely more convenient I would find it to nurse with a finger or something that would enable a wider wardrobe, free my mobility and save my favorite shirts from the accidental leak or lanolin stain.  But, as it is, the breast was made for the purpose of feeding and the fact that we have attached a sexualized stigma to it or socially distanced ourselves from the source of our food (hello, that nugget you're eating is actually chicken; yes, as in "cluck cluck") doesn't diminish the function or utility that God intended of it.  Breastfeeding is beautiful and not something to be regulated.

As I am heading in to have baby #3 in a few short days, this victory for breastfeeding mothers couldn't come at a more prefect time.  I plan to nurse this child just as I did with the first two and, while I prefer to cover and keep the breast-formed bond between me and baby private, I am so grateful that the state has taken the next step to protect a mother's rights to nourish her infant and in doing so combat the discrimination that was no less ignorant than past issues of class, religion, gender or race.  There is so much pressure to make this decision or that choice with regards to how we act and how we raise our children that this new law makes me, as a Mom, feel greatly more empowered to do what is right by my children without fearing that my actions will result in unnecessary drama or legal trouble simply by feeding outside the home.   I've known in my heart since the first day my oldest was born that breastfeeding was right for me and right for our family, but having someone beyond my husband and my intimate friends accept and understand that was a reach -- until now.

So, thank you, Virginia, for the birth day gift you've given me and my new son.  You can bet we'll celebrate your twenty-first century solution the next time errands and snack time just happen to overlap.  

God Gave Me You.

In a moment of impatience to have more contact with the little man, I asked HB to pull out our fetal doppler last night so that we could listen to Baby's heart beat.  Having been relatively quiet for the afternoon with only the occasional hiccup or jab to my ribs, I figured the rhythmic drumming of his heart would bring a calming bedtime reassurance that - even if labor hasn't started, yet - he was hanging out and happily doing his thing.  

Covering the probe tip with the sea-green gel, HB placed it with acute precision on my belly and immediately we began to hear Baby's 131 beats per minute.  But then, all of a sudden, something weird happened... the heart beat stopped and in its place came the unmistakable lyrics of "God Gave Me  You."  Having never before heard this machine transmit radio frequency in the combined 27 months we've used it for our three pregnancies, this change of pace took both of us by surprise...  

Now, the truly funny thing about this is that about two or three months ago, HB and I were talking about the personality niches that our kids fill and speculating about what Baby #3 would choose.  Taking the lead as first born, GW, who has recently become known as "G Wiz" at our house, is incredibly smart, very high energy and beyond compassionate.  Translating that into his actions and aspirations, he's taken to discussing that when he grows up he wants to become one of the firefighters that goes into the Twin Towers on 9-11 (we watched the footage together to help him understand an event we were hosting and he thought the first responders were the most heroic men and women he's ever seen).  While the issue of time travel hasn't been broached and, as his mother, I appreciate his sentiment but would really, really rather he did not pursue such... selflessness... it does fairly well summarize his unique personality.

Following in her big brother's footsteps, GV is similarly brilliant, curious and exceptionally happy - the combination of which she expresses in most creative of ways.  Quick to apply her knowledge and understanding of the world around her (me: "what's this letter, GW?" / GW: "I don't know" / GV: "That's an 'H,' Mama"), she recently dubbed herself "Princess Pee" as a result of her combined interest in the PBS children's show "Super Why" and toilet training.  Given that HB loathes all socially driven princess-phenomenon things, it's hilariously entertaining to hear his accolades emanating from the bathroom for her appropriate application of the moniker.  Proving herself cunning with with words and humorously attuned to the attitudes of people around her, I have no flipping clue what she'll become as a grown-up, but I have zero reservations about the broad scope of possibilities.  

Coming to Baby #3, I'll admit that I have been not-so-secretly hoping that this little one might select the laid-back, easy going and plain-ol'-chill personality niche that we have yet to witness.  Knowing full well that he already looks very much like both his siblings, combining their brains with a bit more tranquility wouldn't be such a terrible thing to my mind... But do you think that'll happen?  Well, let me just tell you optimists out there a little story before we draw any conclusions... 

