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!

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. 

Last Pre-Baby Endocrinology Exam

Going into day four with my CGM down and no estimated delivery time for my new transmitter battery, I went to my endocrinologist's office today for yet another pregnancy check-up with very little confidence that my sugars have been as tight as they ought to be this week.  Knowing full well that these few days won't have a huge effect on my HgA1C as it's a three month average of my blood glucose readings and since I'm getting measured more frequently than is typical, I could somewhat safely estimate that today's A1C reading would be relatively close to last month's of 5.5.  

Sans kids, Grandmama or HB (aka taunting the traffic Gods to let me get home from NOVA in anything resembling a reasonable amount of time), all of my attention was focused on the appointment and I cannot even begin to tell you how mystified I was by the ignorance of my nurse as she asked me questions about my diabetes. 

"Are you still taking Dexcom G4?"  she inquires.

"Yes, I still use it,"  I respond patiently. 

"How many units of that do you take a day?"

My internal monolog: "Seriously, are you freaking kidding me? It's my continuous glucose monitor, woman! It doesn't use or even measure units! And come on, there are only so many of them available on the market and used by this office! Are you seriously asking me this as if it were a prescription drug?!"

My answer: "It's my glucose monitor."

"Oh.  Are you still taking Medtronic Minimed?"

"Yes..." I said in attempts to mask my skepticism of what was to come next. 

"Is that a pill or something?"

My internal monolog:  "O. M. G.  You have got to be kidding me!"

My answer: "It's my insulin pump.  I use it with humalog." 

"Oh.  I'm new to this diabetes thing."

My answer:  "You're lucky."

Scurrying out of the room after checking my blood pressure (98/80 - um, shouldn't that have been of concern?) and taking a sample of blood for my A1C, she skips several of the typically routine pregnant-diabetic questions and leaves me to wait for the significantly more competent and well trained Doctor.  

Surprised to see me without entourage, Dr. Rogacz dives right into my chart and the CGM trends I've provided for her covering the previous week.  Reporting that my HgA1C is up to 5.9, she theorized that this increase - while in the wrong direction - is likely as a result of less prevalent overnight hypoglycemia and an apparent growing trend in mid-afternoon highs.  Merely suggesting that I add Symlin to my late-morning coffee or adjust my bolus settings for my mid-day meals, she snaps my chart shut and announces that as far as she's concerned I'm doing beautifully.

"The next time I need to see you is two weeks after delivery.  Otherwise, make sure that you set your pump to your lowest basal setting for delivery and that your husband knows to turn off or disconnect your pump at the infusion site if you need to have an emergency c-section.  If he doesn't do that, anesthesia will just rip it out and you'll need it after the procedure is complete." 

Finding it terribly ironic that she didn't really feel like she needed to see me today and that the more serious conversation she planned to cover was intended for HB instead of myself, I appreciated the vote of confidence from my go-to diabetes expert that I'm doing everything motherly-possible for Baby #3 and that on her scale of patients - both pregnant and not - I'm one of the few she's not slightly concerned about.  Wishing she could send those exact words over to the perinatologist for their diabetes-rant days where I come away feeling like I'm the biggest diabetic screw up on the planet, it was nice to know that at just shy of 34 weeks of gestation that I'm off the hook for additional "you need to be monitored" appointments until the end of February.  

Again: go me. 

And to top it all off, there wasn't a bit of traffic on the way home and door-to-door my typical 2.5 hour Friday afternoon commute took me 52 minutes.  Now that's a good way to end the week on a medical high note! 

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!

Dexcom Down!

I am feeling like the biggest idiot on the planet.  About four days ago, my Dexcom monitor began to doo-da-loo at me with an error message I'd never seen before: "Transmitter Battery Low.  Order Replacement."  Thoroughly confused by this message as I'd just replaced the monitor this past September, I plugged in my CGM to it's USB port and rolled on with life.

