The Final Stretch
Day-by-Day Adjustments
It has now been 4 days of being off bedrest, and I will tell you that the sorest part of my body is my calves. I’ve been standing up more, walking around the house, and doing stairs. The first day I spent the morning in the hospital bed working as normal, and had the most enjoyable lunch in the garden with my parents, then spent the afternoon sitting in a chair while working. My parents left and I was in the house alone, quiet and free. I will not take this feeling for granted - being able to be alone and move around my own house.
As I fell asleep that night, I had back pain that must have been from sitting up by myself that afternoon. I woke up feeling better and went to work in my home office. I started work at 8am and by 11am I felt so exhausted I asked my boss for 10 minutes off to lie down. It was during that time I recognized that a simple task of sitting up in a chair was not something I could accomplish in one day. For the rest of the week, I sat on the couch with my swivel table, alternating between having my feet up and putting them down/sitting upright. The next few weeks will be a slow adjustment, but I am so thankful to have the opportunity to build up muscle before having a newborn.
Other things I am thankful for: making my own cup of tea in the mornings (and today I even made one for Dave!), getting up to use the bathroom without asking anyone for help, wiping down the countertops, walking around the house, sitting on the couch to watch a tv show, sitting at the dining room table to eat a meal, going outside and feeling the sun and the breeze, sleeping in my own bed (with Dave!), choosing my own outfits to wear, and putting on my socks. Like I said earlier, there is always something to be thankful for! I’m even thankful for the times I bump my bump because I forget its there! (It really takes a lot of getting used to)
Things are looking more “back to normal” in our household!
It is beginning to sink in that it looks like we will actually have a baby by the end of the year, which is something we’ve been unsure of for the past 27 weeks, so we had not discussed future plans. 5 years of prayer later, and we are changing our perspective starting to plan! We officially took the plunge and purchased a crib, dresser, and nightstand for our now eggplant/aubergine sized not-so-little one. God is good. Even amidst the rough journey. Even when we don’t know if things will turn out as we hope.
Time to start shopping...online for now!
September 29
I woke up this morning unable to eat or drink anything but water in preparation for my glucose test - this is when they test for gestational diabetes. We arrived at 8am and they took my blood. Right after, I was given a super sugary drink that I had to finish within 5 minutes. The nurse set an alarm for one hour when she would return and take my blood again.
This was also the first day they put me on the monitors: one for monitoring my uterus/contractions, and another to monitor the baby's heart rate/movement. It was a very old-fashioned looking machine with the kind of plastic topper that a receipt comes out of as it prints the data.
When nurse Shirley returned, she said my uterus was very quiet which was great - no early contractions. The pleasant surprise for us was that if she didn't know we were at 28 weeks, then she'd have guessed the baby was between 30-32 weeks based on the printouts from the monitor. The little eggplant (or aubergine if you’re reading outside the US) had a heart rate that was very advanced for its age as the fluctuations were wide in range. She said we had an overachiever on our hands!
Next step was an ultrasound to check out the hematoma, cervix, and most importantly, baby! The sonographer started off with an internal ultrasound to get a good view of the cervix (3cm - looking good) and the hematoma. She did her zooming in and out, and clicked various points on the screen to measure the size of the clot. It was one of those moments where Dave and I just looked at each other in disappointment. We knew before she said anything that this was not 2cm, but looked much bigger. While the sonographer said it's definitely smaller, and she seemed happy with what she was looking at, Dave and I knew this was not what we had been shown the previous week.
It measured 7.5cm. This is very different from the 2cm we thought we saw before. We wondered if it had grown that much in a week being off bedrest, or if it was just incorrectly measured the previous week. The sonographer was a different person from the week before, and we shared our concerns with her based on what we'd been told last week.
While I was still on the table, the nurse came in to take my bloodwork as her timer had gone off. She asked how everything was looking and we said it didn’t look as good as last week. She could sense the awkwardness in the room. The nurse and sonographer spent a while talking outside the exam room.
Turns out that the hematoma was incorrectly measured the previous week. So we were celebrating prematurely. That being said, we were told that we could continue with me off bedrest since it was clearly smaller and in a better “healing” state.
