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hospital stories

Waiting for you. Week 28.

by Myg on December 8, 2008

At some point last week I lost track of the days. I didn’t know the date and I had to ask Alex what day of the week it was. At first I thought this was a bad sign that bed rest was driving me into a meltdown, but then when I thought about it I didn’t quite know. Maybe free floating in time for a little while isn’t so bad, especially when the last 28 weeks have been an intense marking of days resulting in no small amount of stress here and there.

Even so, be assured I was completely aware when we all reached Week 28.

It was last Wednesday, 12/3. Two days after my last ultrasound and check-in with the OB/GYN and all was well with us. It was some point after that, but before I started to feel fairly ill that I found myself totally unaware of what day it was.

Then Friday night I began to feel sick to my stomach and got a headache. I had no appetite. A couple of Tylenol took care of the headache, but I had a really tough time eating. I wasn’t sure what to think of this. I hadn’t been anywhere to see people I could catch a stomach bug from. I do know later in pregnancy women lose their appetites because there’s not much room for the stomach. With twins this is obviously going to happen earlier. But it seemed to happen suddenly, with no improvement on Saturday or Sunday. I just didn’t feel right.

Then mid-Sunday morning the contractions started again. About four an hour, not regularly (like one in 10 minutes, 20 minutes, 15 minutes, 8 minutes, 30 minutes, etc.) which is supposedly okay, but I had just had a good week with hardly any contractions all day on most days. So the onset of this was unnerving. And the contractions were a little different. Some of them were painful, crampy. The kind they said to look out for.

I’ve read that nausea, diarrhea (oh yeah, for your daily dose of TMI, I had that too) can be early signs of labor. Plus I was having the contractions and they went on and on from about 11 am until around 5, which was when I finally broke down and called the on-call service again.

“Come in,” they said. Of course they did. They always want you to come in. “It’s the only way we can tell anything.”

I am getting really tired of pelvic exams, by the way. But two – yes two – last night showed that my cervix is indeed still closed and thick. The first pelvic they did soon after I arrived so they could do another Fetal Fibronectin test (fFN). The resident said, “How do you feel? You’re not contracting at all.” Well I felt great when I heard that.

But after the pelvic, guess what? I was contracting a whole bunch.

“We’re going to start an IV for fluids.”

No, you’re not. If I’m not going to have surgery, and you’re not planning to give me IV meds, you are NOT giving me an IV. Sorry. I mean, why do they even want to give me an IV for that when I can drink?

“Okay, I’ll bring a pitcher of water.”

Great.

Another ultrasound showed Doot and Bing to be totally fine in there, though Bing has flipped around from head down to transverse. Ouch. I asked the doctor if that much movement could have triggered the onset of the contractions. She said no. I didn’t believe her (she’s one doctor there I don’t like all that much, which is pretty good given that there are about 72 doctors I’ve seen there so far).

My fFN came back negative, though. That’s another 7-14 day insurance policy against pre-term labor. Three residents, a medical student, the doctor on call and the nurse all came in to tell me. No shit – six people. Three of them remained to give me a second pelvic exam, “Just to check your cervix to be sure the contractions aren’t changing anything there. Hey (lackey medical student), can you go get my maglite from the other patient’s room?”

It was still the same, and I am not at all certain the second pelvic wasn’t just practice for them.

Is it me or are pelvics getting more intolerable?

“We feel comfortable sending you home.”

Good. Fine with me.

I am back home now and see my regular OB/GYN tomorrow. Of course, I am with a group that has 743 doctors so the only thing regular is the office space – not the physician. I am still not feeling great, but not sure now how much of it is mental. Am I contracting? Sometimes. I’m trying to just ignore it unless it’s super obvious. You can get pretty stressed out with this stuff. At least I can. Even when you’re supposedly doing okay.

I’m already tired of the hospital, and I’m sure I’ll be there again and again before the big day comes. And as helpful as it is to write, I confess it’s hard to blog when you feel sort of shitty all day. Though for whatever reason I still feel like it’s important. To me, at least.

