31 weeks and ... YIKES! We're delivering!

This is going to be a quick post because I'm sitting in my dark hospital room in L&D because my new night nurse who has to be related to my other Nurse Ratchett has turned off all the lights and tv and told me to go to sleep. Tomorrow is a big day, but this nurse scares me. 

Let's rewind. Yesterday I went to see Dr G for my new weekly visit and I happened to mention to him that I almost called him last night over a bunch of contractions. Then I stupidly whipped out my phone like a the idiot I am, proudly declared that I had tracked them all on my nifty contraction timer iPhone app that all pregnant women need to have, and started reading them to him. 

His usual jovial face quickly turned to stone. He said, "Uh ... That's a lot of contractions. Are you having them now?"

"Uh ... yeah," I couldn't wait to blurt out. "I had one right before I came into the exam room."  Nice one genius. Of course he hooked me up to the monitor in his office. OF COURSE I started contracting like a crazy woman. OF COURSE he sent me down to the hospital immediately. (That laundry in my basement ain't never getting done. *sigh*)

So here I am, in the hospital. Short story is that whenever I'm off the tocolytic drugs to stop the contractions, they start again. They were coming on like gangbusters ... 1-2 minutes apart at one point in the night and very, very painful where I couldn't talk through them. 

Contracting 1-2 mins. Yikes. Not fun. 

So my Dr G, my MFM, and oncologist all decided that it would be better to deliver the baby 24 hours after my last dose of steroids that maturate the baby's lungs kicked in. The reasoning is they want to be able to do the surgery under a planned and controlled environment rather than dealing with me in active labor where the risk of hemorrhaging is so much greater. As Dr P, one of my MFMs, said, "I'm not looking to be a hero." I get it. I appreciate that. 

The other icing on the cake was the discovery by the OTHER MFM (yes, I see all of them in that group), Dr D, during today's ultrasound, of a blood clot right beneath my cervix in the placenta that's imminently ready to blow. 

See that bubble right underneath the colors?  That's the clot. The colors are the blood vessels running through the placenta and landing in the clot. The thin dark line directly to the right of the colors is my cervix and its opening is partially covered by the placenta and the clot. 

The NICU team has spoken to me about my Little Boy Blue. Since he's a boy and before 32 weeks, his lung maturity is still underdeveloped. He'll need some time to  learn to breathe and feed on his own. He'll most likely be on CPAP at first, but hopefully not for too long. Also, his expected stay in the NICU is 3-4 weeks. They probably won't discharge him prior to 35 weeks gestational age. So unfortunately AGAIN, Wayne and I have to leave a baby behind when I check out of the hospital.  It's one of the worst feelings in the world. Any NICU parent will tell you that.  (Crap. Note to self:  buy a breast pump STAT since I won't have the real thing with me at home.)

So I'm now off fluids and food until delivery. At 8AM I go down to Interventional Radiography to get balloon catheters placed through the femoral arteries in my legs to go up to my uterus as a method to control bleeding. Then I have no idea what I'm supposed to do -- stare at my husband? Call the cord blood bank to make sure the kit gets here on time? Watch the Law & Order marathon on TBS again? -- until 1PM. SURGERY START TIME. 

The plan is to 1) deliver my precious baby boy whose chubby cheeks from the sonogram I want to kiss so much; 2) disconnect the bladder from the uterus; 3) remove said uterus; and 4) repair the bladder.  

I also finally talked Dr G out of his cockamamie plan to have me awake but with a spinal/epidural throughout the entire thing. Seriously deluded. I told him I didn't want to be part of the fun. I felt like I already AM the fun so why should I contribute more to it?  The last thing I want to hear is, "Scalpel ... Clamp ... Dear god, she needs another unit!"  No thank you. 

Nurse Ratchett 2 was scaring the bejesus out of me when I was going over it all with her.  She looked at me like, "Really? You want to be out for the surgery?"  No, I explained to her. I want to have the epidural for the baby so he's not groggy when he arrives and I can meet him, but after he's whisked to NICU, I want to be out like a light. No recollection of anything that happens thereafter. She said they've had patients with accreta have their entire surgeries fully awake. To boot, the entire time from when you enter the OR to when you leave the OR is about 6 hours. Okay -- I'm no wuss but I'm calling her BS on this. I don't think doctors have their patients awake for 6 freaking hours in the OR. Especially not for surgeries that could require major blood transfusions! 

My mental state ... I'm trying to be upbeat but I gotta admit ... I'm scared out of my gourd. Frightened of the outcome no matter how confident everyone is going in ... Terrified of the pain ... Petrified of everything. Will the baby be okay after delivery?  With his prematurity?  Although we had younger preemies, each one is different and you never know. I am scared of the pre-op and post-op pain and recovery.  

Alrighty. It's 1AM and I'm turning in. It's only a matter of time before someone comes in to do another blood draw so I need to catch my Z's when I can. Besides, I have a new guy I'm meeting tomorrow and I want to look my best for him.   

I'll post when I can on the other side. Wish us luck!!

That's me unshowered and pumped full of liquids and drugs.  Just wait until after the surgery. Ooooh baby. 

My yummy meal I was allowed to eat after 15 hours.  I was so hungry that it tasted like 2 Michelin stars. 