So there HB and Grandmama were, no shit, sitting in the kitchen watching Saturday Night Live music videos.   Not so much a music fan myself, I was flitting back and forth doing Lord knows what about the house as they went from one random band to the next - Neil Young, Aerosmith, Willie Nelson, LL Cool J - clearly proving no linear taste whatsoever. Now, you'd expect my Mother and HB to skip certain videos for others with actual musical substance, but no, giving all musicians their artistic license they set about listening to all the songs that popped onto the play list.  Tolerating some songs and meeting others with complete annoyance, I was nothing but stunned when Baby not only woke up, but actively started to kick along with the steady beat (aka noise) of Kanye West.  

So, to answer my own question, no, I don't think I'm in for a peaceful little guy this go around.  Given his musical interest - and questionable taste - at this in utero stage, I think it's more likely that I wind up with G Wiz, Princess Pee and a rapper than I will with any other unfilled personality niche, desired or otherwise. 

Bringing this all back to the doppler last night, you can see the irony in the first time presence of music emanating from my belly.  The fact that it was country music rather than Snoop Dogg or whomever else HB has been playing lately and that the song had relevance to the 1 Samuel 1:27 bible verse "for this child I have prayed; and the Lord hath given me my petition which I asked of him" was frankly awesome.  I'm so excited to meet this little man in the next week (can you believe it?!) and to see who he's going to become... rapper or not, serene or not, he's my baby and for that I love him entirely.

Week 37 Update

With yet another week gone and still no arrival of baby, HB and I found ourselves in NOVA for another MFM check up today.  Doing one last non-stress test, sonogram and pelvic exam before going ahead with the planned induction next week, the morning's check ups made me feel both more confident that we have a plan and less sure that we'd actually go through with it: 

• The NST was reactive and perfect.  The nurses had the radio cranked up loud and while it wasn't Blake Shelton or Kanye West, Baby seemed to find the additional ruckus worthy of contributing phenomenal heart rate acceleration and a down right wiggly performance.   Showing a content and thriving baby, this test doesn't guarantee a thing in terms of when labor could or will begin but it does indicate that he's doing exactly what he needs to be doing without distress so proactive action before induction isn't necessary.  
• The pelvic exam was more or less the same as the last several weeks.  Slightly dilated and partially effaced, Baby wasn't showing much interest in making an "early," unscheduled exit as he is still floating - or perhaps he is swimming - at minus 2 station.   Requiring that I come back again next Tuesday morning to see if a cervix ripener would actually be necessary later that evening or if I could skip the evening check-in and proceed straight to Pitocin on Wednesday morning, the exam generally seemed to reinforce our plan for induction. 
• The sonogram, however, indicated that next week's plan for induction may be a pipe dream for predictability.  Knowing for at least one fact that it'll be messy, the sonogram showed that my amniotic fluid index levels had further increased from it's previously "high" measurement of 28.6 cm.  Taking three measurements of the fluid pockets in the four uterine quadrants - 40 cm, 36 cm and 38 cm - to create a best-guess average of 37.8 cm, my case of polyhydramnios (or, as my belly has  come to be called, "poly") is much more significant than earlier in the pregnancy.   

The situation with polyhydramnios is that by week 35, fluid levels should begin to drop rather than increase which would indicate that complications upon membrane rupture may be more likely - for example, umbilical cord prolapse and prolonged uterine hemorrhage post-delivery.  As most pregnant women have an average of 14 cm of fluid around this point of the pregnancy, poly cases are classified as any AFI higher than 25 cm of fluid - which means that last week's measurements had me as a minor case, whereas this week we've been bumped up to "severe." 

While far from reassuring that things will play out smoothly in this last week, the good news from today's appointment is that the worst-case scenario involving polyhydramnios - fetal death - isn't a high concern for my doctors given the fact that the NST results are exactly where they ought to be.   I'm feeling somewhat hopeful that things will continue to be as uneventful as they have been these past several weeks and that we'll repeat our mommy-daddy "date night" of induction next week just as we did with GV, but only God knows what is really in store.  

