The Eclectic Dabbler

That was the nurse practitioner describing the tocolytic I was about to receive.

So, yes, I ended up back in L&D triage this afternoon. After strong contractions four minutes apart through the early (sleepless) morning hours, and then waking up with contractions (not as strong but still four minutes apart), I spent most of my day “contracting.”

Daniel was working from home today, and he decided I really should call the doctor (and we knew the doctor would say to go to triage). So there we were. Again.

We asked our friend Bill, who is working on his dissertation, to come over and sit in the living room during the kids’ naps, which he most graciously did. . .

I know I’m emotional with pregnancy and all, but I really had a hard time putting the kids down for their naps and saying good-by. I was afraid they were going to increase my procardia (like they did with Micah), and it would do nothing for my contractions, but I would have blood pressure issues, and they would have to keep me on the Mom Unit (like they did with Micah).

Once my now-19-month-old Micah was in bed, I sang to him “Great is Thy Faithfulness” (more for me than for him) and then he held up one finger like he does everytime I put him to bed these days, and said, “Muh mo’.” [one more] So I sang one more. He did it again, and I had to say ‘That’s all, buddy. I know you’d have me sing all day long if you could.’

When we got to the hospital, Daniel insisted on pushing me up to Labor and Delivery in a wheelchair, despite the fact that I felt like a total wimp. I said I was pretty sure I could walk, and if I walked, the nurses would have adequate proof that I really was having a lot of contractions. He said we weren’t trying to impress the nurses with how many contractions I was having. I knew he was right–if I had walked, I’m sure my contractions would have just multiplied. He’s a good husband–he’s just what I need.

There were no beds available in triage when I arrived, so we were sent to the waiting room with a huge crowd of people awaiting news on a set of triplets that was to be born that day. Apparently the mom had chosen not to find out whether the babies were boys or girls! (Can you imagine? They had picked out three boys’ names and three girls’ names and were waiting to see what she delivered! Daniel said to me, “With all the logistical challenges in having triplets, why would you add one more by not finding out what they were?” So if we ever have triplets, you know we’ll be finding out whether they are boys or girls or a combination.)

When I did get a bed in “LD,” it was the same old routine: urine sample, hospital gown, cervical exam, various swabs/samples, blood drawn, IV fluids, monitoring the baby’s heart rate, my heart rate, and my contractions. My contractions were steady, 2-3 minutes apart, but varied in intensity. I think they felt worse because I hadn’t slept much last night–I felt nauseous and yucky–and I didn’t know if that was just fatigue or the ever-illusive “something different.”

The nurse practitioner checked my cervix and said, “It’s a loose one.” But it’s still a one, which means after all these contractions, I’ve had basically no cervical change! That was just not the case with Micah. But with Micah they had also waited to put me on any tocolytics until I was already 3 cm and 70% effaced. I’m sure it helps that I’ve been on progesterone for 12 weeks now and procardia for about 2-1/2 weeks.

While they monitored me and waited for results of the fetal fibronectin test, Daniel and I discussed baby names. Unfortunately, I can’t discuss what we discussed, but it was really one of the first opportunities we’ve had to sit and go through names together. I was glad I had made a list, glad Daniel brought his laptop (with my list on it). And surprised by the names he liked and didn’t like. There was one name–a beautiful name–from my list that Daniel contemplated for about half an hour. I was beginning to think it would be Little Boo’s name! While Googling the names’ meaning/ trendiness/ etc, Daniel learned something that completely ruled the name out for him. For one reason or another, every name was scratched off my list. And when Daniel began suggesting new names, there were none that really “grabbed” both of us.

In the end, we arrived back at the name we’ve been contemplating–but got hung up on the spelling. (And no, it doesn’t begin with an ‘M.’ But that’s the only hint I’m giving!) It is still not set in stone, because both of us have a pretty strong opinion on how we’ve “always envisioned” spelling it. We may have to scrap the name altogether and start over.

But I was encouraged that we had the chance to discuss names. Probably we will settle on something soon, and she won’t spend her first three days nameless as Micah did!

My favorite news of the day was that the fetal fibronectin test came back negative again. That means there’s a 99% chance I will not deliver before two weeks from today (almost 35 weeks!). I was so excited that I told Daniel I was going to take myself off bedrest to celebrate! A 35-weeker sounds great to me! At that point, most of the lung development issues are resolved, and many babies can suck well enough at that point that they wouldn’t need tube feeds.