UPDATE:  I feel bad about calling her Nurse Ratchett 2. She's really not. After talking with her a bit and seeing as how she and my favorite resident let me take a shower ... She's actually really sweet and loves her job. I love all the nurses I've had here in NYU L&D.  They were terrific. Just the best. 

30 Weeks -- The Final Countdown

So I'm sorry that it's been such a long time since I've last posted.  Goodness knows there's been enough to post ... it's just that things have been so crazy on the life front with the other kids.  My eldest was knee-deep in college applications so that took up a good deal of my mental capacity.  Helping him out with his college essays by editing them and helping him do research on the schools and scholarships turned out to be a full-time job!  I'm glad to say that after a fortune and 13 school applications later, we're finally done!

Then my youngest was coming home practically daily with a new virus or bacterial infection from the petri dish they call Pre-K.  Of course, with my lowered pregnant immune system, I promptly caught everything he had.  I think this is the first week where I've been able to breathe out of both nostrils in a very long time.  I could go on about the workings of the 4th and 8th grades with my other two kids, but I think you get the gist that things have been nutso.  Oh yes ... let's not forget the holidays.

So let's do a quick rewind here:

27 weeks -- I met with the gynecological oncologist, Dr. B at NYU's Cancer Center.  Let me first say how surreal it was to be sitting in a waiting room with patients suffering from cancer-related illnesses when you're pregnant.  It's just not a thing that you'd ever expect in your wildest dreams to be doing when you're nurturing life.  I had a bout of light spotting the night before and was on the telephone with my regular OB, Dr. G in the hallway.  I knew how out of place it sounded to be talking of babies and such in front of everyone else so I tried to lower my voice as much as I could.  Wouldn't you know it, Dr. G couldn't understand a thing I was saying so I had to repeat myself in my normal tone.  Now half a dozen other strangers near me know my cervical length.  I wish I could have felt more embarrassed but by that point, I'd given up all hope of privacy and decency.

While ridiculously thorough, that visit with Dr. B was the longest doctor's visit I'd ever had!  I empathized with cancer sufferers who need to do this on a regular basis.  By the time you leave your hour and a half appointment, you're drained.  My hat off to you, you brave people, you.

Dr. B was born to be a surgeon.  Sitting with her at her desk, I couldn't help but stare at her long, graceful fingers.  I imagine if she wasn't a surgeon, she should have been a pianist.  To not put those digits to good use would have been such a waste.  Dr. B basically went through the same things that I'd already known.  Not much of a surprise thanks to all the reading I'd been doing the past few weeks.  It was rather anti-climatic really ... that's a good thing, right?  Isn't that what you want?  To be so prepared you're not caught off-guard by anything?  The same thing with my visits with Dr. G.  That is, until today.  But I'm getting ahead of myself.

28 weeks -- I was having contractions like a mofo.  First they were coming on every 10-15 minutes before getting to 5-7.  I did everything I was supposed to ... I stopped whatever it was I was doing, lied down on my left side, and drank enough water to sink the Titanic.  They wouldn't go away.  I called Dr. G and had his partner who was on-call that night tell me to high tail it to L&D at NYU Medical.  I started having contractions around 6:30PM and we got there around 9PM after waiting for the sitter.  I was hooked up to fluids, did a cervical sonogram, and ran a few tests which came back with a positive bladder infection.  Aha! That was the culprit behind the contractions.  After finishing a bag of saline and a nice prescription for nitrofurantoin, I was sent home around 3AM.  All in all, the visit wasn't in vain.  It was a pretty good dress rehearsal ... the residents were all ridiculously thorough.  There's nothing like hearing "percreta" and "previa" to get people to pay attention to you.

29 weeks -- It was a quiet week.  No spotting.  I felt terrific after the antibiotics for the bladder infection, at least initially.  The contractions had quieted down and I was thinking that I really could make it to 34 weeks, no problemo.  But once I finished with my dosage, the same feelings I had before (that I didn't even know were due to the bladder infection since pregnancy is known to mask the usual symptom) came roaring back.  Hello contractions.  I've missed you so.  Not.

30 weeks -- I've been doing the final countdown until 34 weeks.  I had in my head that Little Boy Blue would be here around January 28 or so.  Au contraire mon frere!  After seeing him today, it would appear that Dr. G wants to deliver the baby exactly THREE weeks from TODAY.  WTF??  I'll only be a little over 33 weeks by then.  It would appear that he wants to make sure he bypasses any large bleeds from the placenta previa.  He said I've been very lucky not to have had a major bleed thus far.  Since he's already put The Plan in place, if I were to bleed spontaneously, it would throw everything out the window and we'd have to switch to (literally) survival mode.

He's also not thrilled about the light spotting I had again this past weekend.  He said it was probably a good idea that I didn't call the office to report it because "no one wanted [me] anyway."  Huh?  He explained that he and his partner, Dr. M were away for the long weekend and the other doctors they had covering for them didn't want to see me because of the Christmas holiday.  However, Dr. G said he was off for everyone except for little ole me.  He'd already told his wife that if I called, that he'd drive back in from South Jersey to  take care of me.  Have I said before how much I love this man?  He also said that everyone in L&D knows about me ... they're all on high alert in case I come in.  Dr. G informed me that if I do call again for anything, he's just going to admit me for the duration of the pregnancy.  From a medical and legal standpoint, if I felt something was severe enough to alert him, then it's severe enough for me to be on strict hospital bed rest.  Note to self:  be really, really careful of phone calls here on in.