Then, at about one o'clock in the morning this past Sunday, it hit me.  The error message was so darn clear, the transmitter battery is low, not my monitor battery -- in other words, the gray piece I attach to my new sensor on a weekly basis needs to be replaced.  So no matter how well charged my blue CGM monitor is or how fresh my sensor is, with a dead battery in my transmitter my CGM is about as useful as when trash day falls on a national holiday (yes, we were hit three times recently thanks to Thanksgiving, Christmas and New Years Day all falling on Thursdays... no, I am not annoyed...).

Having contacted my Dexcom customer service rep first thing on Monday morning, I learned that it will take 3 to 5 business days to arrive here at the house.  So with a possible arrival time of this Thursday at the earliest or next Monday at the latest, I have been crossing my fingers that the low battery holds out until the earliest possible time that my replacement transmitter can arrive.  Unfortunately, however, as I was going about the morning routine today my monitor stopped reporting my glucose trends and indicated my transmitter is out of range.  As I'd seen this error message before it didn't initially register that my CGM needs more than my sticking the monitor in my pocket for a while... so you can imagine how dumb I felt after carrying this thing around for an hour to no avail when it hit me that, yet again, I'm being completely dense.

My transmitter battery is d-e-a-d, DEAD.  I have yet to receive shipment notification from my supplier that my new transmitter is on it's way.   I've officially thrown myself back to the Stone Age of diabetes management as, for the second time this pregnancy, I'm back to finger sticks to track my blood glucose.  As my insulin requirements continue to change over the course of the third trimester with the placenta making my body increasingly insulin resistant and with baby and me being incredibly sensitive to glucose swings - him and my AFI levels, apparently, responding to my in-range 70-140 mg/dL blood sugar variations; me responding emotionally to the mere suggestion of my diabetes incompetence or a potential c-section - this is NOT the ideal time to have my high tech gismo go out on me.

Keep your fingers crossed that my new transmitter arrives soon and that the mean time doesn't somehow manage to make my head explode.  I head to the perinatologist later today (solo... boo hiss) and it's my first appointment at the hospital's Antenatal Testing Center, so I'll report back sooner rather than later on how things are going... so, seriously, all the fingers you can spare to crossed are appreciated!

Nesting

I feel like my whole world, including the baby, are upside-down.  Generally speaking, things are lining up where they need to be and they are heading in the right direction (literally, he's vertex), but that doesn't seem to be translating into anything except what I hope to be a short term stint of full on topsy-turvy.   When we moved into our new house two summers ago, I had every intention of leaving the place as is; the previous owner was an interior designer who'd clearly spent quite a bit of time, money and effort on designing a very formal, Virginian colonial theme to the place so it we've been treating the house as move in ready... but the longer we've been here, the more we've found that's needed replaced and the more I've started to feel like we are living in the previous owner's space and not in our own.  

Wishing to remedy that with at least one of the rooms we've yet failed to unpack (at least 1/3 of the house is still in boxes), nesting fever accosted the house as HB and I began to look at simple paint combinations for Baby #3's nursery and maybe a pinterest-sourced wall accent.  I don't know if you have looked at pinterest before, but what a life-sucking, bottomless-pit of amazing ideas... we could do this! Or we could do that!  Or... or... or... bottom line:  what initially started out as the bright idea to "spruce up the nursery" has morphed from a simple application of a few paint coats and maybe new carpet to what feels like a whole house make over. 

Thanks to Home Depot's gentle reminder that it'd be a better investment to take advantage of their free whole house carpet instillation and lifetime carpet/carpet pad warranty than to only superficially replace the carpet in one room, project creep seeped through our entire top floor: we've ripped the carpet and old carpet pad out of all four bedrooms in prep for new flooring to be installed on Thursday; we've repainted both the nursery and the kid's bedrooms top to bottom; we're soon to be wall papering a room for the first time (HB and I have only ever removed wall paper, so this shall be a learning experience); and, much to my literary glee, we've begun work with a contractor to build a series of built-in-bookshelves that will transform our main floor whatever-room into the dream library we've been fantasizing for years.   So you can imagine the mess the house is... both kids are camping in the master bedroom (so much for my bedtime reading routine), Grandmama is back to sleeping on the couch, there are four dressers crowding the landing upstairs and the dog is bunking with all of the extra furniture that needed to be piled elsewhere for safe keeping.  It's the epitome of absolute, piled to the ceiling, someone make more coffee, where's my left shoe, cereal for dinner, insanity. 