It’s definitely given us perspective that we did not have earlier. First off, as Dave’s dad wisely says “Let he who’s never made a mistake be the first to cast a stone”. The hematoma was measured incorrectly, but this mistake had no major impact on my health or the eggplant’s. The hematoma does not need to be gone for things to be successful. The little human can still grow while the hematoma is present. Sometimes we pray for things thinking that we know best, but this has been a reminder that we do not know best, and things can be ok even when we might think they don’t look so good. That’s human eyes for you!
Our little eggplant in 3D! (or at least what’s not hidden by the placenta)
October 6
I was feeling the need for an appointment on this day. I got my first covid vaccination Friday 4th (I was finally given the ok to get it) and was paranoid that I was not feeling many kicks afterwards. I had felt an odd sensation Friday night into Saturday and wasn’t sure what it was. From Saturday-Wednesday morning, I was certain that I wasn’t feeling as much movement as before, but I told myself just to make it through to that next appointment.
As we returned for our weekly follow up, we left the house separately. Dave had to go on to a work conference after. I drove my car for the first time in four months(!) I got stuck behind a slow driver, which meant I arrived at 10:32, and there were zero available parking spots in the multi-level garage. At 10:39, I finally walked in right as they had called my name - straight into the ultrasound room!
While we were sitting there, the sonographer asked how movements were, and I said I was honestly a little concerned as I was not feeling as much as I was the previous week. When she did the ultrasound, she explained that the now “acorn squash” sized being had flipped around since last week and now the kicks and movement was focused towards my spine, so I naturally wouldn’t feel it as much. This is what they call “breech”.
What a logical explanation and relief! The nurse Shirley explained that they receive a lot of calls from women who all of a sudden stop feeling as much movement, and when they come in for an ultrasound, sure enough the baby has flipped. Before we left, they placed me on the monitors for heart rate and contractions and all looked good.
October 13th (30 week milestone!)
Another Wednesday, another weekly checkup and monitoring. Today’s appointment showed us a hematoma that looked about 6cm by 1cm, but we’ve learned not to take those measurements too seriously as they aren’t super reliable! The important thing is that it’s old clotting, and not new blood. The little cabbage was moving around a fair amount during the ultrasound and it had changed positions since last week - it was now laying across my belly, left to right, which explained the kicks I was feeling on one side!
The monitoring part took longer than expected because someone decided it would be a good time to fall asleep inside my cozy womb. They were looking to make sure that the cabbage’s heart rate varied by 10 beats per minute twice over the course of 20-40 minutes. In order to wake the little one up, I was given a cold carton of “very berry” juice which did the trick!
We briefly checked in with our favorite nurse, Shirley, before we left. She said that it was time to increase my walking and add some hills in(!) so that I could build up muscle which I had lost over the past few months. I can’t imagine giving birth in such bad physical shape! She also mentioned that I should start low dose aspirin, formerly known as baby aspirin (but they can’t call it baby aspirin anymore because you’re not supposed to give it to babies). After one week on “low-dose aspirin”, I will return and be trained on how to administer the lovenox injections.
Dave and I did a longer, hillier walk that evening, and by the time I got home my feet felt like they’d just walked on hot coals. My body felt like it had just ran a mile. I did get a very relaxing foot massage from Dave which made things better. Would love to build that in to the daily routine! Time to really build up my muscle and get this body back in shape #preggoandfit!
I may not be as fast as Winston is used to, but I’m up and moving!
October 20th
Every week we go for an ultrasound, this mover and shaker is in a different position. This week was no different, it was head down “getting ready for the big day”! Everything looked good, which is always reassuring.
We were introduced to a new nurse this week - Lizzie. We really didn’t want to deal with anyone but Shirley, but Lizzie was a great alternative. Lizzie is closer in age to us, and has great bedside manner. She is sociable, puts us at ease, and makes us laugh as she tells us that the machine she’s hooking me up to is older than she is. I stayed on the monitors for a while and made sure to snack/drink to get some movement going. Apple juice seems to do the trick!
