A very quick update

Azulito/a’s scheduled birth date is still June 9, 2015. 

The placenta has not moved at all from my last ultrasound three weeks ago. A cesarean delivery is mandatory. 
Thank you thank you thank you for your tremendous outpouring of support and kindness in response to my last post. 

I am going to try my best to mentally prepare myself for the possibility that I may need an emergency hysterectomy on June 9th if the risk of placenta accreta (placenta invading uterine wall, posing risk of mom bleeding to death if not medically resolved, the most extreme means of which is removal of the entire uterus) becomes reality. I am going to will that not to happen but want to stay as calm as possible if it does. So that will be my new project.

That and surviving this awful nausea for the next 13 days. 

I have to go back for one more ultrasound at the Perinatology (Maternal Fetal Medicine) Clinic on June 8th to make sure things remain on track. 

Today baby A was estimated to weigh 6 lbs 4 oz – only a couple of ounces less than what the Miracle Toddler weighed at birth. Of course that estimate can be off by up to one pound at this late stage so the little one could weigh 5 lbs or 7 lbs or anywhere in between! 

We are at T minus 13 days and counting, folks. Holy mackerel!

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Please come home safely – and soon – Spirit Baby

I have been holding off in writing this post for the past week or so because it touches on a topic that sparks deep, unforgiving and breath-stealing fear. 

At my OB appointment last week I thanked my lucky stars for not having a brain or heart aneurysm (at least none of which I’m presently aware) because I was confident either or both would have burst. I have been unable to write about what happened because I’ve been scared to death, not sleeping and very emotional. Admittedly, the lack of sleep from the bruised ribs and last week’s anxiety surge coupled with this evil, unrelenting nausea are not helping me be less emotional or more rational. I am trying to do my best (which for the past 5 days has been not all that well). So it goes.

At last week’s appointment I had asked my OB about what would happen with scheduling and whether he recommended sticking with a caesarean rather than being induced if labour didn’t happen early on its own, assuming my placenta has moved the requisite 6 mm by this Wednesday (at 35 weeks) from where it was on April 29th (at 32 weeks).  If that happens he said it removes the need for a caesarean at or before 37 weeks to avoid me going into labour and facing the risks associated with that (bleeding to death being the worst case scenario, an emergency hysterectomy being another serious risk).

Last week, my OB said that if I get off of the placenta previa watch and only have my crappy placenta (which has been flagged as being at risk of early deterioration and placenta accrete which could also lead to emergency surgery include hysterectomy but apparently that’s all speculative whereas the previa has been concrete) to worry about, he wouldn’t schedule me to deliver until 39 weeks because (a) he’d get in trouble scheduling a section any earlier if there wasn’t a serious risk like previa driving it; (b) studies show babies benefit from staying in until 39 weeks; and (c) that said, studies also show an increased risk of stillbirth in otherwise healthy women over age 38-40 (that ship sailed some time ago!). 

I was so upset, I just shut down.  There is no way I trust this placenta to function properly to 39 weeks.  In the moment last week however I could not express my anxieties. I was struck dumb. Literally.

Some of those anxieties stem from knowing my Mom lost her baby from her second term pregnancy when the doctors would not listen to her saying she felt something was wrong and wanted to be induced – and so I left the office, called the LP and sobbed so hard I had to go for a long walk before I could return to work (which was pointless since I did not billable work after that morning appointment anyway). Suffice to say I was a hot mess. 

If I’ve harboured one unrepentant fear during this pregnancy above all others it is the fear of losing this child. Once we cleared the first and early second trimesters it became a raging nightmarish fear of stillbirth. This fear is potent. It is so profound and deeply seated I cannot tell if it’s driven by intuition (whether a premonition-type thing or otherwise) or merely an overwhelming anxiety.  I suspect it is as deeply rooted as it is in part because of my mother’s experience having punctuated my own childhood and having evoked fear throughout my adulthood since I began trying to have children of my own.

What I can say with certainty about my fear of losing this baby – my dear Azulito/a – at this late stage is that nobody, not even my OB or my other caregivers, are saying it’s irrational or unreasonable or not founded in the reality that we all know that my placenta is troubled, that my immune issues elevate the risk of something going seriously wrong at this late stage, and that a family history of this happening is not something to brush away like a family history (maternal) of male pattern baldness (not to say that hair loss in men is inconsequential but it’s not the life or death of your child). 