Of course, I was kidding about taking myself off bedrest. But comments like that always scare Daniel. (Sorry dear! Didn’t mean to–I’m just excited!) He started asking me questions like ‘What are the characteristics of the 1% that does deliver within two weeks? Do they have all your symptoms? It seems like you’re in the 1% on everything else–why should this be different?’

The question remained: What to do with all these contractions? Supposedly I’m on–not one, but two–drugs that should be keeping me from contracting.

Marianne, the nurse practitioner, asked about my progesterone and procardia dosage, then went to consult with Dr. C. We overheard the entire conversation.

“She’s contracting like crazy,” we heard her say. “But she’s still only a one.” Marianne recommended terbutaline, which I had read is the tocolytic most commonly given to stop preterm labor. I remembered one of my favorite preemie-mom-bloggers, Heather Spohr from The Spohrs Are Multiplying, being given terbutaline for preterm contractions.

I always wondered why I was given the procardia (nifedipine) instead during both pregnancies. Dr. C approved the terbutaline, so Marianne came to tell me more. It’s a drug that is commonly given orally to treat asthma, by dilating air passages in the lungs. In pregnant patients, terbutaline is injected into the arm and apparently reduces contractions by relaxing the muscles in the uterus. She told us side effects include: tremors, nausea, nervousness, dizziness, headache, drowsiness, heartburn, heart palpitations, fast heart rate, and elevated blood pressure. [Oooo, elevated blood pressure! So between procardia lowering my blood pressure and terbutaline elevating it, my blood pressure should be completely normal, right?] She said the primary feelings patients describe are heart palpitations, shakiness/the “jitters,” and headaches.

Honestly, as she described it to me, I was skeptical. I’m on bedrest. Progesterone. And procardia. They’re not working. Sure, add some terbutaline. It can’t hurt, right?

I think she could read me.

She insisted that it works really fast–within 20 minutes–and added, “It’s really good stuff! . . . I mean, it’s not crack. . .”

Oh, good.

I wish I had taken a picture of the contraction monitor! The graph displayed a constant stream of “hills” and “valleys” with each contraction 2-3 minutes apart. Then suddenly I was given my shot of terbutaline, and the graph literally flat-lined.

I was in awe. I did not know that a drug like this existed! (Although I have to say, my heart racing and jitters felt a lot like the side effects of an epi pen administration. And I came home with a headache–but very few contractions.)

Marianne told us it isn’t a “permanent” fix, but at least, we were able to stop my contractions one more time and buy our Little Boo a few more days, or maybe even weeks. She said we did the right thing coming in and she promised Dr. C that I was “very reliable, and she was sure I would come right back if there was anything unusual.”

I nodded heartily in agreement, while Daniel made some comment about having to twist my arm to get me up here. (Shhh! I want to go home tonight and see our kids!!)

So the combination of the negative result on my fetal fibronectin test and my very positive response to the terbutaline, was enough for Dr. C, who said I could go home.

Personally I think they needed my bed there in triage. There were more pregnant women in the waiting room.

And I was most willing to give it up!

When we got home, Mara greeted me with the most enthusiastic tears of joy imaginable from a three-year-old. Daniel’s mom said she had a hard time when she woke up, dealing with the fact that I was in the hospital again. I guess Micah handled it much better. While Mara hugged me (and wouldn’t let go), Micah hugged Daddy’s legs saying “Dadda!” I guess he knew he should be hugging somebody at that moment.

I’m still pinching myself. I really expected them to try increasing my procardia, and then (when that didn’t work) to keep me, at least overnight. I really didn’t expect a single shot to knock out my contractions. And I really expected to go to bed without my dear family tonight.

“It’s not crack,” but it’s pretty amazing, that terbutaline!

I have just a few minutes for a quick post tonight after quite the busy day. (And if you’re wondering ‘how can a day be “busy” on bedrest?’ well, that’s a post for another time! Sometimes I think it is three times as busy on bedrest as it is not on bedrest. It’s just a very different kind of busy. And it’s definitely three times more complicated!)

Anyway. . . my 32-week appointment!

Amazingly, I am still 1 cm!  I really couldn’t believe it.

Over the past few weeks, the idea at every appointment (or triage visit or hospital stay) has been ‘let’s see how we can manage these contractions and try to keep the baby inside as many more days as we can.’  Today the tone of my appointment was completely different. We’re not talking days now, we’re talking weeks. In fact, Dr. Z told me she was optimistic that if my “cervix continues to behave, maybe we can make it to week 37!”

This is the first talk of “week 37.” This is the first time the obs have discussed coming off bedrest, progesterone or procardia.