We reviewed some things with both Shirley and Lizzie - TDAP/flu vaccine, protein shakes each day, importance of choosing a pediatrician, then Lizzie showed us how to administer the lovenox injections. She warned me that it would sting and bruise. Our options were threefold: upper leg, abdomen, or back of the arms between the elbow and shoulder. This injection needs to go in fat, not muscle. We both thought stabbing my huge belly with a needle was not going to happen, even though the nurses assured us the needle wouldn’t get near the baby. We settled on the back of the arms - out of sight and out of mind, right?!
My first shot didn’t hurt until I felt the sting of the liquid, but it was short-lived. I’ve decided to try and not think of how many more I have to go, but instead to take one day at a time. The bruising has made me feel like a bit of a warrior.
October 27th
Every appointment starts with a urine sample and ends with stepping on the scales. At this point, I’m gaining about a pound a week. Sometimes Dave likes to creep up behind me and step on the scales without me seeing just to get a response out of me.
This was the day we got to take a closer look on the ultrasound as the technician took measurements and made sure everything looked on par. As we walked in, Dave asked her what she was looking for weight-wise, and she said she’d hope to get a weight of at least 3-3.5lbs for a 32-weeker. We let her know that the last weigh in was September 29th and that was a 3lb 6oz one, so a month later we would expect her expectations to be exceeded. Dave sent out a group text to his family with a $10 prize for whoever guessed the weight correctly...His dad was spot on with a guess of 5lbs 3oz!
Dave was born a 10 pounder. I’ll just leave that sentence there with no elaboration.
After my ultrasound, I went to get hooked on the monitors by Lizzie. She was her usual chirpy self and we enjoyed catching up and filling her in on our huge baby. About half way through my monitoring, Lizzie came in with a glass of water and told me that I was not drinking enough - my urine tested high and explained that my levels were 1030, when it needed to be around 1010. She even brought in an IV of fluids (which at this point would be easier for me to handle than chugging all this water!) Turns out dehydration can cause contractions which were showing up on the monitor. They did not want to see contractions this early. Shirley popped her head in the room to scold me for not drinking enough, and then Dr. V entered the room and took a seat.
He started off by saying 32 weeks, we made it! 32 weeks was a milestone we set for ourselves and it felt amazing to have made it this far. He then said “I don’t care how you do it, drink a beer, just hydrate!” We appreciated his sense of humor. Our talk with Dr. V included some discussion about what to expect over the next few weeks, our plan for the actual birth (!), and a brief conversation about the latest James Bond movie. Dr. V never makes us feel as though we are inconveniencing him with our questions. He always sits and engages with us and will say “what other questions do you have?” He is an amazing guy!
November 3rd
After being told I was having contractions because I was not hydrated enough, Dave sprang into action and ordered me a beautiful new water bottle to motivate me to drink a gallon (or more) a day. It was not enough for me to say “I’ll try harder”. We needed an action plan. I went in to this week’s appointment convinced that I had to ace the urine test, which I did! The BABY was transverse - it had moved again. We were told that as of next week, I’d be monitored twice a week, and that Dave didn’t need to come since I’d just be hooked up to monitors and he’d be bored.
November 7th - To Labor and Delivery! (Test run)
On November 6th, I noticed my body was getting super itchy. It had slowly started a few weeks back, but it wasn’t severe, and I read that it can be a side effect of lovenox, so I let it go. As the day went on, it got progressively worse, and at night it was like nothing I’d experienced before. I posted a question on my “lovenox ladies” facebook group asking if this was normal, and received two helpful responses advising me to report it to my OBGYN.
Sunday morning, we reported it along with the fact that I was feeling decreased movement. The nurse on call (Shirley) called us back and said that the most conservative thing to do would be to go to the ER, where they’d send me straight to labor and delivery, to hop on the monitors and be checked out as well as run some labs to test for cholestasis (something that often manifests through severe itching). If we weren’t feeling that the ER was necessary, then we could do some kick counts - sit still and quietly for 30 minutes and look/feel for at least 5 movements.