To make things more complicated and (to a spoiled wife like me) less pleasant, HB's work schedule has really ramped up due to an end of the month project review he must complete for his customer.  With a smaller than ideal team working on his particular program, this task - while not insurmountable - is demanding to say the least and causing his hours to lengthen both in the mornings and evenings.  While you might be sitting there thinking "so what?" I have to take this time to remind you that at 33 weeks pregnant, I'm going to NOVA for non-stress tests and sonograms once a week, soon to be twice a week, and that as of yet HB hasn't failed to attend a single prenatal appointment with any of our pregnancies.  Unfortunately, my appointment this week marks a first... we can't have him home to help with carpet installation (a must since I can't move furniture) and at doctors appointments and still enable him to make his deadline while simultaneously fighting shorter weeks due to the holidays being "forced" days off -- it's just not going to happen (#FirstWorldProblems).    So cutting slack where it's curable, he's not coming with me to my appointment(s?) and that makes me sad.  Perhaps I'm just whining at this point, but it's a big shift for us to have me head into the unknown with Baby #3 at the hospital on my own...  granted I'm carrying him on my own and I'm responsible for all things baby-making post x or y chromosome contribution, but it's been a team effort thus far and it feels like for the first time I'm fielding an incomplete roster for the MFM reindeer games. I'm sure that I'll get over it, but the anticipation of going solo tomorrow is nauseating for the time being.  

I guess at the end of the day, the boxes are all still getting checked: we're moving forward with nesting by creating total havoc in the house and the baby is being checked on even if only 50% of his parental team present.  I know it's all working toward a positive end state that is family-time oriented, but in the upside down world of progress I feel like my current steps forward are backward and the finish line is perpetually out of reach, yet somehow it's still rapidly approaching.  Hopefully this dizzy, confused feeling subsides and come Thursday evening we'll be so far past the remodeling, nesting, emotional mess we're currently working through that this blog post will seem utterly ridiculous in retrospect.

If I weren't pregnant right now I'd go back up to my bedroom, shut the door, put my arms out and spin around in circles like I have GW do to "change his attitude" in hopes that my vertigo would reorient life into some ultimately sharper form of clarity... but, since spinning while 8 months pregnant isn't exactly recommended, I'll just continue as is down what I can only understand to be an Escher interpretation of my life circa January 2015.

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. 

UPS Fail.

Okay, I know that it is the holidays and for that reason alone slack should be granted to the poor schlubs who are working exceptionally long, seasonal hours to deliver packages across the country before the good ol’ Saint Nick deadline of December 24, but right now I am beyond angry.   Just five minutes ago, my Mastiff gave me the pleading look of “oh dear goodness, I need to go outside or you need to get the Bissell” so I wrapped up what I was doing and went to the front door to let her out.  Now, our yard doesn’t have a fence and our dog is one of those freakish varieties that won’t run away, stays on our property and comes back to the door as soon as her business is addressed, so I thought nothing of it when I opened the front door, realized it was raining and stepped back to wait for my 118 lbs of pooch to return.  Seeing as she’s more terrified of rain and water than I am (and that is saying something), she ran down the front steps, skipped her typical condeming look of “wait, you aren’t coming with me?” and proceeded to run out into the darkness.  Wanting to keep a watchful eye on her for good measure, I flipped on the front porch light and waited for her to reappear with a wet-cat skulk.

Scampering up to the door, I opened it and looked down to watch her track wet paw prints into the foyer when I saw it.  A lone cardboard package sitting just beside the door on the brick landing in the puddle that perpetually forms whenever it rains.  Now, I could be mad at the person who incomprehensibly formed the stoop to be concave at just the precise location where packages were apt to be delivered, but they screwed up back in the 1970s and I am fairly positive that the statute of limitations on that one has expired.  The UPS guy, however, knows better.  Having delivered package upon package to this address over the last year, he’s aware of the circumstances that surround our house:  the stoop collects water, the dog barks when you knock or ring the door bell, we always answer the door and say “thank you” regardless of our streetability (I’ll wear what makes me comfortable, dang it, and I don’t care if we live in the “south” make-up should be optional at home), the newly awake child screaming (no it wasn’t nap time, she’s just really excited to see you), or whatever is on the stove (quick someone stir that!).  

