Thursday, April 5, 2012

Preterm Labor Clinic Begins...

My OB's practice sends their twin pregnancies to the preterm labor clinic at the perinatologist starting at 22 weeks.  I did it last time, but only made it to three visits before "it all changed."  Had the first appointment for this go round today and it went well.  Was greeted with a deja vu comment.

I'm up 15 pounds now, which is less than they'd ideally want, but is enough that she isn't worried and says to just to keep up working on it!  I'm 22 weeks and I'm measuring 31 weeks based on fundal height which interestingly is the exact same measurement that I got last time at 22 weeks with her!

We talked through all the activity guidelines and reviewed preterm labor symptoms.  She wants me to work towards working part of each day from the house sooner rather than later, so I need to get my technological ducks in a row.  She also wants me to really minimize my carrying of Chiron as much as possible.  Don't need to eliminate entirely, but cut back as much as I can.

After the discussion, she had me leave a urine sample and then she measured the fundal height, listened to the heartbeats with a Doppler and then did an internal exam.  My urine was excellent, an odd phrase to hear, but I'll definitely take it.  And that coupled with a 120/60 blood pressure (which I think is great for me in a OB/perinatologist setting at this point) indicates all is well on the preeclampsia type front.  Righty had a heartbeat at about 150 while Lefty was around 160.  And my cervix is still very long, she said she would believe it's still around the 5 cm that it was the last time we measured, and the inner part is completely closed.  The outer is open, but that's just because I've had a kid before.

The only thing she absolutely ruled out is that she says I am NOT to be the one to stay with Trajan for getting the tonsils out.  She says that that would be a perfect storm nightmare to cause preterm labor.  She actually had her son's out at the exact same place with the same surgeon a few months before and she adamantly said no.  I can be there during the day for the procedure and all that, but I need to leave for the evening hours.  I'll need to talk with Paul (he has a webcast at work this morning), but I imagine this isn't really an issue and he can just stay with him.  She also recommended that we do get the alcohol-free version of the pain meds for a reason I hadn't thought of.  It burns less when they swallow it, so kids are more willing to take it, so it's less likely that we will fall behind his pain and have issues with that.

Everyone I talk to is making me more and more nervous (not sure that's the exact right word) about getting the tonsils/adenoids out and the degree of discomfort, pain and just plain suffering Trajan will experience with it.  I'm cautiously optimistic that at 4.5 he is much more capable of reasoning and discussing than most of the kids who are at 3 and so perhaps that will help.

Look for another ENT update this afternoon or tomorrow on the Chiron front! (and no, that isn't really an exclamation point of excitement, but it's kind of like the theory of you either have to laugh or cry.  I am going with laughing and living.  And glad that Poppins is in place so both of us have been able to work this time).

And to finish up the preterm labor thoughts, I will see her weekly until 37 weeks or things hit the fan.  She is looking for continued weight gain, clean urine, good heartbeats, cervix staying long and closed and me reporting that I'm cutting back more and more on activities. 

She gave me a sheet just like last time that outlines the key dates (I'd already converted my old one, but just for fun, here they are:)
  • April 4 - 22 weeks : Need to be resting a minimum of 1 hour midday and 2 hours early evening and begin decreasing all activities at home and work.
  • May 16 - 28 weeks: Uterus will be full-term size and contractions more common.  Need to work a maximum of 4 hours a day in office (if no appreciable work at home).  Can work more hours from a reclined position.  Minimum rest intervals of 2 hours midday and 2 hours early evening.  Curtail activities much further
  • June 13 - 32 weeks: "Big Goal to Pass" aka it's all bonus from here.  Moms can tolerate very little activity and no activities of any type should be undertaken lasting over 2 hours.  Work should solely be from home and a reclined position.  (She said I could run up and get stuff, putter around the office for possible an hour a day depending how I'm tolerating)
  • June 27: 34 weeks: Will not need steroids to mature babies' lungs, will not give medications to stop labor and babies likely in NICU about 2 weeks
  • July 11: 36 weeks: Typically no NICU time
  • July 18: 37 weeks: Ideal delivery timing
This whole long list is a little funny as last time I didn't make it past the very first entry before I was no longer free and loose in the world.  But I'm thinking positive!  And always laughing.  No matter what, laughing.

And one last thought.  I was wrong about something.  I'd written before I got pregnant that the reason that I wouldn't ride this ride of pregnancy again for a round three is that my sanity couldn't handle it if something went wrong and in particular if we last another baby.  It turns out that I'm pretty sure that that is not true.  I obviously am not rooting for it, but I have had time to really think about what that would be like and I think I can say with pretty high confidence that I would make it.  That I would process it, work through it and come through it still me, just a little bit different.  I am strong enough.  This may seem a warped thought, but knowing it helps me.


  1. Yes, you are strong enough. You will make it. I am praying you won't have to find out, though. (((hugs))) I think your mental outlOok is great!

    For me, after I hit the gestation when I had the twins, I knew what I'd be getting should I go early, and that calmed a lot of my major anxiety. I knew we could do it because we already did do it if that makes sense. I didnt want to deliver early, for sure, but I knew we'd survive. The really stressful time for me was the time up to the 28 week mark.

  2. I love reading your updates. You've got a cheerleader here. Your last paragraph had me tearing up, though. I wish that wasn't a piece of the puzzle that you have to configure. Your strength is astounding.

  3. Wow that sheet is pretty impressive. We don't have anything like that here in the UK. Made me a feel a bit sad but who knows, life's a crap shoot right? Sounds as though you and the girls are doing brilliantly.

    I'm so sorry for Trajan. I know he's very clever and I'm sure he'll be able to understand what is happening (I also feel that being able to talk about it might help) but I know that I would be extremely nervous and anxious to see my child go through any procedure, no matter how minor. Think it is an old NICU thing. I don't even like taking Jessica for shots.

    And um yay for 5cm cervix and excellent urine! Now there's compliments you don't hear every day.

    I can understand why you would consider how you would feel if you lost one or both of your babies. I know that I thought about this long and hard before I fell pregnant with R (as I actually had the luxury of a deliberate pregnancy) as I didn't want to create a situation where J might have a mom who was utterly destroyed. Doesn't sound warped to me, not in the slightest. I think, having been there once, we have to consider the possibility again, no matter how unlikely the scenario might be.

    I'm rooting for you and these girls, so much.

  4. It's funny (well, not funny-funny) but when we learned I miscarried, we were at my first perinatologist appointment and had already talked about all the bed resty sorts of things. I'm not trying to be a downer, but your post just reminded me of all that stuff.

    Sounds like you're doing great! And I'm super happy about that :)

  5. I am so happy that you are being closely watched. Be sure to keep taking it easy!

  6. You are an inspiration! Seriously. I love your strength and outlook on laughter. I could learn a thing or two from you, friend.