This is a stage I never experienced with Micah. With Micah’s pregnancy, we knew he would be premature, it was just a matter of how premature. I never asked about coming off bedrest or procardia–I clung to them as the only hope for keeping my child inside–growing stronger and staying healthy.

So mentally, this is a shift for me.

Someone from church wrote to ask what help we could use with meals and childcare, so Daniel asked me to write up a schedule for the next four weeks (Four weeks!) of who is helping which days and determine when we have gaps.

Today we found out that Daniel’s boss granted permission to work from home two days/week, which will be a huge blessing. But obviously he will technically still be working, right? so it would still be best for me to have some help for a couple of hours on those days.

We’re working the schedule out.

I told my Due Date Buddy Donna that we should team up and write a book: On Surviving Bedrest. Maybe in four weeks I’ll have this thing figured out. Ha!

That said, I have to be careful. I’m feeling so encouraged, but I need to remember how much worse my contractions were before bedrest and procardia. There are no guarantees.

But I am starting to imagine what it’s like to room with your baby after she’s born, to nurse her right away, to bring her home when you leave the hospital. . . it all seems a bit too good to be true! I think I may need to pack a diaper bag and have the carseat ready!

For now, I’m just taking one day at a time. On bedrest. For the Little Boo.

But I’m asking myself, is the tide turning? Is this the week where we begin to see a marked difference between my pregnancy with Little Q (Micah) and my pregnancy with Little Boo? . . . only time will tell.

I have a good friend, Donna, who unfortunately lives in South Carolina while I live here. But she grew up about 45 minutes from here, and that is only the beginning of our similarities!

Donna and I were in college together. Started the same year. Sat out of college to work our second year. Returned to college the same year. Worked as RA’s together in our college dorm. While she was interior design and I was accounting/journalism, we bonded through our RA experiences. We graduated the same time. Went to the same church in South Carolina for about seven years after college. We were in each other’s weddings. In fact, in addition to being a bridesmaid, she also did my flowers–my wedding bouquet and the topper for our wedding cake! All that to say, she’s a dear, dear friend.

She knows a thing or two about preemies and bedrest as well. In 2003, her son was born premature (due to PPROM) at 31 weeks. He spent five weeks in the NICU, although today he is perfectly healthy, and you’d never guess! In 2006, she was on bedrest with her second pregnancy because of preterm labor. I was with her in the hospital when she went into active labor at 34 weeks (her husband, a pilot, was out of town). Somehow with medications, they held off her labor until exactly 37 weeks, when she delivered her second son full-term!

Here’s where our stories merge again. On baby #3, she is (like me) . . .

• Having a girl this time
• Having a lot of contractions, especially anytime she is going out shopping or on her feet for long periods of time
• Spending a lot of time with the Maternal Fetal Medicine people
• Having a lot of similar tests: like FFN (like me, still coming back negative so far) and ultrasounds monitoring the baby and her cervical changes
• Rejoicing in similarities: our same-day ultrasounds a week ago Thursday, indicated weight estimates of 3 lbs. 13 ozs (my girl) and 3 lbs. 10 ozs. (her girl)
• Puzzling over similarities (like awhile back, when both of our cervical lengths went up from 3.1 to 3.9! How weird and crazy is that?!)
• Struggling with the same question of when to call the doctor when you have contractions all the time? and what is that illusive “something different” that they keep telling us we’re looking for?
• And, craziest of all, she is due the same day I am! (Although neither of us have plans to actually deliver in March, we will both be happy if our girls wait until at least February.)

Unbelievable!

When we first discussed our pregnancies, I quipped, “We should have a race to see who can keep the baby inside the longest!”

She said, “Yes, but what would the prize be?”

I couldn’t believe she had to ask. Incredulous, I replied: “Being the mom without the NICU baby!!!!” But on further reflection, I thought, “That’s really unfair to the other mom, who honestly would have no way of keeping her baby out of the NICU.”

Unlike me, Donna is not on bedrest, which both of us consider absolutely miraculous, given her history with her previous two pregnancies. I fully expected her to “beat me” to bedrest! She also is not on progesterone or procardia this time, as she prefers more natural methods whenever possible. She is also (unlike me) hoping to deliver with a midwife, if all goes well.

Donna called me again Friday morning after her latest materal fetal medicine appointment.

I can’t explain how much I enjoy talking to her about our pregnancies.