But tonight, despite all we’ve been through and come to treat as routine, there was no knock on the door or constructive use of the door bell. There was no barky-dog to alert us of the thoroughly vulnerable package that was placed directly in to the formed (and growing) puddle.  And there most certainly isn’t an appropriate application of the word “thank you” to be found on these lips as UPS messed up R-O-Y-A-L-L-Y.  

This could have been a run of the mill Christmas package - something we ordered or someone carefully selected, packed and sent our way - but it wasn’t.  No, it was far from a frivolous purchase that would have received a muttered curse word and eventual shake of the head with ”what a shame.”  Instead, this package contained medical supplies - three months worth of my continuous glucose monitor sensors to be exact - that I use on a daily basis and rely upon for their unfailing accuracy and constant data for my glucose control.  Something that a night’s worth of sitting in the rain would have destroyed, cost me or the supplier, Dexcom, hundreds of dollars to replace and would have left Baby and me up a creek with the occasional finger prick as my source of sugar control.  I’ve long since left behind the CGM-hating band wagon and Lord help anyone (talking to you, UPS!) who gets between me and my necessary - YES NECESSARY - medical technology…  

All I can say at this point (suffice it to say their customer service will be getting an ear full tomorrow) is Thank God the dog needed to go out just then, thank God I turned on the front porch lights for her despite the need for them, and thank God I had that disparaging thought about her wet paws causing me to look down and notice the package when I did.  If this sequence of events hadn’t occurred, my head would have exploded upon finding the mushy pile of trash waiting for me in the morning.  But, fortunately, the cardboard was thick, the boxes of sensors insulated by tissue paper and the sensors individually wrapped in sterile plastic - meaning I got lucky and the damage is largely restricted to the exterior packaging.   Thank you little baby Jesus!

To the nincompoop who skipped putting the package in a sealed plastic bag, opted out of notifying us of it’s delivery and voluntarily left the box in an EXISTING puddle, whoever you are, here’s your sign.  That was excessively dumb, poorly executed and completely unnecessary.  Clearly someone up there is watching out for you, too, but come on man!  Not. Cool. 

Week 30

All I can say about my week 30 appointment is that I am beyond grateful that I am already a parent, because if it weren't for GW and GV I'd be a furious, incoherent mess as I sit here typing at the computer.  Having spent the last two weeks fretting about my weight, my amniotic fluid index (AFI) levels, and Baby's rapid weight gain I hardly slept a wink last night as I tossed and turned in anticipation of my perinatal appointment this afternoon.   Waking up twenty minutes after the alarm clock went off and finding an abnormally high weight on my home scale (up two pounds from yesterday... guess I shouldn't have had that banana) didn't start the day off well.  Attempting to look at least partially decent for the first time in a week, I threw on some clothes, quickly did my hair and make-up and went into the kid's room to find both GW and GV awake but still lounging in their beds.  Happy to not continue the morning battle with our usual "but, Mooooom, I'm still tired..." argument, the kids easily slipped into their laid out outfits and went downstairs to the kitchen to begin our breakfast routine - which, again, went surprisingly well. 

So off to school we go and as I'm dropping GW off in his class room, I pull his teacher aside to let her know that I'd need to pick my son up early today to accommodate our perinatal appointment that is scheduled for just after lunch in NOVA.  Informing me that, "well, we're not going to be here today and we won't be back by that time," I was a) shocked to learn of the field trip that the parents weren't informed about (seriously?!), and b) dreading the dream crushing "you can't go" conversation that I was about to have with GW.  As this would have been the first time he would have been able to ride the school's bus, something he's been begging to do since September, you can imagine the near tear confusion and anger that seized his face... I explained the issue and apologized for his disappointment (to which he countered with several suggestions about his walking home from school alone, sleeping at school so we could just pick him up tomorrow and even running to the appointment on the side of the highway so he wouldn't get lost) and we finally came to a calm, albeit not happy, understanding.  We then attended morning mass and began to run some errands. 

