Scary Times – 27, 28, 29 Weeks

Well, what a crazy last couple of weeks. I just want to thank everyone for all of their love and support – people have really been amazing.  I know most of you know the story, however, this blog has definitely become a cathartic experience for me, plus, I want to document it for the babies, so I will re-tell the tale below.  There may be a tidbit or two in here and there that didn’t get shared broadly (can’t make it ALL serious). :) 

Everything started a couple of weeks ago (week of July 13th).  I hadn’t been feeling feel well all week.  I had some abdominal cramping, and even brought it up to my doctor, but it was always associated with a poop, so I just thought the rascals were stepping on my colon (totally logical).  Work was also particularly difficult that week as well.  In fact, I remember telling my mom that Thursday that I really wasn’t sure how I was going to continue working until September – I was just so uncomfortable – the commute, the sitting scrunched up, the walking, the pain – total killers.  Well, wouldn’t ya know it – I was in preterm labor.  Uh – makes one kind of uncomfortable.

Now you’re probably asking yourself – why didn’t she just call the doctor?  Well, I had JUST been to the doctor as well as had an ultra-sound on Tuesday of that week, and my cervix looked really great – super long (more cervix details below – don’t worry, I included diagrams).  Even when I told my doctor about some of my pain, she was like, well, if your cervix didn’t look this good, I’d be more worried, but just kind of keep an eye on it. 

Friday, July 17, 2009

So Friday morning I woke up and felt really crappy.  I mean, REALLY crappy--super crampy and hardly able to stand and walk.  I stayed in bed until the last possible moment, didn’t shower (again), no make-up, and finally made it out the door to my dentist appointment.  Yes – I sat there through my whole dentist appointment, because  I didn’t want to get charged a cancellation fee (see, my brother and I DO have something in common…), besides oral maintenance is very important while with child(ren).  So, here is Lesson #1 for those folks who have yet to go through pregnancy: loose stools are one sign you may be going into labor (cleans you out naturally so you don’t poop all over the labor table – nice gesture and all, but you still do).  And thankfully  I knew this sign, because as I came home from the dentist and proceeded to go to the bathroom like four times in a row (listen, it ain’t pretty, but people gotta know the signs), and it was really painful cramping, I finally called the doctor.  The nurse said that it was probs just a gastrointestinal bug, but that I should watch it.  Well, when I got off the phone, the cramps started coming every ten minutes, and they were extremely painful.   In fact, I couldn’t do anything during them, couldn’t talk, couldn’t move, couldn’t think, nothin.  I just laid there in the Baby Norwegian position willing the pain to go away.  Lesson #2: Listen to your womanly instincts.  I decided to call my nurse back to tell her this just couldn’t be normal, and I wanted to come in and see a Dr.  By now it was about 12:30.  So, Aaron took a cab home from work, so he could drive me to the Dr.  (so painful I def couldn’t drive).  They hooked me up to the contraction machine, and non of my contractions were being picked up!  WTF.  The doc came in, and said that I looked like I was having contractions, so she did a manual check of my cervix (always a good time).  Well, my cervix had softened and dilated, so she immediately got a wheelchair, and they wheeled me right to the hospital.  They also did a test, which basically tests to see if you are going to have babies in the next two weeks.  Mine came out positive.  Now, keep in mind, that they typically only use the results of this test if the result is negative, because about a 1/3 of the positive results are false positives.

On the way to the hospital is where the fun really began.  I started going into full on hard labor.  Constant contractions, no break in between, 9.5 on the pain scale.  So I get into my hospital room, and they have to weigh me.  WHAT???  Are you friggin serious?  I’m dying here, and you want to make me get on a scale?? So not only will I be in pain from the contractions, but I can then also feel bad about myself – the brutal reminder that for some reason, the babies in my belly only weigh 2 lbs, but my face gained five and my ass gained twenty (I still have my ankles though.  Oh yes, I still have my ankles.  They are purdy and slender.  I’m not quite sure what will happen the day that I wake up to cankles…let’s not dwell it.).  And it was a digital scale so I couldn’t even pretend like I couldn’t do the math, like I typically do on the ones in my Dr’s office. 