Either way, Baby in bound in T-minus 7 days or less.  

Week 36 Update

Feeling like a rare treat after the last month of solo-trips to NOVA, HB came along with me to the Antenatal Testing Center yesterday since it seemed plausible that Baby's so called "any minute arrival" could prompt an early check in to my labor and delivery suite.  But instead of encountering baby-induced (harhar) excitement or the prompt test-test-doctor visit rhythm I've become accustom to over the past several weeks, this appointment was short on facts, long on time and unsettling in it's general execution.  

Waiting ages before starting the non-stress test, the nurses left Baby and me on the monitor for 38 minutes - almost double the time required for an accurate pass or fail assessment.  Granted, the machine kept mixing my heart rate in with the baby's and would drop from a fairly consistent level of 130 beats per minute into the low 60s for a half second here and there, but by and large the requisite five accelerations were appropriately high and lengthy to excuse me at the 20 minute mark.  So, although it was fun to watch the monitor together and listen to the whub-whub-whub of his heart for a little while, it was no surprise to me when I looked up from my book halfway through the NST to find HB asleep and snoring.   (If only I'd had my camera within reach... dang it!)

After finishing the exam and sounding the alarm that, once again, it's time to wake-up for the day, HB and I marched ourselves back out to the waiting room to do just that: wait.  A considerable amount of time later, a sonographer I didn't recognize called us back and instructed me on just how to lie down for an ultrasound... lady, this is the 15th sonogram I've had with this pregnancy alone, I believe I know what I'm doing and, if for some reason I don't, please hold my sign.  

Beginning with the scan, she did a quick biophysical profile (8/8), an amniotic fluid index check (28.6) and then announced that we'd be doing fetal measurements.  Having just done these last week and knowing that the doctors try to keep such measurements to at least two to three weeks apart at this stage, I was a bit surprised to hear this, but who am I to argue? More information is more information - go right ahead! 

Finding he'd barely put on a few ounces in the six days since my last appointment, I at the very least felt comfortable going into my doctors visit that I'd maintained the option of a scheduled induction for one more week rather than propelling myself forward as a volun-told c-section candidate.  Taking a minute (or twenty...) to breath a sigh of relief, we watched GW's favorite chef, Michael Symon, on The Chew as waited to see which doctor would eventually call us back... 

Shuffling out from his office with an air of exhaustion, the doctor looked at me with an expression of amused surprise and asked: "how are you still pregnant?" 

Feeling like maybe there was a reason for the extended testing for the morning and that maybe, just maybe, he was asking this because things were obviously progressing to the point that it might have been thoroughly fortuitous (as opposed to great planning) to have HB tag along today, I responded that "I'm not entirely sure."

Sitting down at his desk, he looks at my chart and says: "Oh! That's why! You're 33 weeks."

Wait, what? HB and I looked at each other in utter confusion and attempted to correct the situation stating that, no, I'm 36 weeks and my due date is February 21.

Adamantly arguing the facts listed before him, the doctor continued: "Yes, this says here that your due Feb 21 and that you're 33 weeks."

Attempting to read the upside-down ultrasound report from across the desk, HB craned his neck to look at the  information detailed on the paper.  Noting the date on the top line, he says, "um, that report is dated the beginning of January."

Reviewing that "minor" detail, the doctor responds with a simple "oh" as he began to shuffle papers and click through my electronic chart.

(Seriously?!)

Promptly following this, um, reassuring remark with a series of yawns and additional confusion about what report details today's exams ("no, that's still the old one, Doc") we finally got down to the business of being 36 weeks along, a ways into the effacement process and presenting persistent elevated amniotic fluid levels:  "well, we'll see you next week if your membranes are still intact then."

Again, seriously? That was anticlimactic.

"And call the girls at the office to get your induction scheduled for mid-week 38."

At least that's progress.