Nobody has tried to tell me that there’s nothing to worry about. Because that would be a lie. My worries are legitimate. The risk is real. And none of that helps assuage my fear or my wish to end this pregnancy sooner rather than later if it means I get to hold a living baby at the end of this journey and not mourn the loss of one whose life expired before the generally applicable expiry date.
Another thing I can tell you about this fear is that it’s a powerful motivator. I would climb mountains, wrestle wild beasts and tear out the eyes and heart of anyone who stood in the way of my goal to deliver this child before it’s too late – whatever too late might be. I have never been more of a mama bear than I have been in my non-sobbing moments during the past week. I would move mountains if I had to. Those of you who’ve been ‘here’ or somewhere like it know what I mean. And I know you’d do the same. I *know* you would.

 I would also consume supplements and drink horrible-tasting and devastating side effect-inducing cocktails to bring on a natural labour. On that note, I’ve been lining up the ducks for that eventuality should it become necessary. Whatever it takes.

 For now, however, at least until early Wednesday morning this week, I am still considered to be diagnosed with Placenta Previa. I cannot say I want my placenta not to have moved – I don’t really want a caesarean to be honest and most of you will recall I never did. The LP still wishes I’d forego the risks and just choose that path regardless. My OB is letting me decide if the previa diagnosis disappears this Wednesday (so is the LP though he knows I know what he would prefer).

 This morning, my OB relented on the 39 weeks requirement and said we can talk about inducing earlier if the previa is determined this week to have resolved itself. I asked if he’d agree to 38 weeks and he said possibly and agreed we could talk about it next week (Wednesday) if the previa is resolved. He also gave me another requisition for blood work to test my bile acids (more fasting – awesome!) in case there is any chance of me developing Cholestasis again (there is a 50-70% risk of reoccurrence). If I do, that would involve an earlier induction or caesarean too. Why? Because the big risk with Cholestasis is stillbirth.

(I know, right?)

I said I was not wishing to be diagnosed with that again even if it meant an earlier scheduled delivery. Thanks but no thanks!

I really like my OB but this roller coaster is no fun. I want someone to hit the emergency stop button so I can get off. I’ve had enough. 

As matters stand, I might be delivery via c-section on June 9th. I might be ingesting stuff that in the course of making me sick I hope brings on labour and a vaginal delivery. Or I might be getting medically induced or going through a scheduled caesarean sometime in the week of June 15th. The LP is in trial every day from next week until the end of June and two days this week. The timing could not be more perfect. So it goes.

It is time, Azulito/a. Please come home safely.  And soon.

The Mystery Remains Unsolved

To you lovely friends who offered comforting words and condolences yesterday evening about the pain and sleep deprivation I’ve been experiencing lately: Thank you from the bottom of my heart. Your kind words, wishes and prayers meant so much. 

And they may have worked! I got some sleep last night. Still interrupted by pain jags but much more sleep overall than in many days.

At the hospital, we eliminated all serious conditions that could be causing the pain: pulmonary embolus, lung infection, enlarged or dysfunctional spleen, low platelets, signs of infection via blood test. Thankfully, all of those were ruled out. That’s the good news. 
The not-so-good news is that they cannot give me anything I can take for the pain. The only drugs they recommended at this late stage when the baby (whose liver is far more vulnerable than ours) would get it too are Tylenol and Tylenol 3 (with codeine). I am allergic to a filler or bonding component that’s used in codeine; drugs containing it make me throw up (a rather violent action I’ve been trying hard to avoid). So that’s not an option. Darn. 

The pain is likely a result of inflamed rib joints and surrounding tissue which has gotten worse rather than better – mysteriously – over the past couple of weeks since I injured them coughing my lungs clear. Because Azulito is a big-time mover and shaker, I suspect that the kicks and jabs to that area (which are very painful unlike the kicks to the same spot on my other side, which are just slightly uncomfortable) and the muscle spasms they bring on (man, those hurt! And take my breath away) are largely to blame. 

I also think that the LP’s insanely busy work schedule replete with long hours that mean I’ve been flying solo with the Miracle Toddler much more than usual for the past several weeks and the MT’s decision to become my Velcro-child recently (insisting I pick him up and carry him often or endure his sobs and anguished expressions) are not helping me heal the bruised ribs and surrounding tissue. There is no easy remedy for either of those at the moment, unfortunately. 
Last night I took two extra-strength Tylenol and 3 mg of Melatonin. The latter knocks me out when I’m not pregnant. I do not usually take it while pregnant because of the conflicting information about its safety to baby. Last night I was desperate. And I slept more than I have since Wednesday night of last week. Sorry, Azulito/a, if I made you drowsy or screwed you up in any other way last night. Your mommy needed some rest. 

