Tuesday, June 26, 2012

Still Trucking

Yesterday, we were actually on the verge of discharge.  Not as a vague hypothetical, but scheduled in a few hours after the completion of the normal testing for the day.  Part of that normal testing was an NST (nonstress test) which Lefty has been looking good on for about three weeks and Righty overall for a week.  You guessed it, BOTH had late decels (3 or 4) and then they BOTH had a thirty-plus minute episode of tachycardia.  One of the decels was interesting because they did it at the same time, but from different baselines, so perhaps they are already working on their synchronized swimming?

This was bad enough to get our discharge yesterday cancelled, but not bad enough to deliver right then (yeah!).

This morning the on-call OB came and actually made a plan clear.  Part 1 of the plan is we will stay inpatient.  Had we actually been discharged, they were going to have me come into the office Monday through Friday and up to L&D on Saturdays and Sundays, but the theory is it's easier to stay here than to have to get sent back, so might as well stay in.  It also facilitates them delivering unscheduled.

That leads us to Part 2.  There is a scheduled c-section at 37&1 (July 19) and they would prefer that date, but apparently the tolerance for decels will drop with each passing day and they will play it by ear, but very well may decide to section them ahead of that date based on a strip.  She apparently was very close to delivering them yesterday and let them know that she would have if they had been 34 weeks (they were 33&5), so the girls are definitely on notice.

My OB is back on Monday, July 2.  I think that's all the dates.

They had a growth scan today which also confirmed that my sensations are correct and instead of breech/breech, they are transverse/transverse.  So Lefty is now more bottomy and Righty is now more toppy, but I'm sticking with Lefty and Righty.  Lefty continues to be more petite than her sister, weighing in at 2077 grams (4lb, 9oz) while Righty is a hefty 2420 grams (5lb, 5oz).  These are obviously ultrasound weights and have a large range of error, but it is safe to draw from these that they are good-sized! 4497 grams total!

While 34 is obviously great and awesome, more is better and I'm starting to get greedy and want more and more gestational time.  I was playing with a prematurity risk calculator on perinatology.com and getting from 34 to 37 decreases the risk of respiratory distress syndrome from almost 20% to 3.5%!  And the risk of NEC drops from 1.57% to 0% and the sepsis risk from 4.69% to 0%.  The risk of grade III and IV IVHs already drops to 0% at 34 weeks, so I really feel comfortable and happy with any gestational age from here forward, but would LOVE them to make the July 19 date.

However, these girls will likely be leaving the hospital in diapers and the long-sleeve hospital white shirts if they do make it that long because the clothes are all organized and sorted in the garage rather than in the house or packed to bring to them or anything ;-).

Last thought is that it is really quite odd that I'm here on some level.  I feel great and am really symptomless.  If they'd let me, I'm still completely capable of walking, maneuvering and generally am still very mobile, flexible and all of that.  I sleep fine, I'm not in pain, I'm not grumpy, I'm not swollen.  I've got friends who are more like 20 weeks with singletons who seem much more uncomfortable and are having to waddle and dealing with pain and sleep issues and all that.  So, excepting the whole being stuck in the hospital, I'm in great shape!  We will see how well I handle going from two to three months of total bedrest to keeping up with four kids with an abdominal incision healing though...

Friday, June 22, 2012

Passive Superstition Be Gone

I think I have not been posting through a mix of passive superstition, by not typing things it is totally logical that I'm not tempting fate (right?), and honestly just not wanting to process some thoughts.  Neither of these was a conscious move, just kind of happened.  But I got forced to a few thoughts, including realizing that I wasn't writing anything for silly/nonexistent reasons, so here I am.

First thought: at some point in the last week or so, my expectation has changed from this could result in 0, 1 or 2 babies to there will be 2.  Yesterday morning, my OB was as usual sitting in the rocking chair beside my bed chatting and writing up my chart and when she finished she asked if I had anything else.  And then said that she thought there was something else and that I sometimes get a look where she knows I'm thinking something, but she just doesn't know what it was.  I felt oddly stressed, but couldn't identify what it was.  In thinking after, I think it really was just that I'd made the transition to expecting 2, and thus exposing myself.