(Half-heartedly) thanking the doctor for his time, HB and I shuffled out to the car with a sense of confused apprehension.  On one hand, we are glad that I didn't have an overly tired obstetrician attempting to pull a baby out of my ear yesterday, but the lack of more definitive answers just leaves us sitting at pre-stage one: labor could happen any time, or not.  I guess the best news to come out of the appointment - besides, of course, the fact that HB and I enjoyed some awesome one-on-one bantering time - is that we have an official eviction date to plan around:  February 11.  So, if he doesn't arrive before then (gee wiz, thanks for the perpetual "who knows" time frame!), we know that I'll head into the hospital on the evening of February 10 and go through a similar process to that with GV last go around.

I guess induction wouldn't be such a terrible thing - there wouldn't be a mad dash up I-95, the pitocin helps the uterus contract back to it's normal size quicker and we'd have the maximum amount of nesting time left on the clock - but my impatience (and that of GW, too, actually) to meet Baby is beginning to show.   I want my body back, sans swollen ankles and midnight contractions, and I want to really start bonding with this little guy...  ah well, it will be when it will be.

All until next week, maybe. 

Week 35: Right now, right now? Maybe later, later?

Well, my 35 week check up was yesterday morning and I can’t even begin to understand where my head is today as things are just all jumbled.  Going into the appointment, I was anticipating all sorts of doom and gloom due to my weight gain this past week, a four-day headache that acetaminophen just wouldn’t shake and the knowledge that we’d be repeating fetal measurements (in other words, just how huge are we talking? And is vaginal delivery even still an option?);  but having hopped in the car almost two hours early to learn that the inner-loop of the Capital Beltway was closed due to a turned over vehicle blocking both the two Hot Lanes as well as all four of the regular lanes, I began to think my pessimistic expectations of the morning’s happenings were a bit too cheery for what was actually in store…  

Taking just shy of those two hours to get to the hospital due to knock-on accidents and residual area-wise back ups, I arrived just on time to go straight from the ATC reception into the ultrasound room for my exam.   Running a biophysical profile, checking my amniotic fluid index levels and measuring Baby’s overall growth, Tamara - the wonderful sonographer I’ve worked with through both of my pregnancies with this doctor’s office - was comforting, yet frank about where things currently stand: 

Biophysical Profile: 8/8

Amniotic Fluid Index: 29.6 

Estimated baby weight:  7 lbs 3 oz (85% percentile)

Abdominal Circumference:  34.2 cm (+18 days)

Head Circumference: 34.1 cm (+19 days)

Showing me the 3D pictures of his (practically identical to GW and GV) face, Tamara and I couldn’t help but notice the chubby cherub cheeks that Baby’s acquired in the last few weeks.  Suggesting that I cut even more carbs than I already have (okay, I’ve been cheating on my protein only diet some, but not terribly excessively… I’m dreading the idea of three more weeks of omelets…) to ensure that Baby doesn’t continue to put on excessive weight and break through that magical 9 lb 4 oz threshold that would ensure a doctor mandated delivery by cesarian, she encouragingly said that things were by and large looking good before sending me down to another nurse, Kaye, for my weekly NST. 

Delivering me to my reclining blue chair with waiting goo, padded belly straps and monitor, Tamara provided a report summary of the ultrasound which I promptly scrutinized for the twenty minutes Baby's heart accelerations and movement were monitored.  Passing this go around with no-prompting (thank you!) I was relieved to hear that, in spite of his large size, the NST and ultrasound were exactly what the doctor would be glad to see.  Setting my pessimism aside, but not out of reach, my meeting with the perinatologist was all that remained of the morning's flaming hoop session. 

Surprised not to be seeing Doctor Bronsky as he's typically the go-to in office practitioner at the ATC on Tusesdays (apparently Doctor Nies, along with everyone else in NOVA, is down with the flu so he was off covering for her on the L&D floor), Doctor Khoury called me back to his office in a flourish of compliments: "look at that belly!" -- "you look wonderful!" -- "it's so great to see you, dear!" Having dreaded my next appointment with him since my early November given the zero tolerance, minimal wiggle room estimation he made of me, my weight and my macrocosmic baby I acknowledged his praise with a half-hearted "thank you" and began throwing up as many emotional barriers as possible to handle whatever read he'd make of my test results.  