I am truly hopeful that this is the last time I feel compelled to go to L&D on an emergent basis to rule out any serious issues that could impact the safety of baby or me in this pregnancy. Three visits like this are enough. Only three weeks and one day left for my placenta and baby A to hang in there. Thank goodness the end is near. 

And thank goodness for all of you. Thank you again for your love, kindness, support, prayers and sweet words – both when I was stuck in the hospital last night and always. 

Persistent Pain, I Hate You

I’m at the hospital. Labour and Delivery. Again. 

I am here to get this persistent and at times debilitating pain in my upper left abdomen, just below and behind my ribcage, checked out. I have not been able to sleep more than 30 to 60 minutes at a time the past several nights (and earlier today when I desperately tried napping) before the pain wakes me up. Tylenol does nothing for it. 

There is something about constant pain and sleep deprivation that ribs me of my emotional stability and repeatedly reduces me to tears or near-tears in a flash. I feel like a lousy parent because I can’t do much with the MT and have no energy or endurance when (understandably) he is frustrated and disappointed. He was so sweet today, playing by himself and picking me a gazillion dandelions to cheer me up (I am allergic to dandelions according to my last immunologist but whatever, these are still yellow and not spewing their pestilent pollen). I was looking forward to taking him out today. That did not happen. 

I’ve seen the Resident on duty (who is very kind and remembered me from my first of these three visits to L&D back at 20 weeks) and she has said she is not too sure what to do with me as the only risks from where this pain is are blood clot (not likely since I’m on Lovenox), lungs (they checked my oxygen saturation as step one to rule that out – it was 97% – and are waiting on ordering a chest X-ray as some radiation does pass to baby), spleen and otherwise musculature.  

In Chinese medicine the spleen channel is associated with excema around the eyes (the return of which about 5 weeks ago necessitated my going back on prednisone). I wonder if there is anything to that?

I have been poked and palpated (ouch!! on the left side), had blood drawn and expressed my reservation about the X-ray unless it’s strongly recommended. If platelets are low I will likely need an ultrasound to look at the spleen. The Resident said it is very unusual for a mom to develop a spleen issue during pregnancy, however. Not impossible but unlikely. May I not be the statistical minority once again (cholestasis, which led to the MT’s emergency induction, is also a rare occurrence). 

For now we wait and see. 
Being the mystery patient kind of sucks.  At the same time, I suppose it’s better than being told there is something seriously wrong. The Resident was reassuring as well, saying that since I’m almost 34 weeks now even if something requires that Azulito/a arrive earlier than scheduled, we may not even need steroids for baby’s lungs. 

The LP and MT have been waiting for me nearby but I can’t see them. I wish they were here in this sterile room with me. I miss them and I feel a little stupid for being here as the unexplained case (again).  

My nurse, while clearly skilled, is not pleasant.  I hate drawing the chilly nurse who leaves me feeling disbelieved, as though I am a hypochondriac of a pain-wimp (I’m neither). I don’t think people with that mindset or who exude they attitude should be in this profession (or at least should not work in L&D). If I were in charge…

Anyway.  Here I am.  In the hospital. Uncomfortable. Sleep deprived. And hating on this mystery pain in my upper left quadrant.  Curse you, pain. You suck. 

As I was about to sign off the Resident returned and said the OB on call (who did my lady D&C) said we need the chest X-ray to rule out a lung issue. The Resident gave me stats on the risk and I have signed the consent. Now I wait for that and the blood test results to come back. 

Meanwhile, Azulito/a has been busy busy busy. That is the good news in all of this. 

Fingers crossed that we get some answers and a way to let me sleep before this little person makes a long-awaited arrival. 

We have a date (and a change of heart)

I am now officially scheduled to deliver  baby Azulito/a on Tuesday, June 9, 2015 via ceasarean section. 

I have spent the past several months being upset and frustrated that I would not likely have a chance to deliver this baby as I did the MT, without surgical intervention.  Last week a glimmer of hope appeared – maybe my placenta would move enough and I would have the opportunity to attempt a vaginal delivery.  Along with that glimmer came a dark cloud: the risk of an emergency hysterectomy.  

I have spent much of the past week worrying about this. Ultimately I decided in consult with the LP that I would prefer to avoid risking an emergency trip to the OR more than insisting on a vaginal delivery (or an attempted one), if that even becomes an option. I  going to speak with my OB next week about this but that’s where I am presently leaning. 

Stay tuned!

A Short Update: Good News and New Worries

Yesterday’s appointments went well for the largest part. I got to push Baby Azulito’s head out of the way (is it creepy I felt accomplished having an actual role in an ultrasound if it involved shoving my kid’s head around?). I didn’t cry once. I felt lighter and more grounded by the time our anniversary dinner rolled around. 