So our bundle of blue joy will be here in 21, now 20 days.  Yikes!  I have nothing prepared for the little bugger.  I have one Rubbermaid bin of infant clothing down in the basement that I need to wash for him, a mobile from one of his brothers, a crib bumper, and that's about it.  After our fourth child, I gave all of our baby gear away thinking there's no way I'd need it again.  No swaddling blankets, no car seat, no baby stroller, nada.  Not even a breast pump.  I've quickly thrown things into my Amazon shopping cart and all that's awaiting me now is a click of a mouse button.  I love technology.  Unfortunately there's nothing technology can do to help me get the rest of the house ready.  Egad.  Life is going to be a bit of a bear for the next few weeks.

Dr. G also sprung on me a couple of other surprises.  The first one is the inclusion now of a gyne-urologist to help reconstruct the bladder.  He thinks that maybe the reason why I can't get rid of the infection is because the bladder wall has finally been breached.  They won't know for sure until they cut me open.  I also get to have ureter stents beforehand.  Can't wait.

The other goody is actually cuckoo if you ask me.  The darling man wants to attempt to have everything done -- the baby's delivery, the hysterectomy, the bladder repair -- with me under an epidural alone.  Is he crazy??  His reasoning is that if I'm put under for the birth, they need to rush to get the baby out and I'll have to be intubated and then put in ICU afterward.  He wants it so I'll just come out from the surgery, go in to recovery, and will be able to get on with seeing the baby soon thereafter.  I'm dubious about this.  Maybe I don't want to be asleep?  Of course, my sick husband doesn't mind this.  This might mean that he won't have to leave the room during the rest of the surgery.  The sadist wants to be witness to the surgery because it reminds him of the days of his hospital residency.  Nice.  Sicko.

Okay ... I have 5 minutes left on my laptop's battery.  That's it here.  Will try to post more often.  Thanks for everyone's support who's reached out to me when I was in that terrible funk.  I really appreciate your concern.  xoxo

26 Weeks ... and now the countdown's on ...

So the past couple of weeks have been a bit hectic with Thanksgiving and whatnot ... I've been so busy with my other kids, trying to finish college applications with my 17-year old, dealing with a snotty, sick and cranky 4-year old, and all the rest in between.  On the pregnancy front, it's been trying to say the least.  

I saw Dr. G Monday for my regular visit and finally got the results back from the MRI last Tuesday.  I must say, I went into the MRI with such trepidation that the actual event was ... rather anticlimatic.  After dealing with insurance issues -- the freaking company denied my claim of all things, saying the MRI was "not medically necessary" -- for an hour and a half, I finally went in for the procedure.  For anyone who's pregnant and unlucky enough to warrant an MRI and is worried about the ill effects on the baby, be cautious, but don't panic.  I had what's called a "visceral pelvis without IV contrast" MRI, which means I didn't have to ingest any of that nasty tracer agent.  I laid down on the table, had a couple of shield placed over my abdomen, requested my favorite radio station on the headphones, and stayed still as the technician slid me into the tube.  Half an hour later I was done.  

The good news is that Dr. G gave me a copy of MRI report so I don't have to rely on my faulty pregnancy brain to recount our conversation.  It could have been better.  The report impression reads: 

"Abnormal appearance of the anterior inferior placenta-myometrial interface with bulging, lobulated margins, dark intraplacental bands and irregularity at the border of the posterior bladder/uterine margin.  Findings are most compatible with a placenta increta.  Focal percreta at the left lateral superior bladder wall cannot be excluded (possible.)"

Placenta increta -- Irregular interface (lobulated) between the placenta and adjacent myometrium. Enlarged vessels extend through the placenta to the serosa surface.

An irregular interface between posterior aspect of the bladder and adjacent uterus.

Placenta previa

Basically, what this means is that a placenta increta has been confirmed and it's still "suspicious" for a placenta percreta in the left corner of my bladder.  They don't know for sure if it's definitely breached the bladder but they believe it's gone through the serosa, the outer membrane of the uterus.  Results from an earlier color doppler ultrasound found that there were placental vessel imprints on the outside wall of the bladder.  As my darling husband likes to put it, "It's like someone's knocking on the door but no one's opened it yet."  Yup.  That pretty much describes it.  Again, I'm told there's a caveat:  no one knows for sure what is really in there until they cut me open.

I'm partial to previa ;-)  ... just a joke to lighten the mood.

I was also given Dr. R's MFM consultation write up on me.  I'm chuckling a bit over my "active problem list": -- placenta accreta/increta/percreta; history of preterm labor; partial placenta previa; uterine fibroid in pregnancy, and here's the best part ... AMA (advanced maternal age).  She made the recommendation that I'd have a repeat ultrasound at 30 weeks with Dr. T, keep up with the cervical length ultrasounds every two weeks, and if my cervix does, indeed, shorten, or if I have regular contractions (6+ an hour), or if I start bleeding, then I should get the steroids immediately.  However, if I don't have any of these things, then the steroids would be administered at 33-1/2 weeks with a scheduled cesarean hysterectomy at 34 weeks.  (This means we've got exactly seven weekends to get everything ready before the baby gets here and I'm incapacitated for a while.)