Donna understands the difficulty of caring for toddlers and the struggles of maintaining a house while on bedrest. She did that with her second pregnancy. She understands the challenges and risks a NICU baby (and NICU parents) are facing. But she’s come through and she’s seen God’s grace in her own life and the life of her family. And she always points me back to Him. There’s no sense of pity or despair: it’s just where we’re at right now. Right now, there are very few people I can talk with that way!

It’s kind of like when I was studying for the CPA exam:

There were people who pitied me and said ‘oh I’ve heard how terrrrrrible that exam is! Good luck studying, and I hope you ever get your life back since no one people actually passes it the first time.’  (Oh the drama.)

Then there were people who had no clue what the exam was like, and would say things like ‘yeah, I’m thinking of starting a lemonade stand, so I’m studying too.’ Okay, no one actually said that, but my point is their comments told you they had absolutely no idea what was involved in becoming a CPA!

But when I talked to my peers (those taking the review course two nights a week from July – November, while working crazy hours starting out at the CPA firm, those spending most every weeknight and most of their weekends studying instead of hanging out with college friends), those were the people I could really talk to. Half of the conversations (that I had with everyone else) went unsaid, because I didn’t have to explain–we were in it together. And they understood.

So when Donna and I talk, we understand because we’ve both been there, and we both could potentially be facing many of the same circumstances all over again.

We share test results, and we don’t have to explain what the test is for or what the results mean, because we both have them. We compare notes from our appointments. We laugh over our husbands’ responses to everything going on. Together we are thankful for husbands that provide for us, care for us, jump right in to help whenever the contractions get more intense–and sometimes even protect us from ourselves (Donna’s husband told her a few weeks ago, ‘if the doctor doesn’t put you on bedrest, I will.’).

It’s always such an encouragement to talk to someone whose been there, and is walking much the same path right now, looking to God for His grace and strength each step of the way!

Next call: Monday morning, after my appointment. Can’t wait!

November is Prematurity Awareness Month. Did you know that? Today, November 17, it’s Fight for Preemies Day. After one baby born at 32 weeks, we are fighting for this next one! I’m at 24-1/2 weeks now.

My case manager called this afternoon–she is so perfect for me! I need her in my life! She always says, “I’m not telling you this to frighten you–I just want you to be aware.”

And for me, that awareness is exactly what I need.

She called today to follow up on Monday’s ultrasound. She too was perplexed by the cervical length from the ultrasound.

A little background: My initial ultrasound showed a cervical length of 3.4. The next ultrasound: 3.1. We were hoping it would remain around 3 cm, with the weekly progesterone shots I’m taking. But yesterday’s ultrasound showed 3.9, although the tech seemed to second-guess herself several times during the ultrasound, and later told me one thing and then changed her mind, which raised questions for me about the accuracy of the measurement. When I asked her, “Is that typical? To go from 3.4, to 3.1, back up to 3.9?”

She didn’t offer any explanation, she just said, “Oh absolutely! Absolutely it could do that!”

I was about to ask her if she could double-check. But then I realized that when I asked if she could tell me if she was still seeing “girl parts,” she had responded, “Was it a girl last time? . . . Well, then it hasn’t changed.” :-/ So I decided not to bother asking her to re-measure, and just to discuss it with the Ob.

Of course, when she called the high-risk specialist (on the phone), and said, “She’s a 3.9″ (without mentioning my prior measurements), he thought that sounded great.

Monica, my case manager, said that she does see those kind of variations, but typically they are due either to a difference in the way the techs measure or an inaccuracy in measurement.

“Unfortunately,” Monica said, “this raises more questions, than it answers and just leaves you with more anxiety, since you’re still experiencing contractions.” That said, she added, “I do think it’s probably safe to say: it’s likely that you are still a 3, although I doubt you are actually a 3.9, so we are probably not dealing with cervical incompetency. It’s probably more an issue of an irritable uterus. The question now is: How much irritability does your uterus withstand, before it becomes preterm labor?”

She told me that the 17p progesterone is supposed to relax the uterus so it doesn’t contract at all, and there is no way to gauge how many more contractions I might be having at this point, if I were not on the progesterone.

She raised an interesting point. She said with contractions this early in pregnancy, we are not looking for all the traditional labor signs that you would look for at the end of pregnancy. She said if I experience more than four contractions within an hour (and they do not subside with rest and hydration), I need to be on the phone with my Ob. Some women who have delivered babies previously assume, since they’re not in “hard labor” or having difficult or very close contractions, that the baby is alright. That’s not the case. Her point was that the baby weighs about 1 lb., 12 ozs. at this point. I’ve delivered two babies already. She said at this stage of pregnancy, you don’t have to be dilated 10 cm to deliver–this baby could easily come at 4 or 5 cm because of its size. She said if I am dilated at all, even 2-3 cm at week 24, I would be likely hospitalized (unlike with Micah, who was larger when I was at 3 cm, and I was allowed to be home on bedrest until 4 cm).