Now, let us not forget there are two babies inside of me growing and growing. It’s week 28 and the boys are:

  • through the 28 week hurdle, which is a huge deal when you’re worried about pre-term labor. 90% of babies born at 28 weeks can survive.
  • 2.3 oz (Doot) and 2.5 oz (Bing) each and continuing to grow. I thought those weights were fairly kickass, but then I saw this chart and realized that they are merely average. That’s okay. I know their spectacular specialness will shine in other ways. And in pregnancy, I think it’s good to be average.
  • are opening and closing their eyes. But you’ve got to wonder, what can they see in there? It’s gotta be fairly dark, especially under the covers most of the time.
  • still kicking, after all these weeks.

As for me, the above has covered most of it. But a few other things to mention:

  • Colostrum. I’m not going to say anything more about that, other than it was one of my “what the hell is that?” moments last week. If you don’t already know what it is and truly need to know, go here.
  • Mood. Was feeling pretty good last week when the contractions had subsided. Not so much this week with an upset stomach and all. It’s like a dingy damp cold towel has been wrapped around my brain and I can’t get it off. It’s absolutely no damned help at all that “general malaise” is often cited as a precursor to all kinds of terrible pregnancy problems, like HELLP and/or pre-term labor.
  • Alex put up curtains in our bedroom to block out the light so I can sleep during the day. I love that man.

As badly as I want Doot and Bing to hang in there for the next 10 weeks and go to full term, some days I feel so done with this pregnancy stuff. It’s little things that I miss being able to do, like go for a walk or hey, how about out of the house to someplace that’s not a medical facility? I now have too much fear about every little thing I feel in my body and I am a lot more frightened of giving birth than I let on.

Can I say all that and not feel like a jerk? Because when you’ve overcome infertility to get to this point, sometimes you just feel ungrateful voicing those feelings. I swear, I am not ungrateful.

I’m just tired. And worried.

And I know, I know. “Get used to it – you’re about to be a mother.”

{ 5 comments }

Waiting for you. Patiently. Weeks 25, 26 & 27.

by Myg on November 26, 2008

I’m home now.

They sprung me last night when one of my doctors, another high-risk Maternal Fetal Medicine (MFM doctor) decided to do another Fetal Fibronectin (fFN) test. “Let’s just see,” he said. He was curious if my last test could have been a false positive. I was curious too because you know, I just had this feeling. I don’t know what it was. Something about the look on the resident’s face as he wielded the swab. I didn’t quite trust it.

Last night at around 6:30 the new fFN test came back negative, which is a 98% insurance policy against preterm labor in the next 7-14 days.

“Pack up – you’re going home,” they said. I so wasn’t expecting that. Luckily Alex had just brought me sweat pants or I would have been leaving the hospital in my bird jammies. But I would have left just the same.

Monday night I started a different medication called Indomethacin. It’s sort of like strong Advil. You can only use it for about 48 hours or else you start to have risks for the babies, but this medication actually seems to work – a lot better than Procardia. And I haven’t had any side effects from it. So my contractions stopped. Two hours at different times of day, on the monitor, with nada, zip, nothing from my cranky uterus.

“Have you been feeling any contractions?” they asked.

See, here’s where it starts to get frustrating. What I thought I’d been feeling as contractions were often not picked up in monitoring. Or, I’d feel nothing at all, and they’d tell me they’d picked a few contractions up. So now I don’t really know what I’m feeling. That doesn’t help.

My plan? Do NOT to over think this. Last time my body was acting in a troubling way I knew it and I called the doctor. This is me, trying to learn to trust my intuition – something I’m normally really bad at. But I think my intuition has been pretty spot on during this pregnancy. So I’m not going to obsess over every little twitch. Not with a 98% assurance that things are okay for now.

So, this was quite the tricky pregnancy diary update. I tried starting it a number of times in the hospital and as you can see it’s a late getting here. Not that I couldn’t blog, mind you. But blogging specifically about the boys’ development and my wait for labor was so close to the epicenter of my fear for the last several days, it wasn’t a real go-to blogging topic.

But we’re alright now.

And hey guess what? I’ve been calculating my weeks wrong, so when I was writing these updates all along I thought I was a week behind where I was. As of today we have finished 27 weeks worth of gestation. That means last week was week 27 and now we are crawling to that magical 28 number – the point in time when 90% of babies born prematurely survive. This is key given the last couple of weeks.

Here’s the package as of last night:

Funny, for a month’s worth of growth it doesn’t seem so dramatically bigger than week 23, does it? But it is bigger, that I can tell you. And so are they.