I'm a little annoyed at both Dr. R and Dr. G.  It would appear that both expected the other to refer me to a gynecological oncologist but neither did.  So now I have to wait for Dr. G to decide who he wants to work with and make the appointment myself.  It's got to be made in the next week or two.  I think I'm burying the lead, but the contractions are becoming more and more frequent and pronounced -- sometimes 4 or 5 an hour-- and on Sunday I started spotting (today's Wednesday).  The stabbing pain is so much more and have migrated toward the left side of my lower abdomen.  Now that I know the MRI results, it all makes sense, right?  Dr. G thinks that I'm basically a walking time bomb.  According to him, there's no knowing when I'll start bleeding but he thinks I probably will if I've already begun to spot.  I could go into labor prematurely -- thank you positive fFN -- any time between now and the scheduled delivery.  

Dr. G and I discussed bed rest at length.  I told him that my contractions occur regardless if I'm lying down or standing.  Yes, they absolutely do get more frequent and painful when I'm active, but we've agreed that I'll take it as easy as I can.  That means no exercise, no walking for more than a few minutes at a time, and plenty of chair breaks.  Having been through this before, I know the drill.  I lie down on my left side when I have too many contractions, drink a lot of water, and sometimes they'll go away, sometimes not.  There's not much else I can do.  Luckily, I've managed to hold off on going to the hospital again for preterm labor.  At 26 weeks+4 days, that's a record for me.  I usually have my L&D frequent customer card punched a few times by now.

Wayne and I have been trying to put on a brave face for the kids but Sunday and then Monday after my visit with Dr. G were hard.  Something inside me broke and I spent the better part of both days crying. I couldn't help it.  The boys all saw me, but only my little one said something as only four-year olds can do.  I feel myself withdrawing, pulling back from friends and family outside of Wayne and the kids.  I just want to envelope myself into them and not deal with anything else.  They are my priority.  

One of the reasons, I know, of why I'm retreating has a lot to do with not wanting to hear other people's comments.  I've gotten a few from folks who are essentially clueless about this, despite what I've already told them.  People who tell me to stay away from the internet, to stop reading about the condition because they think it's making me crazy.  But that's not it.  A journalist before I had kids, I was and still am an amazing researcher.  It's in my nature to till information forwards and backwards until I understand the scope of a matter.  I really took offense at those comments and found them patronizing.  I know I'm sensitive now, but people telling me that everything's going to be alright, to not read anything, to keep up positive spirits ... well, first of all, they don't know that for sure. Plus, I just want to turn it around and ask them, if this were you, what would you do?  I dare anyone who's been diagnosed with a serious condition to not read as much as they can on it.  Can you imagine telling a cancer victim not to research their prognosis?  Why, then, is it so galling to some of my "friends" that I should do the same?  Does it make me feel any better to know that maternal morbidity has been reported to occur in up to 60% and maternal mortality in 7-10% of cases with placenta accreta?  No, but at least I have my facts and I'm prepared.  It's always easy to talk when the discussion isn't about yourself. 

Also, I've found that most don't people understand the whole concept of a preemie baby.  I've gotten some comments in the vein of, "Well, at least you won't have to go through the last trimester and be uncomfortable."  Others seem to think that a preemie baby is just a small baby and all they need to do is "feed and grow."  Ah, to be clueless.  Never mind the fears of NEC, open PDA, ROP, brain bleeds, lumbar punctures, high jet vents, desats, and bradys, and so on and so on.  Wayne and I have been through them all. Again, some of the comments have been pretty ridiculous and infuriating. So I'm barricading myself for the time being because if I leave myself open then I'll say something I'll regret.

Another thing that I'm bugged about ... I had thought that Dr. R was was going to be in charge of the operation since she's the MFM.  Nope ... turns out that Dr. G will be handling the C-section and the oncologists would do the hysterectomy.  I love Dr. G. I've been with him for the past 15 years, but what's niggling at me is that he didn't catch the increta initially.  The sonographer at the hospital where I was taken into the ER found it.  Once he knew about it to look for it, he easily found it.  So that begs the question, if I meet all the risk factors for placenta accreta, then why wasn't it ever discussed?  The women I've spoken to with this condition certainly had never heard of it before their diagnoses.  

A GOOD Day ...

Well, it's been a while since I've had a visit to the doctor that didn't end with me in tears, either in the office itself or on the sidewalk outside.  But today it finally happened! I left the appointment feeling lighter than I have in weeks thanks to the lack of new news from Dr. R, the new MFM.  Yessirree ... no news is good news, that's what I always say.  Or, at least that's what I'm going to start saying from now on.  Before, it was always something ... I'd dread going to Dr. G because I'd always learn some new thing, condition, complication, you name it that it became a joke between Wayne and I.  "What are you going to have this week? Leprosy?"  Who knew anymore?  

So when it became apparent during the meeting with Dr. R that we were just going to talk and discuss overall strategy, and look over Dr. T's doppler ultrasounds, I was mightily relieved.  The visit turned out to be cake!  Then on top of all that, Dr. R whipped out the cherry to put on top by saying that since yesterday's cervical length measurement was so long, I wouldn't need to go on bed rest after all unless I started to bleed or have changes in my cervix. She gave a couple of reasons for her decision, both of which I've heard before:  

1) Bed rest hasn't been shown to definitively prevent preterm labor unless you have a weak cervix.  That doesn't seem to be my case because when I go, it doesn't matter if I'm lying down or running a marathon. I just go from zero to 10 cm in record time.