Finally I get to lie down in the bed, and they get to work. They gave me a shot of Terbutiline, a pill of Nifedipine, and an Ibuprofen pill, all of which are supposed to stop the contractions.  Did this work?  No it did not; not even close.  Meanwhile, there are a few things going on through this:

1. Baby Names – we don’t have them. Panic ensued.  I turn to Aaron at one point in between contractions and was said (perhaps rather loudly, as the contractions never fully subsided):  These babies can’t come!  If they do, we might have to actually name these babies Amos and Barnaby!  We have since gotten a bit more serious in getting together a list.  
2. Anger management during labor – clearly something I need to work on.  Apparently I was holding my breath during the contractions, so my nurse (innocently) said, it would help if I breathed through them.  Now – no doubt this is totally true – but at that moment, pure hatred entered my heart. Frustrating hatred though, because I was in so much pain, I couldn’t even snarl or at the very least pass along a dirty look. 

Alright, back to the story.  The contractions were still coming in one wave after another, so they gave me another shot of Terb (that’s how we refer to it in the biz), and an entire bag of IV fluid (PS: As many of you probably know, the highlight about getting an IV is when they can’t find the vein.  It’s quite enjoyable indeed, especially while in labor.)  So once I received this second concoction things started to settle down a bit.  To put a timeline to this whole shadoole,  I got checked into the hospital, around 3:30 pm, and it was maybe around 8-9 that they had finally subsided to about four minutes apart.  And by 2-3 am, we finally reached our goal of 10 minutes apart (or 6 an hour). 

Emotionally, I was pretty ok during this whole thing.  I think I was in so much pain and shock that I just kind floated through the day going from contraction to contraction.  That is, until they told me I was getting steroid shots (one on Friday and one on Saturday).  As a bit of background, steroid shots are given to help the development of little babies’ lungs in the womb.  It was at this point that I started to get emotional: this means that they really think these babies might come tonight.  For some reason, this is what brought me into reality that this could really not have a good ending.  In fact, for the next three days, I think I started to cry every time I talked about those darned steroid shots.  I reacted similarly when, later in the week, my contractions broke through the meds, and they decided to start charts for each of the babies, in case they were born.  I had to sign release documents on their behalf… as their parent.  Just very overwhelming experiences to have.

Now, there are a number of things that might cause preterm labor, all of which, they have to check for up front. Option #1: Urinary tract infection.  They have to test your pee for this, which is becoming more and more complicated these days, because I can’t see down there even a little.  So basically, I just start going and then move the cup around down there until I hear that I’m in the right place.  Needless to say, there is a lot of hand washing involved afterward.  Negative – no infection.  Phew.  Option #2: Strep B infection.  So, my nurse comes into my room and talks to me about how I need to be tested for Strep B in case this is what is causing my labor.  I was like, great, let’s do it, let’s go, why the hesitation?  They needed to take a swab of my butthole.  Uhh… Hmmm… and in all honesty, I panicked. Why?  Well…  the thing is… you see…  OK, if you remember some details from earlier in the story, mainly that I hadn’t showered since Wednesday (it’s Friday night), and that I had gone #2 four times that morning, which started this whole mess in the first place, coupled with the elephant in the room that I haven’t even had the courage to talk about on this blog, which is that I can’t reach anymore to do a proper, um, cleaning job, especially when I’m in so much pain.  So… I panicked.  What were they going to find back there?  Well, sure as shit – she went in clean and came out dirty.  I was horrified.  And what’s a perfect end to this story?  In the middle of the night, the nurse comes in and woke me up to tell me that the swab she used earlier had expired and she needed to do it again.  At your own risk, I thought, at your own risk. 

Intermission: Apologies for the long post, it’s been constructed over days, as I can only write a bit at a time, since I can’t be sitting up for too long at one time. 