We decided to do kick counts and not spend our day at the ER if avoidable. I drank a bunch of cold apple juice and then sat down to see if we could get some movement going. We got 20 movements in 30 minutes. This was extremely reassuring. We ran a few errands and checked off our “nesting” to-do-list items, feeling happy that we didn’t need to go to the ER. Later that afternoon I made a loo trip and realized that I would need to call the on call doctor again because I saw something unusual. I decided I’d wait until Dave finished mowing the lawn to call - it was his big “to-do” item for the weekend. As he was finishing up, I called and Shirley said she’d give labor and delivery a call to let them know I was on my way over. I popped my head out the front door and told Dave. He got ready in record time and told Winston on our way out “Bye buddy, we might bring you a friend home when we come back!”
After Winston galloped out the front door to join us for a car ride and we coaxed him back in, I assured Dave that I was not in labor and that Winston would have to wait a while for his new buddy.
We arrived at the hospital and asked where Labor and Delivery was, and the receptionist signed us in. She asked if I was in active labor, and I said no. Dave said he wasn’t either, just to be clear. We walked past a fireplace, some beautiful art, and a therapeutic fish tank before we came to the L&D desk. It was just enough to make us feel at ease and relaxed. We had to ring the most gentle sounding bell to get the attention of someone, and were met by a friendly nurse who took down our information, and reassured us that they were clued in to our situation.
She told us she’d come and bring us to our room in a second. Dave turned around, excited to sit by the fish tank while we waited, but before he could take 4 steps, the nurse appeared and said “right this way”. She led us down the hall and to a large room which was clearly ready to welcome a newborn. It had its own bathroom, a nice view, and a comfortable chair for Dave who immediately made himself at home as he reclined the chair, put his feet up, pulled out some wine gums (these are English sweets that are not wine-based) and said “ooh yeah”.
I was told to get dressed into a gown and situated in the bed. A few minutes after, nurse Ashley walked in to greet us and get our history. This is where I’m very thankful to have Dave as an advocate and avid note-taker. She asked if I had any significant medical issues and I said “I don’t think so”. Dave said “um, she has thrombophilia, kind of something significant”.
Ashley told us we could expect to receive labwork, a speculum exam, an ultrasound, and fetal monitoring. She wrote our details on the whiteboard in our room and then our resident Dr walked in. Between the two of them, they set up an IV, drew blood, conducted an ultrasound, and hooked me up to the monitors. We were very impressed at their team efficiency!
The pineapple-sized little one (measuring ahead) passed the tests with flying colors. They saw a few contractions on the monitors, but nothing major. Next up, speculum exam - not fun, not comfortable. Dave said it would have been nice to have an epidural for that! They were able to see there was no new bleeding. The final exam was a “digital exam” which Dave and I both assumed had something to do with technology, but it did not. It was a “digit” exam, which I’ve always heard referred to as a manual exam. Thankfully my cervix was firm and closed, just the way it should be at this point in time.
Nurse Ashley came back to check on us and informed us that we were waiting on lab results, then they’d call Dr. V for direction on how to proceed. As she was leaving, she said “let’s get you some food...I’ll come back with some menus and we can order you dinner”. Dave and I looked at each other in disbelief. We enjoyed perusing the menu and Dave had a nice phone chat as he ordered our food. Somehow he managed to get an extra chocolate pudding and oatmeal raisin cookie thrown in on top of our carrot cake and brownie desserts.
At around 7pm, it was shift change and we said farewell to Ashley and met our new team. The doctor came to sit with us and review our history/situation. She mentioned that my liver enzyme labs came back elevated and asked if we had any history of liver disease along with some other conditions. I mentioned that I remember something coming back in our Sema4 carrier screening that indicated I was a carrier for something related to the liver. Dave was able to find the results and share that I am a carrier of pregressive familial intrahepatic cholestasis type 2 with the doctor.
At this point, they consulted with Dr. V and said they would be treating me as if I had cholestasis, since my liver labs and itchiness were both big indicators, but that the official labs would take a few days to come back. They said often in this situation, they induce around 36-37 weeks and give a steroid shot to boost baby’s organ development so that breathing is easier when they are born early. I received a stingy shot in my butt and they also took more blood to test my “coags”, then sent us on our way home with instructions to go to Dr. V’s office in the morning.