2) I've got four kids and the chances of me staying on bed rest with them around are slim to none.  She's totally right. I tried to stay in bed a couple of days ago when I was still told I should, but after three hours I'd had enough of daytime TV, I went downstairs and cleaned the kitchen countertops because I thought I was losing my mind.  

So basically, if I had a short cervical length on top of my positive fFN, I'd be marched straight to my bed, or worse, to the hospital bed.  But since I've only got one out of the two, I'm safe for now.

Dr. R also told me that she wants to hold off on the corticosteroid shots until I really needed them.  She wants to time their administration to about a week before an elective C-section or, God forbid, when I go into preterm labor as the medication is most effective two to seven days after the first dose.  After that , it loses its efficacy.  Dr. R said that since things seem to kick into gear with me around the 27/28 week range, it was imperative that we get everything into place within the next two weeks since I'll be 25 weeks on Friday. 

That said, she scheduled me for an MRI bright and early next Tuesday.  Dr. R assures me that having the MRI is perfectly safe for the baby and will give a clearer picture as to the extent of the damage wreaked by that naughty placenta.  From what she saw on Dr. T's ultrasounds, it looked like in places where it wasn't a percreta, it was just a plain old increta instead.  Oh gee ... that makes it all so much better!  Regardless, she echoed Dr. G and Dr. T by saying, yup ... I'm going to lose my uterus.  Replying to my question of whether or not I'd also lose my cervix, she replied that I would, only if there wasn't too much blood "clouding the operating plane".  Okay.  Fair enough.  If you can see it, you'll take it.  If not, then it stays.  I get it.

She explained to me that as a teaching hospital, I'd have a few more bodies than normally would be present in the OR with us.  First, the delivery will take place in the main operating room. (I'm not sure if it's the main OR in L&D or THE main OR.  Wherever it is, my surgery is big enough so that it warrants something big, not the little ORs I've had in the past.)  Among the people present will be Dr. G leading the cavalry, Dr. R or Dr. P and some OB/GYN fellow and residents, the gynecological oncologist (whom I've yet to meet) and his/her team (a Fellow, a resident, and their nurses), the anesthesiology team (about two to three of them too), and the neonatal team for the baby.  From past experience, I know this last team to consist of five or six people alone.  There is always the attending, the fellow, a couple of residents, and one or two nurses.  And then there's Wayne and I ... all in all, about 20 or so bodies watching our little one make his debut.  I wonder if I can start charging admission ... it would be an interesting show, that's for sure.

I asked if I could be awake when he's born, to which she replied, absolutely.  It would be in the baby's best interest if he was born while I was on an epidural instead of general anesthesia; he would be less groggy that way.  After that, they would most likely put me out.  The baby would go up immediately to the NICU, since that's where all babies born before 35 weeks need to be if they're born at NYU, for evaluation.  Wayne could stay until the baby was born but then he'd have to leave the OR and wait outside.  This is actually something my husband, the sicko, is disappointed about.  During the Weet's C-section birth, he shocked everyone by standing up to look over drape and watch them work on me because he wanted to say he knows me inside and out.  Like I said, sicko.

Dr. R also explained that prior to surgery, the oncologists would probably want to insert surgical stents into arteries and ureters to control hemorrhaging and to illuminate the "plane".  Because so much blood is involved during an accreta/percreta surgery one of the common mistakes is to accidentally nick one of the ureters.  If that happens, then you're F---ed.  After the uterus is removed, the oncologists will then shoot methotrexate, a chemo drug into placental blood vessels around the bladder to kill them and hopefully shrink whatever tissue is left in, on, or around that organ.  She reminded me that I will most likely lose a lot of blood and will require several, if not more, transfusions during the process.  I told her that my good friend, Barbara, wants to hold a blood drive for me.  Dr. R thought that wasn't a bad idea, but we're limited with the issue of freshness of the supply since we don't know for sure that I wouldn't need it prior to 34 weeks.  Plus, she wants to wait until the MRI results come back to see what it is that we're going to be dealing with ... 

So the next steps are to 1) have the MRI; 2) meet with the oncologist(s); 3) go back to Dr. G to hash out an emergency contingency plan; 4) see Dr. T again between 28-32 weeks for another ultrasound; 5) get the steroid injections; and 6) have a baby at 34 weeks.  Granted, this whole plan goes out the freaking window if the fFN test proves right and I go into labor within the next two weeks.  Not gonna lie ... that would really, really suck and you might be getting more maudlin posts from me.  

This little man just has to obey his mama and stay put for a while:  "There's nothing for you outside the womb now dude!  Stay in! Stay in!  You have all your meals served to you without even asking for them.  It's nice, warm and a 98.6 degree cozy, whereas outside it's a cold New York autumn/winter.  You can sleep when you want, eat when you want, pee when and wherever you want ... it's all good inside!"  Gosh, I hope this kid listens.