Baby A is estimated to weigh 4 lbs 9 oz at 32w1d. That sounds huge to me this early. The Miracle Toddler was nowhere near that size by this point although he ended up a good size at birth thankfully (~6.5 lbs). Way to grow, Azulito/a! It is a relief not to be facing any sign of Intra-Uterine Growth Restriction (IUGR) at this point since I’m at elevated risk for that with my autoimmune issues. 

The pediatric urologist was very lovely. She says that “architecturally” baby’s kidneys are perfect-looking and that there are no presently visible signs of a medical problem with their operation. Because of this she is hopeful that in time the determination will be made that this kid simply has large kidneys and nothing more serious than the need for monitoring through his/her early life. 
We will have an ultrasound at her office in the local Children’s Hospital at 6 weeks after baby’s birth.  If no red flags appear then, baby will likely be checked once a year for a few years unless something changes. If red flags do appear we may be sent to the kidney specialist at the teaching hospital for more testing.  Fingers crossed that this all works out fine in the end. 

In other promising news (this is where I got to push baby’s head out of the way so the Perinatologist could measure the space between the edge of my placenta and cervical opening (OS)): My placenta has moved! Not enough to no longer be classified as placenta previa but 1.4 cm. This means that if it moves at least another 0.6 cm I may be cleared to try for a vaginal delivery. I will get rechecked, as will Baby A, on May 27th at 35 weeks. Fingers crossed on this front too!

The energy healer was not really “out there” to me at all. She is so much more reserved and demure (introspective?) in person than in her web presence. I have really no idea what she did or how apart from the fact that she did Reiki first then Yuen method for energetic clearing but I felt much more grounded and relaxed afterward. That was fantastic. 

She said some things about what she cleared that threw me for a little loop. The biggest one was that in a past life I was persecuted and this was interesting to her being that now I practice law.  (I think it better explains my activist youth and younger adulthood actually but that’s because the law I do now is primarily about other people’s money and corporate divorces. Nothing noble, really, except my pro bono work.) 

I had a persistent sense of Azulito/a and my late Mom being present throughout the treatment.  Afterward, I definitely felt my feet more rooted to the earth and my emotional and spiritual energy vibrating lower and more peacefully. All good even if I have no clue why or what happened during most of the hour I spent there. 

As for the scary news: I asked the Perinatologist (MFM) about what my OB had said the day before regarding the risk of my needing an emergency hysterectomy.  The MFM said that this could be due to placenta accreta (where the placenta invades the uterine wall) for which I’m at risk or because the lower part of the uterus does not contract like the upper portion does and has much more vascularization generally (more blood vessels, less natural ability to stop bleeding in lay terms) and sometimes bleeding with low-lying placentas cannot be stopped due to these factors, resulting in an emergency hysterectomy. 

Upon reflection that left me with a new question I plan to ask my OB on May 20th. I spoke with the LP about this last night and we agreed that if vaginal delivery is discouraged even if my placenta moves enough I will accept the scheduled cesarean over running the risk of delivering vaginally and then being rushed to the OR for an emergency hysterectomy. One more thing to worry about. Darn it. 

The anniversary dinner date last night was awesome. I gorged on seafood (Lobster Bisque and Lobster and Giant Prawn Thermidor, taking an extra antihistamine and some tummy meds for the dairy allergy) and the LP had to-die-for mushroom soup and a veal chop.  (I cannot bear the thought of veal calves suffering so have never and will never eat veal and the LP does not eat it except at this restaurant which supports locally and responsibly raised livestock.). 

We know the restaurant owner and he was so happy to see us and brought us a special dessert with “Happy Anniversary” beautifully written in dark chocolate on the plate (which we sampled even though we were both stuffed beyond belief). Our server also recognized us and made me a fancy mocktail while the LP had a lovely Pinot Noir. It was wonderful and recalling the evening and our love for each other now brings tears to my eyes. I also got a beautiful new necklace that touched my heart – it’s made with a stone my Mom introduced me to with beautiful earrings late in her life. 

In other news: My left-side bruised rib is killing me… Last night it hurt so much I was whimpering as I tried to get comfortable at bed time. I hope this doesn’t take as long as an actually cracked rib to heal. It woke me up and resulted in me writing this post, however, so I suppose it’s not all bad!

Thank you all so much for your kind words and warm wishes yesterday. They mean so much to me, as you do. 

As the Baby Turns – 32w1d and Counting

The fun continues!