And then my phone rings... "Mrs. Cammack?  It's Perinatal Associates.  We have you down for a 1:30 appointment this afternoon, but we're going to need you to come in at 12:45 instead." 

No problem... if you live in NOVA.   Big problem if your husband works 45 minutes away, isn't answering his work phone, cell phone, texts, email, instant messages or my ESP and, in best case scenario traffic, the doctors office is one hour away.  While I had an hour and forty-five minutes before we no-sh*t needed to be on the road, I spent the next 55 minutes trying to reach HB before he finally answered and had exactly 50 minutes remaining to pack up and get home before we were officially late.  Shockingly enough, his little commuter car got him home exactly on time and we hit the road. Thanks to construction and accidents, we wound up only being slightly late to my (considerably earlier than we were prepared for) appointment. 

Then guess what happened... 

For the first time in our experience at this doctor's office, HB, the kids and I were left to wait.  Usually prompt and punctual, we waited for an hour and twenty minutes before my appointment officially began.  So, for those of you who are parents and know the agony of cooping kids for an excessive amount of time in a non-child friendly environment like a business or office, you recognize that had we kept our originally scheduled appointment for 1:30 we would have only fought 45 minutes of "place of business" behavior without lunch, toys or books rather than the doubled length of frustration.  

Enter miracle number one:  those kids were complete angels.  Granted GV didn't want me to read my book and she insisted on climbing to the adjsent chairs exclusively from my significantly smaller lap (at least something is smaller about me!) than from the floor, but they whispered "psst I love you" to one another and to each of us, they snuggled us individually and in turn, and they even managed to let the other two couples in the waiting room wait in what could almost have passed as a child-free sense of peace. 

During that wait time I was called back briefly to the nurse's station for my typical vitals check. My BP was great at 114 over 69 and, thank goodness she measured that first, because the minute I saw the number on their ruddy scale I flushed with anger.  Eight bloody pounds up from yesterday on the home scale and right back to the number I was advised would cause a c-section four weeks ago.   Yeah, yeah, yeah, I know you can't compare results between two different scales and in one instance I weighed myself sans clothes before breakfast and in the other I was fully dressed (a seasonally appropriate sleeveless shirt and flip-flops for today's gorgeously frozen tundra weather, mind you) and it was post 1 cup of greek yogurt, but STILL! Are you freaking kidding me?!

Enter miracle number two:  upon slumping back into my waiting room chair, GV climbs up into my lap and, taking my cheeks between the palms of her hands, she looks deeply into my eyes and says with the most sincere concern "you okay, Mama?" Forcing the deep breath I wouldn't have found anywhere else, I was able to tell her "yes, I'm okay, GV" before giving her a hug and feeling at least some of the world's weight fall from my shoulders.  Too bad I couldn't have been weighed again...

Finally, finally, finally the nurse comes out, calls my name and leads our troop to the sonogram room. Having discussed with GW that he'd be able to help with the sonogram if he asked the sonographer  very nicely, my heart sank when Dr. Bronsky walked in to the room in place of our normal nurse.  Knowing full well the answer to GW's question would be either silence or "no," when he approached the table to inquire "may I try?" I spoke as kindly as I could to him "no, not now GW." Automatically lead to the "but you said I could!" face of anger and tears that I'd already seen that morning regarding the bus, I briefly explained that we'd talk about it after the appointment before shifting my attention back to the sonogram.  I found the doctor ever so casually checking Baby's position (head down, good), heart rate (132 bpm, good) and ... yeah, that's it. 

"What are the AFI levels?" inquired HB, trying to prod for additional data. 

"They looked fine," was the brief response. 

"Oh, well those numbers and his weight have been of concern at the last few appointments..." HB said suggestively. 