Before I go, I just wanted to thank those of you who've reached out to Wayne and I with your thoughts and prayers. Honestly, I had given up on prayers for a while because I didn't think they were working for us anymore in light of everything.  However, a good day like today was all I needed to give me that sense of hope again.  I think your good vibes did the trick.  It really meant a lot to me to hear from friends, old and new, and even those of you who I've never even met but cared enough to reach out.  It really raised both Wayne's and my spirits when we were feeling pretty low.  I hope that you're never in a position that brings you down to where we were, but if you are, you can bet your bottom dollar that we'll be there to repay the favor.  

xo,

L

24 Weeks Pregnant and I've Got Another Big Fat Positive!

It's late, the house is quiet, and I thought I'd finally write as there is so much swimming around in my head tonight that I know if I don't get it out, I'll never be able to sleep.  If I ramble, again, it's because it's late.

The past few days have been rough, to say the least. Yes, as my last post read, I was most definitely in a funk.  First, a very close family member -- who I can't name since she forbade me to outright talk about her in public, but her name rhymes with "bomb" -- was admitted to the hospital a late last week with severe heart problems.  We were all plenty worried since things were touch and go for a while ... it was made even more difficult to handle as we're so far away.  They are in California and we're 3,000 miles away in New York.  The feeling of helplessness is overwhelming.  When someone you love is in so much pain, all you want to do is to be there with them to hold their hand or stroke their brow.  As soon as I heard that they were in trouble, I called Dr. G to ask him if I could fly out there.  At first he was going to let me go as long as I took precautions and made promises not to carry anything or exert myself.  Then I had to go and open my big fat mouth and tell him that the sharp, stabbing pains I'd been having in my lower abdomen were getting stronger and more hurtful.  Well, that did it.  There was no way he was going to let me go anywhere at that point.  Open mouth, insert foot.

In the end, I know he's right.  After all, he did make me cancel the babymoon to New Orleans in early December because he said that was a critical time for me.  And now it appears it's even more so.

Today started off well enough ... Wayne and I got the kids ready for school, we shared a nice breakfast, he kissed me on the lips, and sent me off to see Dr. G for another OB appointment.  When I got there, I was already in enough of a mood that I told Gloria, his assistant, that I didn't want to know anymore how much I weighed.  So, taking a page from a wise friend of mine, I got on the scale backward and held in my stomach.  I don't know why I did that ... as if sucking in more air and tightening my muscles would make me weigh less.  This pregnancy brain is getting to me.

Before Dr. G took the cervical length measurements with ultrasound, he swabbed my cervix for the fetal fibronectin (fFN) test.  Fetal fibronectin is a protein that acts as a "glue" during pregnancy, attaching the amniotic sac to the lining of the uterus.  Fetal fibronectin begins to break down and "leak" into the vaginal canal toward the end of pregnancy.  A negative fFN test result means that you have a 99.5% chance of not giving birth within the next two weeks or so.  However, a positive result is a clue that the "glue" has been disturbed and you're at risk of preterm labor within two to four weeks.  I'll bet you a million dollars to guess the result that I got.  You got it ... a big fat positive. Awesomeness. Dr. G called me while I was driving 3 teenage boys home from school.  I should really apologize to those boys' parents for having a conversation with my doctor on speakerphone with them in the car, and perhaps giving them a lesson in the female anatomy.  Hopefully there were enough Latin words thrown around that most of it went over their heads.

Now, I've read and been told by countless of well-meaning people that false positives are pretty common with an fFN test, but you know with the way my luck has been going lately ... I wouldn't hold my breath that the results are totally wrong. Seriously though ... NICU ... three times??? This baby can NOT come this early.  I swear, I will ground him for LIFE if he does.  

The up side is that my cervix is still pretty long ... at 24 weeks and 4 days it's still measuring 3.7 cm.  (I think the average is 3.5 cm at this point.)   It's still open a little more than halfway up but the internal and external os are still closed.  I wish I had taken a photo of the sonogram with my phone camera.  It's actually pretty cool ... it looks like a broken zipper.  I've been told that it's a "dynamic cervix" which means that it changes length depending on pressure or whatever.  However, because the range since I've been pregnant has been from almost 5 cm to 3.5 cm (which is still pretty long), he actually backtracked on his promise that I'd be on bed rest at first sight of a positive fFN sign and told me it's not "immediate".

However, as always with this man who I've come to know pretty well over the last 15 years, there's always a caveat ... it being the new MFM's opinion.  Tomorrow (or today, rather, since it's now 1AM), I have a consult with Dr. R, the associate director of the OB/GYN Residency Program at NYU School of Medicine. Dr. G is obviously lining up the big guns since I also found out today that I'm only the SECOND percreta case he's seen in 20 years, the first when he was a resident.  If Dr. R wants me on bed rest after all, then he'll defer to her and off I'll go.

In any case, Dr. R will be the gate-keeper of sorts, handling the various specialists who will be on hand during the delivery, along with setting me up with the MRI and steroid shots.  It should be interesting.  I know that I was going to have the steroid shots for the baby's lungs at some point, but I guess now with the fFN the way it is, I'll get them sooner, rather than later.  If I remember correctly, I'll probably have to spend a night in L&D for that.

A few more interesting things to note, then I have to go to bed because it's taking a lot for me to be somewhat coherent now ...

1) Dr. G came out and agreed with me that last November's miscarriage was most probably a very early accreta.  That explains the 10 weeks of bloodshed.