Saturday, July 18, 2009

It was a new day (do I get to shower today?).  I was still contracting in the morning, and I started my schedule of baby and contraction monitoring three times a day for forty minutes.  This actually seemed like a walk in the park, because I had been on the monitor since I got to the hospital.  The monitor measures the babies’ heart beats, as well as my contractions.  As you can see from below, this can be a fairly uncomfortable process (do you see the muffin top that the band creates because of how tight it is??).  I share this with you only in the interest of honest documentation.

Later in the morning, I needed to have another ultra-sound to see what my cervix looked like.  Here is Lesson #3:  What happens to the cervix during labor.  First, picture the cervix like a mini-bagel; it’s about 40-50 MM in height and there’s a hole at the bottom, but it’s closed.  During labor, two main things happen to the cervix that you can measure:  it gets shorter, and the hole gets bigger (dilation).  Please see below for a simplified visual representation of the journey of a normal cervix during labor. Note: for some unacceptable reason, there was not a good cervix option with clip art, so we are going to have to make do with a cylindrical shape.

The day prior, when I was at the Dr. office, and had the manual exam, she estimated that I was dilated a fingertip’s worth.  Since then, they have not done another manual exam.  It tends to stir things up quite a bit, and we don’t want to risk going to the bad place again.  We could do an ultra-sound, however, and to determine how short my cervix was.  If you remember, I had just had an ultra-sound on Tuesday of that week and things went swimmingly well.  Unfortunately, we did not have great results this time around.  Shows how quickly things can change.  Essentially, on Tuesday, my cervix was 41 MM long, and by Saturday it had shortened to 13 MM. 

Soooo, it was at this point that the language around the hospital started to change.  Prior to this, I kept hearing, ‘We’ll keep you here for at least a few days…’.  After the ultra-sound, I started hearing things like ‘long-term’, ‘until they’re born’, ‘hospital parking pass’.  New people also started coming into the room, telling me about the different things the hospital offers to people here long term, etc.  It was all just so shocking.  Here, just yesterday morning, I was at my house, and when I left, I hadn’t even shut the windows!   And now, I might not go back for months, and that is the best scenario, because it means the babies are cooking longer??  What about our kitty?  She’s like our child and I won’t get to see her for months?? What about the nursery?  Getting things purchased for the babies?  Nesting?  Work?  We had counted on my income for the next month and a half. I had wanted to take all of my maternity leave actually with the babies and not before!  Am I selfish for even caring about those things when I know that I’m really in the best place for these babies?  All of these things were swirling in my head.  Still no one would give me a firm answer.  I was to have another ultra-sound on Tuesday to see if things got worse.  Well, as you can see from the diagram, they did.  And here I am.  Day 17.  Babies are 29 weeks and two days.  I have heard people talk in passing that if I make it to 34 weeks, they might let me do bed rest at home.  We shall see.

What would happen if they were born?

Another scary evening for us was when the neonatologist came to our room to talk with us about what would happen if these babies were born.  Note that this discussion happened when I was 27 weeks, and we’ve come a ways since then, but it definitely served as incentive to keep my legs closed for as long as possible.  Weeks 26-30 are crucial for their development and survival.  A baby born at 25 weeks has a 50/50 chance of surviving.  By the time they are in the 29th week, it is hovering at 97%, which is quite the spike.  So, really, during these weeks, every day counts.  My nurse said that for every day that I can keep them inside, it shaves three days from their stay in the Neo-natal Intensive Care Unit (NICU).  Additionally, at this point, they had about a one in five chance of having some type of long-term disability (e.g. cerebral palsy, blindness, deafness, autism, etc.), which is a scary prospect to look toward.  These chance also obviously go down the longer I’m here.  If they were born now, they would probably be in the NICU until mid-late October.  If I can make it to 32 weeks, they would stay about 6 weeks, which is a pretty significant drop off!  All-in-all, probably the scariest meeting I’ve ever had, but also the most informative, and one that provided me with a lot of incentive!