She said, “I’m going to call you next week before Thanksgiving, and I know you’ll have family in town. But I just want to be that little voice in the back of your mind saying ‘Take it easy. You don’t want to be on bedrest or hospitalized.’”

I needed to hear that perspective. It really didn’t frighten me at all. But the awareness is something I need! And I appreciate that “little voice.” Little Boo, someday, will appreciate that little voice–after she is born healthy at full-term, right?!

That brings me back to Fight for Preemies Day, which is all about awareness!

One of my favorite blogs is The Spors Are Multiplying about Maddie, a 28-weeker who spent 10 weeks in NICU and unfortunately passed away at 17 months due to complications of her prematurity. Her mother is pregnant–due in February–and they are obviously monitoring “Binky’s” pregnancy very closely. Today’s post was about Fight for Preemies Day, written by a mom who through deep grief has learned all too well the need for awareness. . .

Fox News ran a story today about March of Dimes’ work to prevent preterm birth. It’s the story of Joshua Hoffman, who was born four months premature, weighing 1 lb. 11 ozs. His family is the 2010 National Ambassador Family for March of Dimes. Joshua’s mom successfully delivered her second son full-term, with the help of my favorite weekly shot–you guessed it, 17p hydroxyprogesterone! That was encouraging to me as well.

I never ever imagined I would have a preemie–even after two of my best friends–bridesmaids in my wedding–had preemies. It just seems like something that happens to “someone else.” Thankfully, my little 32-weeker (who incidentally was throwing my little decorative pumpkins over the back of the couch tonight and crawling off the couch to go get them and do it again) seems to be completely normal now, free of any long-term developmental problems or needs for surgery or special treatment! We named him “Micah”–which means “Who is like our God?!” We praise Him for His goodness!

So! On this day, take a moment. Be aware. Fight for Preemies.

My prescription for Progesterone shots (17P) arrived in the mail today, along with a bunch of needles and syringes.

Imagining my husband (who is not in the medical profession for a reason) administering these shots is a little, well, unnerving. Shots don’t bother me too much at the doctor’s office.

You know, with a trained professional.

When I try really hard to “think happy thoughts.”

But just imagine coaching someone the very first time they give a shot, and it’s in your rear end. That will be a new experience–for both of us! Thankfully our insurance company is sending someone to our house to train Daniel on giving the shots.

Oddly enough, I’m actually looking forward to getting the shots, because I’ve already noticed contractions beginning. And I’m only 19 weeks. So yes, bring on the needles!

When I called my insurance case manager today (I’ve been assigned a case manager, since my pregnancy is considered high risk), she said my file at the doctor’s office indicated I would start the 17p shots at week 20.

I was actually disappointed. You mean, I have to wait a week?

My contractions usually come at the end of the day–often around dinnertime, bathtime, or the kids’ bedtime. But I notice them every day now.

Carrying Micah up the stairs, bringing groceries from the car into the house, carrying laundry up from the basement, long walks outside, walking/standing for a long time (for instance, last Saturday’s 6-hour Goodwill/ consignment store shopping trip!). All those things cause me contractions. I’m really not doing anything excessive, just normal housework and child care kind of things. But it is amazing how many activities around the house require the use of your abs. And for some reason, those activities seem to bring on the contractions.

My contractions aren’t regular at all. And like my contractions with Micah, not painful, just tight. My uterus is still so small that they aren’t really even uncomfortable yet.

But it makes me a bit nervous. For Little Boo.

I talked to my Aunt Terrie a couple days ago. (Aunt Terrie knows a thing or two about pregnancy, having delivered eight children of her own and worked as a La Leche League consultant. When I told her I was starting to notice contractions already, she said, “Yessss, it starts earlier and earlier with every one.” Yay. I thought. So I am probably not physically capable of carrying eight children full-term, am I? (What a relief, right, Daniel???) He wants four children. I’m wondering if five would be all that bad. . .

I find it helpful to rest when I’m experiencing contractions. They do go away. And that’s a good sign.

I’m also trying to drink tons of water. (Dehydration often contributes to preterm labor.) I’m trying not to walk too much, or be on my feet too long, & I try to ask for help lifting (despite the fact that I am the do-it-yourself kind of person that hates to ask for help).

All that to say:

Bring on the needles!