2) If I had been diagnosed in the first trimester with an accreta/percreta, then he and any colleagues he referred me to would most likely have recommended a termination of this pregnancy.  He justified it by saying many pregnancies like mine never make it this far and almost always pose a life-threatening risk to the mother.  But then he looked at me and shook his head, "But you probably wouldn't terminate, would you?"  I replied, "Not after that last miscarriage.  It almost killed me."  (Emotionally, I mean. It was revealed from the genetic testing done on the tissue that the baby had been a girl. That's another story for another day.)

3) He said the sharp, stabbing pains are in the location of my bladder.  You know what that means ... and it isn't good.

4) My contractions aren't as often as they had been, although when they do come, they're quite painful and last longer.  I'd say that on a scale of one to 10 with the latter number measuring more pain, they're around  6 or 7 ... enough that I drop what I'm doing and can't talk while I'm having them.  Sometimes I even have to hee-hee-hee through them.  Dr. G tells me that Dr. R will probably recommend 17P again, but after that last episode, he's reluctant to go there with me again.

Oh, I almost forgot ... last night I had some really crazy dreams ... three to be exact.  With the first one, I was in an elevator that could go anywhere in the world with just a press of a button.   Somehow it could take me to Antarctica or London, but it could never send me home, no matter how many buttons or configurations of such I pressed.  I was trapped and kept on traveling, never going home.  The second dream, I was with a little girl and we boarded a subway train car that had two levels.  She didn't want to climb the stairs to the second level, but I made her because it was brighter up there and the lower car was too dark and small.  It didn't take long before I realized that the subway blew through my stop and kept going.  I couldn't get off, even after pulling on the emergency brake.  The train kept on going and going and going.  I couldn't go home and the little girl was so scared.

In the third dream, I was driving a car in Manhattan and tried to turn onto West 34th Street to head to the West Side Highway to go home, only to face a gigantic warehouse with a garage door that was closing fast.  I tried to step on the brakes to stop before the car hit the door, but it wasn't fast enough.  The car slid into the dark garage where I spent some time trying to figure a way out.  Eventually I succeeded (I forget how I did it, but I'm pretty sure I performed some MacGyver move) and started driving again.  I decided to take 36th Street to the highway which should have been a safe bet, but instead it took me onto a road ramp high in the sky near an airport.  While I saw people taking luggage out of cars and kissing each other goodbye, all the time I wondered how in the world did this pop up without me ever noticing it?  I kept driving and driving but the ramp wouldn't stop ... I saw the same people rotating back as if on a merry-go round.

Wayne says I was crying in my sleep, saying I want to go home.  I think it's pretty obvious that I'm worried and it's spilling over into my subconscious.  Any psychology majors out there who can take a better shot of analyzing my dreams?

Okay, now I'm finally going to go to sleep ... I would say "going to bed," but ever since I got home, Wayne's banished me to the bedroom and wouldn't let me get up to do anything despite my protestations that I don't have to be on immediate bed rest yet.  I spent the rest of the afternoon and evening in bed with the Weet, playing dinosaurs and singing songs from "Daniel the Tiger's Neighborhood."  Then I had a few good cries because everything is still getting to me and I'm still trying to digest and understand what's going on with my mom, with me.  There's too much to process.

Sometimes I don't think that most people get it.  I wonder if, by some of the comments I've been getting, if they think when the baby comes out early, that he'll just be smaller and spend a little bit of time in the NICU to gain weight.  If the fFN is on the money, that couldn't be further from the truth.  If he comes this early, then it will be all kinds of bad ... so many bad things remembered from Josh and Spike that I can't even list them again.  Then on top of that, I wonder if they realize that as soon as the baby is delivered, then that's when I'll go under the knife.  That's when the fun begins for me and it won't stop until months later.  (Dr. G told me it could take up to three months to recuperate, barring any unforeseen complications with my bladder.  I can just see it now.  Baby AND mommy are both wearing diapers.)  Thank goodness for Wayne.  He lets me cry as much as I want, tells me he's in it with me through thick and thin, and keeps handing me the Kleenex.  I sure am in love with that man.

Thanks for reading my ramble ... I'll try to post earlier tomorrow, when I'm actually cogent, after I meet with Dr. R.  It should be an interesting appointment.  If you recall, the last time I met with Dr. P, the last MFM, I stood on Second Avenue crying on the phone with Wayne.  Hopefully I'll get better news this time around.

xo,

L

Funk

The past 24 hours have been rough.  I think I'm officially in a funk.

Rollercoasters Aren't Always Fun

Our four-year old son's school called today around noon to tell us that he had a 102-degree fever.  So Wayne rushed to pick him up since he was on his lunch break anyway and I've been plagued by contractions all day today.  I think I overdid it yesterday because I was out and about working, then at home making cooking for seven boys, four of them ravenous teenagers. At this point, the contractions are like white noise to me ... I've almost forgotten what it feels like to not have a belly that's rock hard like a clenched fist all the time.  The pain in my right lower abdomen hasn't resurfaced too much today ... only once in a while to remind me that life can be so boring and vanilla when there's nothing to worry about.  Yeesh..  I'd really like my "bitchy" not "irritable" uterus to chill out.  Maybe it's a good thing we're parting ways after the baby's born.  My uterus and I obviously don't see eye to eye and it's only pissing me off.