What is my goal? 

A lot of people ask me how long they want me to last in here.  What’s my goal.  It’s so complicated, because, really, the goal of every pregnancy is to get to 40 weeks to make sure we don’t have an undercooked casserole coming out of the oven.  That being said, there are some pretty major milestones that we are hoping to hit. 

Milestone 1: Week 28 – I OWNED that.  Done and doner.

Milestone 2: Week 30 – Still at risk for many complications and a pretty long NICU stay, but way better than being born at 27 weeks.

Milestone 3: Week 32 – the  by this time, most everything is developed, they are just itty bitty. NICU stay is about 6 weeks.

Milestone 4: Week 34 – this is getting into the territory where many twins are born.  Their stay in the NICU is probably only 2-3 weeks.

Milestone AMAZING: Week 36 – let’s get those suckers OUT.

What do you do all day long Lisa?

Surprisingly I haven’t been too bored.  They keep me busy in here. Until earlier this week, my schedule has been as follows:

• 6 am: Ibuprofen, Nifedipine
• 9 am: Monitoring (1-2 hours), Pepsid, Stool softener, fiber
• Noon: Ibuprofen
• 2 pm: Nifedipine
• 6 pm: Ibuprofen
• 9 pm: Monitoring (1-2 hours), Pepsid, Stool softener, fiber
• 10 pm: Nifedipine
• Midnight: Ibuprofen

I say until earlier this week, because I had another ultra-sound on Tuesday, and in addition to my cervix shortening a bit once again, we found out that Baby A’s amniotic fluid is very low.  One of the known side-effects of Ibuprofen is that it can reduce amniotic fluid.  As a result, they took me off of all Ibuprofen, of which I was taking 600 mg, four times a day. This was one of my lines of defense against the contractions.  Dammit!  Soooo, I went off of it on Tuesday night, and my contractions have broken through every day this week, and had to have a Terb shot almost every day.  Now the contractions start when I’m sitting up for too long, so I’m able to be on the computer  meaning that I can be sitting up an on the computer even LESS than I was before.  And on the days that I have to have Terb to quiet things down, I can’t really get up at all.  Makes the heart race, and I get really, really shaky for about 3 hours, and then nauseous.  And by the time that’s all over, I’m exhausted!

So, all of this means that I spend the majority of my time, laying down on my side.  I can get up to use the bathroom, and I can get up to take a shower (sitting down in the shower).  I’ve been doing many crosswords, logic puzzles, reading books, reading my COMPLETELY badass Kindle (thanks Marty and Bob!), and philosophizing. Regarding the last activity, I have not yet made any major break throughs, nor solved any major world problems, however, I will keep you informed.

The silver lining.

The best thing about this gi-hugic roller coaster that we’ve been on over the last few weeks is that the babies are continuing to look fantastic.  They don’t seem to be under duress at all, even through all my contractions (they never completely go away – the very least I have is 1-2 an hour).  Their heart beats are good, blood flow to the brain, blood flow to the umbilical cord, placenta – all look great. 

How is Aaron holding up through this whole thing?

This definitely has not just been hard on the mother.  I’m not sure which is worse, having to go through it all, or having to just sit there and watch your partner go through it all feeling helpless.  That’s the boat that Aaron was in, and it’s a tough one.  The first few days were particularly hard, and the adjustment to having me in the hospital all the time has been a challenging one.  He sleeps here most nights, gets up and walks down to work.  After work, he comes back up here to say hi, then he goes home to do the house stuff (mainly be home for Turtle).  Then he’ll come back in time for my nightly monitoring – in bed by about midnight, and then we start it all over.  Overall, a pretty exhausting schedule, but he’s being a rockstar.  I can’t even imagine what we would do if we had another child at home. 

Well,  my oh my, there are so many more topics to discuss (wouldn’t you like to be a fly on the wall for bed rest support group?), but I think we have covered enough here today getting everyone up to speed on what’s been going on.  More stories to come.  Thank you again for all of your love, prayers and support!