Stating that he didn't feel like a c-section is required at this point, he began by stating that the issue with diabetics with large babies - regardless of previously successful delivery histories - is that even if the baby doesn't measure above the weight threshold requiring surgical assistance for delivery, there is a significant risk for shoulder dysplasia that we'll need to  address mindfully.  Moving on to look at my AFI numbers and wishing to alieviate his concern with the possibility of preterm labor, he called down to the nurse practitioner, Laura, to have her check for effacement and dilation before sending me on my way for the week.   Running the Group B Strep test while at it, Laura made the ambiguous comment "oh yeah, you're super soft" before returning to her other patients.  Knowing that this generally meant things were heading in the correct direction for delivery, I gathered my things and began to walk out to reception with the intent of asking "anything else?" when Doctor Khoury practically tackled me in the hallway preventing my hasty exit. 

"Sit, please!"   (Uh oh...)

"You're moving quite a long - 80% effaced, 1 CM dilated and baby is at -2 station - so really he could come at any time.  I want to see you sooner than seven days, come in next Monday for your next appointment and we'll check you again.  In the mean time, if things progress at all - even if you aren't sure - get to the hospital immediately... subsequent babies tend to come quickly, but with the higher risk his size presents for delivery, we really can't afford to have you have this baby in the car.  Okay, dear?" 

Knowing that the numbers he rattled off are definitely a sign delivery is coming (but not necessarily imminently - darn AFI levels making "any minute" something that could last from right now-right now through induction in February), all I could do was nod my head and attempt to process the morning's events.  So I am looking at a large baby.  I am looking at a large baby that may or may not be premature.  I am looking at a large baby that may or may not be premature and is potentially going to be ill effected by my diabetes (sugar level or lung development wise). I remember with GV we did the amniocentesis at week 37 to determine if she could be delivered that week or would require more time for lung maturity, so being mid-week 35 with a large baby that may or may not be premature and is potentially ill effected by my diabetes has me freaked by "what-ifs" of his sooner rather than later arrival.   I mean even with waiting for 38 weeks to induce her, GV still wound up in the grow-box for a few days due to her jaundice and she suffered from post-birth hypoglycemia even though my sugars were tighter than the jeans on any one of those Hollywood film stars (at least they're wearing jeans, right?).  

Feeling excited, anxious, nervous, terrified and completely unsure of what is to come, I am flat out overwhelmed by yesterday's appointment.  On one hand, GW was a 36 week 5 day baby and he was just fine with a mild case of home-treatable jaundice... but he was born well over a year before I became a diabetic.  On the other hand, GV was born over a year and a half after I went on the insulin pump and, despite all of the terrible placentra-related complications of that pregnancy, was considered a perfectly healthy, completely normal newborn within four or five days following delivery - no NICU or micro-management required by the pediatricians.  So, optimistically speaking, things could go well even if Baby decided to come early...  would things be better if he arrived following induction the week of February 9th?  Yeah!  He'd get more lung development time, he wouldn't run the risk of being delivered on the side of I-95 in a traffic jam and I'd have another few weeks to button up the house into the home it's supposed to be.   Of course, he'll likely be so huge by then that that adds more cons to the mix, but hey, there is no one perfect way to have a baby and only God knows what's actually in store. 

On that note, I'll end my weekly blathering and hope that the next update I have for you is a clear-headed one.  Fingers crossed. 

Asleep diabetics say the darnedest things. Apparently.

So early this morning, I feel a nudge from HB as he asks me the question: “are you going to correct your blood sugar?”

Marginally aware that an alarm is going off, I grunt in response: “that’s just my alarm clock.”  

Ironically not satisfied with this dismissive answer given his, um, professional ability to sleep through his alarm clocks, HB insists: “NO, that’s not your alarm clock. That’s your glucose monitor.  You need to fix your blood sugar.” 

Annoyed with his persistent inability to just let me sleep, I hit snooze as I conclusively state: “If I fix my blood sugar for it every time, it will never learn to fix it for itself.”

Gotta love a sleepy diabetic's hypoglycemic logic...  thanks for the looking out, HB!