November 8th
They had us come in that afternoon to space out the steroid shots and because they wanted me to meet Dr. V who was more likely to be free later in the day. Unfortunately, when we arrived, we found out that two people were in labor, meaning Dr. V was not able to meet with us. They did call him for instructions, and told us that he’d like to try and meet with us tomorrow, but in the meantime I got my second steroid shot, and was told to start a medication for cholestasis that should help with itching. They asked if I had trouble sleeping the previous night and I said YES! I was wide awake, unable to fall asleep. They said the steroid can do that, and a little benadryl can help.
I slept much better that night, after my benadryl, Tums, baby aspirin, progesterone, colace, fish oil, iron, ursodiol, and lovenox shot (and that’s just my evening meds!)
November 12th
Today was the first appointment I went to without Dave. I sometimes think he’s the one everyone’s looking forward to seeing with his fun personality and witty comments. He did join via phone, so thankfully I was able to not feel the pressure of remembering everything at the meeting.
Ultrasound: guess who’s changed positions again! Looks like the little one is head down this time!
Monitoring: Again, it took a little while to get the movements needed on the monitor, but after a carton of cold apple juice, we were good to go!
We got to meet with Dr. V himself today which we were so grateful for. He reviewed our case and hospital trip from the weekend, and told us that due to my high levels of liver enzymes, he is treating me as if I have cholestasis until the lab results come back. He mentioned that he is focusing on my liver function, the presence of amniotic fluid, and the baby’s heart rate (all of which looked good today). He will continue to have me go in twice a week to make sure the pineapple-going-on-pumpkin passes the tests.
We got on the subject of Christmas music, as Dave plans on creating a playlist to listen to in the delivery room and he wanted to make sure that Dr. V was ok with Christmas music in November, which was a thumbs up! Dave also said he’s going to pick an entrance song for Dr. V when he comes to deliver Baby D. While we were discussing Christmas traditions, the nurse came in and gave him the results that had just been faxed over while we were meeting with him. Dave said if we hadn’t got to talking about fun things, then we’d have missed the results!
Dr. V laughed and said well those levels are super high and that confirms intrahepatic cholestasis of pregnancy, or ICP. The symptoms I was experiencing were severe itching and loss of appetite. Because of this diagnosis, we have a change in plans for delivery - I will be induced at 37 weeks. This is because there are risks to the baby since my liver is not getting rid of toxins like it should.
Dr. V talked us through the logic behind waiting until 37 weeks instead of inducing earlier. He explained that there are three things that don’t usually happen until 37 weeks. 1) The baby is unable to balance temperature control outside of the womb 2) The baby has trouble with bonding since it has to go to the ICU at least for an evaluation 3) Sucking and swallowing reflexes are not as developed, so breast feeding can be a challenge.
So the plan at this point is to have me go in to the hospital the evening of November 28th in preparation for an induction the next day. Yes, that is one week from now. Yes, I am excited. Yes, I am ready. No, I am not ready. But we do have the nursery coming together and a nice little wardrobe thanks to Dave and his brother!
Despite the continuous bumps on this journey, we are thankful for answers, for plans, and for continuous monitoring. God’s certainly giving us an eventful story!
Here’s a picture from a beautiful baby shower that Dave’s family threw for me in the “hundred acre wood”. It turned in to a bit of a blustery day at the end, but was a lovely celebration!
Update: Appointment After Appointment
November 16th / 19th
I had my regular monitoring and ultrasounds this week and on Friday I left feeling as though this baby might arrive sooner than we thought. The nurse had asked me to schedule an appointment for Monday (I already had one scheduled for Tuesday). She told me to keep that one too. She also said that it was time to start heparin instead of lovenox injections. This is something that doesn’t stay in the system as long as lovenox, so if I were to go in to labor they could give me an epidural sooner as reducing the risk of spinal bleeding. She gave me a few days’ worth of a supply and called the prescription in to my pharmacy.
I received a phone call a few minutes after I left to ask that I return for a Strep B test. The nurse on the phone said “just in case you go into labor this weekend we’d like to have that test completed”. So I turned around and went back for the test. As she administered it, I told her I’d probably not have turned around if I knew where she was sticking the swab!