Wayne and I had a nice talk last night.  He had been distant and really quiet since the doppler ultrasound with Dr. T last Thursday.  I knew that the percreta diagnosis was weighing heavily on his mind.  Sometimes I would turn around and catch him staring at me with this funny look on his face.  However, every time I asked what was bothering him, he would answer -- in that totally guy way of his -- "Nutthin."  Of course I knew he was lying.  How could there be nothing?  He just sat through two doctors' appointments within the span of four days where he was told that his wife could bleed out at any moment or be left with some serious complications.  The man was obviously sh!tting bricks.

I almost wrote about this a few days ago, but I wanted to give him some time to process everything before I did because what he's going through is also sitting badly with me.  His agita is giving me agita.  

If I had written about this before, my first line would have been, "My husband is pulling away and shutting down," because that's what he does when he's stressed.  I always rib him that he'd never make it as an emergency first responder in a fire ... we'd all be screwed.  So he's been putting around the house and his office pretty much in a daze, not saying much. One night, I found him lying on our bed holding his eyes with one hand and rubbing his temple with the other.  A few times, when my insomnia kicked in because my brain wouldn't shut off, I whispered his name in the dark to see if he was awake. He always answered me immediately so I knew he couldn't sleep either.  I think it was his way of keeping "watch" in case something happened in the middle of the night.  His macho, defend-what's-his mentality was kicking in big time. Finding out that you've got this major, potentially life-threatening condition is bad enough ... I imagine being the partner who might be left behind with five kids is pretty sucky too.  We talked about this and I joked to him that no woman would touch him with a 10-foot pole with five boys in his care, no matter what he does for a living or what he makes.  He didn't laugh.

So last night, we're watching "Masters of Sex" on Showtime. (No pervy people, it's not porn. I wouldn't write about THAT here. Ha! Surprisingly I DO have some boundaries.)  It's that show about famous sex researchers, William Masters and Virginia Johnson.  Dr. Masters was also a famous obstetrician who routinely treated infertility or high-risk cases.  It was the episode where Dr. Master's daughter, born at 24 weeks was delivered stillborn after his wife started to bleed.  (My money was on her having a previa.)  Of course, with everything we're going through, I just shook my head disbelievingly, "Really?  Serious?  You have GOT to be sh!tting me."

That got Wayne and I talking and he finally opened up.  "I haven't been this scared in years," he said.  I asked when the last time was.  "When you were down at Beekman [Hospital] with Josh.  It was the uncertainty, the lack of promises and guarantees.  I didn't know what to expect because everything was so new."

Here's the thing, even though this has been a turbulent pregnancy, this isn't our first time on this rollercoaster. When I was 28 weeks pregnant with Josh, our firstborn, I went in for a routine exam, only to be told I was 2 centimeters dilated and admitted into the hospital for preterm labor.  I was so young and green that I didn't even realize that the tightening feelings I had every now and then were contractions!  I wound up giving birth five days later at 29 weeks after having been told by a home healthcare nursing agency that I wasn't really in labor and that perhaps my stomach pains meant I had to go to the bathroom.  I almost gave birth in the cab on the way to the hospital, but managed to hold out for 15 minutes after I WALKED through the doors of the L&D operating room.

Josh in 1996, born at 29 weeks weighing 2 lbs 14 oz, measuring 16 inches.
I think he's 2 or 3 days old here.
He needed mechanical assistance to breathe for over a month.

Daddy and Josh

Then came Spike, who was born at 27 weeks after they couldn't stop the preterm labor contractions and learned that I had a uterine infection -- listeria, of all things -- causing the contractions. The doctors told me that because of my high fever -- 104.5 degrees -- that there was a good chance the baby would come out with meningitis and suffer from brain damage, or blindness, or deafness. They would have to take the baby in an emergency C-section, but even then, they couldn't guarantee a successful outcome.  We were so terrified then too.  I'll never forget how the anesthesiologist very somberly told us that because of my high fever, he couldn't place an epidural for fear of the spinal site becoming infected.  Instead, he would need to put me under general anesthesia with the severe caveat that, again because of the fever, they couldn't guarantee that I would wake up.

Here's Spikerman.  He was born at 27 weeks at 2 lbs, 2 oz, measuring 14 inches. (That's my hand next to him.)
Like all babies, he lost 10% of his birth weight in the first 3 days of life.
Unfortunately, it took him 2 weeks to gain that weight back. He's about 5 weeks old in this photo.
He was on oxygen for the first 5 weeks of life, which is an amazingly short period for someone of
his gestational age.

My sweet little  man ... 

After that, things got hazy, but Wayne was given the choice in the event something dire occurred, who he wanted to give priority to ... the baby or I.  He never told me who he chose, but I'd like to think it was the baby ... you know I don't go through all of this without something to show for it in the end.  So before I was wheeled into the OR, we cried and said our tearful goodbyes.  I hadn't seen him cry since Josh was born, eight years before.   I told him everything I thought he'd need to go on without me.  For the record, to tell someone you love that it's okay to love someone else is hard.  You really need to be at that precipice where you think there's no going back.  That's where we were in 2004; I sure hope we don't find ourselves there ten years later.  That would really bite.  

Okay. It's off to bed to go hover over my sick little Weetheart, like I always do when they come down with something. I also have to be at work early in the morning.  It's my last week!  After this, I get to breed and brood!  Egad -- whatever will my posts be like then?

xo,

L