In the past couple of weeks, the boys have:

  • grown to about just over 2 lbs each, according to our last ultrasound on 11/20. Not too bad for twins, if I do say so myself.
  • been flipping around in there like two-pounder circus fish, if there was such a thing as circus fish (there isn’t, right?)
  • fully developed hands, which I am certain they’re using to spar with each other in utero
  • fingerprints and foot prints
  • begun to recognize my voice. Too bad it’s not giving them something more compelling to listen to besides “Alex?!?! Can you ________ ? (get me some water, let the dog out, throw this in the laundry, etc, etc, etc.“

And what’s important to note, according to Mayo, if babies are born at 27 weeks they have about an 85% survival rate. I don’t like to think morbidly but after 5 days in the hospital worried about such possibilities, I couldn’t escape it. So there it is.

As for me, well you probably know all that’s needed about the last few weeks from the previous few entries, but I’ll share some belated wisdom:

  • I KNEW I should have been out of work earlier. I knew it because of my back pain, which I bitched about endlessly here from week 21 on. I really thought the degree of pain I was having was not right, and I am kicking myself that I wasn’t more assertive about going out of work sooner. On the weekends when I could lay down every time I started to feel uncomfortable I had little back pain. Every day I had to stand or sit for longer than an hour I had problems. The contractions both times started the day after I’d been to work. I explained this to one of the doctors after the first hospitalization, but still she said, “Let’s put you out at 28 or 30 weeks.” I should have said, “Uh, no dear, I know how I feel and I’m not going back.” Let that be a lesson to me. Especially since work didn’t care one iota about me coming back.
  • I didn’t mention it, but I am on strict bedrest now. And after less than 24 hours of being home, I’m staring at the walls of my bedroom going, “Damn, this room needs to be painted.” Nesting instincts are a piss poor match for strict bedrest. I can get up to go to the bathroom, take a quick shower and downstairs once a day. Not going to get a lot of nesting done in this context. “Alex, can you please paint the bedroom?” No, seriously, he’s got enough to do.

Thanksgiving will now be here. Everyone wants to visit, which is really nice. But I will be horizontal and Alex will be frantically putting the house in order today to receive said guests on short notice. I am not sure but I think he gets the raw end of the bedrest deal. I think a nice invite for him out somewhere tomorrow with a plate of leftovers for me might have worked a little better, but oh well. Thank god he’s a good sport and has a better sense of humor.

And anyway, I’m still totally psyched for turkey, and all the more so with my dog at my feet drooling at the chance for dropped crumbs. (Okay I admit, not all of them are accidental.) But I’ll have to work on Alex to get the whole “afternoon tea” thing down.

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    Afternoon Tea at the Ante-partum Unit

    by Myg on November 24, 2008

    Everything is still status quo, but it’s Monday and I’m not going home from the hospital today. Probably not tomorrow either.

    This mostly boils down, once again, to what I call my “clusterfuck of life timing” issue. Because I am having preterm contractions now at this moment, when we – me & the boys – are only 26 weeks and 5 days along, and because of my positive Fetal Fibronectin test, the medical team is understandably nervous about sending me home.

    Now, they would have sent me home if I could take Procardia, a medication that stops contractions, but I seem to react badly to it. I tried to take another low dose this afternoon but within 15 minutes I had heart palpitations that made me feel like I was in a full blown panic. Man did that suck. There are other medications they can use to stop contractions, but none of them look like a good long-term bet for me right now, so I think the plan is to just watch me here and make sure I don’t go into labor.

    They will probably keep me here until we hit 28 weeks, which would be next Wedneday. At that point they said they might be more comfortable with “watch and wait” at home. But we’ll see. As I now know, anything can happen in a week.

    I am pretty okay with this plan, as much as I want to go home. I’d rather be bored here than home biting my damn nails over every flutter or tightening in my belly. We’ve come a long way to get to this point and I will do anything, anything at all to keep the guys in there gestating for as long as possible.

    A little while ago a 14 year old Chaplain (okay, maybe she was 26?) came in and asked me if I wanted her to pray over me. It was so awkward, but I felt bad for her so I said okay. She rambled a little, “Um, God, um, heavenly father, dear Lord um please be with um Amy here today…” and I tried to look serious – but it really wasn’t easy.