Baby Azulito/a has officially turned into head-down position. That may be mostly pointless considering that unless this placenta previa and risk of placenta accreta situation resolves itself, I will be having surgery to deliver this baby but I understand that in Chinese Medicine having baby aligned vertically is important regardless of the delivery method so I’m counting this as a blessing. At least until the baby turns again (which could happen, the little one hasn’t been the most compliant with plans to date).

At yesterday’s OB appointment I was reminded that I’m at risk of having an emergency hysterectomy following the baby’s delivery if my imperfect placenta does not release from the wall of my uterus (or has invaded it, which can be difficult to determine on ultrasound with certainty, I’m told). I know that my OB has to make sure that I understand that this is a risk but I could have lived without the reminder. It is much easier not to worry about something when the last time it was mentioned is more than 3 months ago. The risk of this happening is not great – which is awesome – but the fact that it is a risk at all brings me to my knees every time I think about it. Plan: Do not think about it. And no visits to Dr. Google.

I have been coughing so hard from the respiratory flu I contracted (thank you, LP) a few weeks ago that I’ve pulled muscles and am now experiencing the equivalent of bruised ribs on both sides (worse on the left). This was confirmed by my OB yesterday as being just that and not something more serious, thankfully. Still, the coughing gets me up every night and has worn me out most days. My kingdom for some cough syrup or a good sedative.

I’m now 32 weeks which means about 5 weeks to go. Yesterday I discovered that the scheduled caesarean was mis-scheduled for almost 39 weeks. I felt and heard the panic in my voice as I challenged the date at my OB appointment. I barely contained myself from bursting into tears with my OB. He immediately acknowledged this was not in accordance with his instructions (his instructions were 37 or 37.5 weeks), said he’d have the surgery rescheduled and left a note on my chart instructing the staff to call me with the correct date. The risk of going to 39 weeks is stillbirth, of course, and my anxiety over that has been at an all-time high this past month so I really did not need that emotional kick in the cajones yesterday. I have yet to receive a phone call and I will be calling tomorrow if I have not heard by then. Call me distinctly unhappy about this hiccup.

In other news, I have our next follow-up and first biophysical profile (BPP) ultrasound with the Perinatology (Maternal Fetal Medicine) Clinic at our local women’s hospital later this morning (very soon, in fact). I am praying that baby Azulito/a passes that test with flying colours because more worries is something I can live without. I am also scheduled to speak with the Pediatric Urologist about those enlarged kidneys, what they could mean, how any medical issue with them might get diagnosed after delivery and what treatments could be required if they are not simply “large normal” or don’t resolve on their own as everyone hopes.

The LP is in trial today so I’m going it alone at these two medical appointments (same with yesterday’s little chat about placenta accreta, hysterectomy and messed up delivery dates). This is probably better for him in the sense that he is able to stress and worry less when he is not face-to-face with these realities but I do wish things were otherwise and he could be with me. My nerves feel jangled.

On that note and how to unjangle: Later today, I will be seeing an energy healer whom I’ve never met before. She’s trained in Reiki, Yuen Method and Trilotherapy. If any of you have experience with the latter two practices, I’d love to hear from you! My long-time TCMD and acupuncturist recommended I see this woman after I admitted to being at a breaking point last week emotionally from being sick with the flu, sick with morning sickness that has debilitated me despite the drugs lately, and being scared of this baby not making it out of me alive. She suggested it did not seem to be something physical in origin but energetic or spiritual. I’ve been warned that this healer is “a little out there”. We shall see. It cannot hurt. I hope.

Finally, tonight the LP and I are going on a date (!?!) to celebrate our fifth wedding anniversary. When we got married, I wanted to go to Italy and be married with two witnesses and nothing else. The LP wanted a big wedding. We did the latter and the deal was that by our 5th anniversary we’d make that trip to Italy that I wanted (I really wanted to get married on the Amalfi coast. Cliché perhaps, I know, but call me romantic and in need of an exotic honeymoon). Well, that’s not going to happen. This is our fifth and we are so in debt as a result of the past two and a half years of trying to have a second living child that a trip to Europe is out of the question. Maybe for our tenth?

It’s weird to think about the fact that we’ve been together for over 8 years… almost 9 years though officially only eight and a half… we have been through so much, suffered so many heartaches and heartbreaks. We each wear many scars from our prior lives and from the wounds that came with forging a life and trying to build a family together. I started trying to get pregnant before we were even married… wow. It has been a rather lengthy and complicated journey. Ten pregnancies later, here I am… praying that baby Azulito/a comes home in our arms, safe and sound, in another 5-ish weeks and celebrating five years of marriage to my soul mate.

Excuse me whilst I wipe away the tears.

It will be a busy day. Wish us luck. Please.