Taking the wand back up, Dr. Bronsky then began to actively measure the amniotic fluid pockets around Baby.  Correcting himself, he then stated, "yeah, your fluid level is definitely high.  It's up to 27 cm.  But that's almost the same as it was last time."

Percentile wise, perhaps 23 cm and 27 cm are somewhat comparable for their respective
gestational weeks, but they're both at 99th percentile and not where I ought to be

Upon collecting the two pictures he'd printed for my chart (none for us today - boo), wiping off my belly and instructing us to follow him to his office, HB and I were stunned but the limited information collected and the dismissive statement that equated 27 cm to 23 cm... neither of which is considered a good number.  

Enter miracle number three: every time we've brought the kids to these appointments and it comes time to sit down with the doctor for the last five to ten minutes before their sweet freedom is realized, they've flat out lost their minds. They roll on the floor, flop on the couch, grab things from the desks... anything distracting and disruptive they could do, they've probably done it.  But today, they sat by our feet in relative stillness as they watched a movie on mute for the duration of the appointment.  Feeling rewarded by the access to the iPad (a very rare treat at our house), they didn't interrupt, they were polite and they gave no-reason to illicit the "and you're having another one?" face and/or comment we've unfortunately received from particularly judgmental people previously.  

Sitting board straight out of anxiety, I watched the doctor as he rapidly typed the data he'd collected into my chart and answered the random questions he asked regarding symptoms I'm experiencing and my previous deliveries.  Providing very little council on my and Baby's condition or the red-flag concerns we've been fretting upon since our appointment on HB's birthday at the beginning of November, Dr Bronsky - my go-to guy and ally during GV's pregnancy - practically brushed me aside and shooed us out the door with his paltry information: he noncommittally indicated that a vaginal delivery is still possible; he distinctly commented that I can't do anything more than I already am; he passively dropped that a c-section would be required at "4200 grams or more"  for any diabetic (had to look that up, gee thanks doc, meaning 9 lbs 4 oz); and, to finish things up, he concluded that my weekly appointments and non-stress tests will begin on December 30.  

Leaving the office with my blood pressure soaring from frustration and unassuaged concern, HB and I both felt like today's visit was a waste of time and a full drain of our emotional energy.  I know I should be grateful that a professional looked things over and that he didn't feel comment was required, but less is not more with me and simply dropping off some biometric data on me and Baby surely didn't need to take the four hours - and that's before the drive home! - to accomplish.  I needed reassurance today.  I need hard facts to concentrate on for the next two weeks.  I need to know what progress, be it good or bad, we're making and how things are shaping up just in case I'm hospitalized (God forbid) anywhere except the one place my chart is electronically stored.  Walking away empty handed, empty stomached and cranky is not ideal for anyone leaving a doctors office - let alone for a woman who is 30 weeks pregnant. However...

Enter miracle number four:  those darn kids couldn't have been better behaved, more compassionate or more encouraging than they were today.  On any normal day their actions would have been ten times above and beyond the norm, but given how challenging the day was and how HB and I were seething unhappiness from our every pore, GW and GV rose a whole new level of my esteem that I didn't know I even had.  I've always loved them more than anything, but actively appreciate them? That's something I need to do more often. 

To be honest, I've found myself much more cognizant of the little things with them over the past few weeks that I simply feel I was blind to previously.  I have been so wrapped up in the drama of life and the worries of what if that I haven't given them the benefit of blossoming in my consciousness in the way that they've been doing entirely on their own.   The appointment today was, in my estimation, a complete disaster and something I would gladly take a time machine to, but in the grand scheme of things it's only one afternoon in one week of one pregnancy that will lead to a lifetime of family moments and memories with all three of my wonderful kids.   GW and GV kept my feet grounded today where my temperament alone would have taken me sky high in vexation.  While I hope to come back from my next appointment on December 30 with solid facts, answers and some semblance of comfort, I am clinging to the awareness they gifted me today that appreciating them, our time and our family in spite of the darkness that can cloud around can leave a wake of happiness where otherwise there would be none. 

Thanks, guys.

Good behavior ice cream and Santa all in one swoop?
Yeah, they're that good.