    Besides that, they brought me a cannoli and a cream puff this afternoon and asked me if I wanted tea or coffee. And the pastries? They were totally edible!

    As long as wireless holds and the boys stay put, we’re doing just fine.

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    Replay

    by Myg on November 22, 2008

    I’ve had almost no sleep since 4pm yesterday. Pardon me if I’m a little edgy.

    I started having more mild contractions again yesterday. Again, they weren’t painful. I just had a lot of them in a short period of time. No other preterm labor symptoms though. But all the same I had to go back to the hospital.

    They poked me, prodded me, stuck things in me. Early this morning I had the roughest pelvic exam of my life and at this point, that’s really saying something significant. Sweet Jesus, this doctor (a stout grey haired man I’d never seen before) was barbaric. It’s 15 hours later and I’m still sore. Sure, he wanted to be certain my cervix was closed but WTF? Men like that have NO place in gynecology, I’m sorry. I’d really like to give him a reciprocal rectal exam while he’s constipated, shoving a fist up his ass with all of the vigor he employed with me this morning. Actually, no, I wouldn’t like to do that. Not at all. But I would appreciate it if  someone, preferably big fisted, would do it to him. Let me know if there are any takers.

    Other than the contractions, which I kept having, all was well. In fact, they thought they’d send me home last night. But to be safe, they repeated the Fetal Fibronectin Test (fFN) and the result was positive. A refresher on what this means, from the March of Dimes:

    Fetal fibronectin (fFN) is a protein produced during pregnancy and functions as a biological glue, attaching the fetal sac to the uterine lining. During the first trimester and for about half of the second trimester (up to 22 weeks of gestation), fFN is normally present in the cervico-vaginal secretions of pregnant women. In most pregnancies, after 22 weeks, this protein is no longer detected until the end of the last trimester (one to three weeks before labor).

    The presence of fFN during weeks 24-34 of a high-risk pregnancy, along with symptoms of labor, suggests that the “glue” may be disintegrating ahead of schedule and alerts doctors to a possibility of preterm delivery.

    and…

    The greatest value of the fFN test is the high level of reliability of a negative test result. According to ACOG, “Fetal fibronectin testing may be useful in women with symptoms of preterm labor to identify those with negative values and a reduced risk of preterm birth, thereby avoiding unnecessary intervention” (1)

    In women with symptoms of preterm labor, a positive fFN result, while less reliable, allows doctors and patients to take preventive measures to delay labor for as long as possible and to consider labor-suppressing (tocolytic) medications.

    They were fairly surprised. I was upset. They reassured me, a positive is not something to get terribly worked up over. But since I did have it and I had two episodes of contractions within a week, they decided to give me steroid shots to help the development of Doot’s and Bing’s lungs along, just in case. It wasn’t a tough decision, but it was a recommendation that scared the crap out of me. Like, there was enough of a chance of the boys coming early that I needed to do this. That’s not what I want to hear right about now. I got my first shot yesterday and my second and final shot tonight, 24 hours later.

    Today the very nice, and very gentle, and might I add, FEMALE High-Risk Maternal Fetal Medicine doctor came to visit early this afternoon and did an ultrasound of the boys and a very gentle transvaginal ultrasound. “Your cervix is the size of Kentucky” she said. Apparently, this is a compliment. It’s a very good thing. Especially when carrying twins. The boys looked “perfect.” So all in all it looks as though things are okay. I am not, repeat, not having preterm labor. Not at this point, anyway. They just want to be sure and do whatever they can to prevent preterm labor from happening and god forbid it happens in the next week or two, give Doot and Bing every chance.

    “You’re pregnant with twins – your body is not going to act the same as if you were carrying one baby.” the nice lady high-risk doc said. “How can we expect you not to contract with two babies in there at this point? Your body has stress on it more like you’re 30 weeks along, not 26.”

    Well, that was a good point and made me feel much better.

    Still they’re keeping me. At least until tomorrow morning, possibly through the weekend. I’m now officially out of work. But I am less freaked out by the contractions and that’s a good thing.

    I keep telling myself, I’m just along for the ride now. I’m trying to let go into this experience while still remaining a strong advocate for myself. It’s a delicate balance. And it may or may not be obvious at this point, but “delicate” is not my strong suit. With two boys on the way, that’s probably a good thing though.

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