That's my big thought.  Figure I should give a status update and summary now since I have been so non-communicative.  However, just like with Chiron/Aurelia, I've actually done a good job through Facebook and it's hard to keep straight what I've said where, so figure I'll just go general here.

Two new things were declared by the OBs this week: next baby who pulls a hijink is getting born at that time and bring her sister with her and we are staying through delivery.  Why, you ask?  Well, Monday when we actually were at the point of considering discharge in the next couple days, Righty aka baby A, started having late decels followed by tachycardia on our normal morning strip.  Initially responded with trying positional changes while a nurse got the oxygen setup in place.  Then she called the OB and had her look at the strip just to be sure she knew what was going on and the OB told the nurse that we were going to c-section them and to start an IV, get labs drawn and get me moving towards L&D.  Then in the thirty minutes all that was going on little miss behaved perfectly and so my OB backtracked and said we would do 24 hours of monitoring.  No more incidents occurred after that, so was shipped back to stable antepartum, but it was declared that these two were out of chances.

Background: at 25 weeks, I had a cold and my body started contracting/dilating in response to there is stress on the system, lets do something to simplify.  Stayed in-patient for ten days, things calmed down and was discharged to home bedrest at 26&2.  Then at 28&5 I was at the perinatologist for normal BPP and Lefty, aka baby B, was having variable decelerations and some moderate bradycardia on her NST.  He wasn't worried, but wanted to make sure that it stopped rather than continued and since it was 5 pm, sent me over to L&D for two hours of monitoring.  Instead of discharge after two hours, I instead got another 2 rounds of steroid shots and was admitted.  She continued having some of these events until the morning of 30&5 when there was some insane fetal motion and I again started having contractions.  Had dilated more and so went over to L&D.  By middle of the day, I was having beautiful, rhythmic contractions of mountains and values every 2.5 minutes and it looked like we were heading towards birth.  Then it just petered out.  Stayed in monitoring in L&D another day and a half and then back to stable antepartum.  Good news of that event was the huge motion was Lefty moving from transverse to breech and as a result seemed to have gotten her leg or whatever out of the cord loop and we haven't seen variables at all, much less bradycardia from her since.  Then on Monday, at 32&5 we had the late decels event with Righty.

So, now I'm back to hanging out in stable antepartum.  Looking pretty stable and while I have a couple rounds of regularish contractions a day, nothing significant.  Both babies are behaving on their strips and so we continue on.  The delivery date barring someone misbehaving ahead of then is July 19 at 37&1.  My OB, who you may remember is really amazing, competent and just a good human, just left my room and is heading out on vacation and will be out of town until July 2.  Of course, there will be other OBs on call and I know them all, but I am spoiled and really prefer MY OB, so think behaving thoughts through at least July 2. That would also get us to 34&5, which I would count as pretty awesome.

That's my ramble and now some random pictures because captions are fun.

Chiron playing around with one of the new strollers while hanging out at Trajan's swim lesson.
Trajan is by the rail waiting at swim.
Amusing nurses with hijinks and jocularity make the world better.
So do nurses drawing fun pictures.
And awesome coworkers who bring amusing things as well as folding zombies out of paper!
And grandparents who come into town and amuse boys and generally help.
As well as hold little boys with colds when the pass out.
Friends coming by, talking, bringing food, amusement and even making a five-foot tall kangaroo makes the world a lot better as well.
So do wonderful friends who I've actually never met in person who amuse me every single day on multiple occasions and have sent more surprises, notes and thoughts than I ever would have imagined.
Even being challenged to a massive hamburger eating contest is pretty cool.  And as a bonus, you see here the pictures that some amazing friends I work with thought to print and bring up (and some of the zombies!).
This little man loves wandering around the hospital on our 30-minute wheelchair privileges and is amazing us with all he's mastered.
This little man prefers to be silly and luckily there are some great nurses who go along with it!
These three are pretty awesome and photographic evidence that Trajan may come here to play iPad almost as much as to see me.
Happy, loving boys

I don't have an innie or an outie now, I have a flattie.  Also, tell the kids at home not to pierce their belly button because even if it's only for two days due to some impulsivity and fun with roommates, it will stretch to impressive size as a scar.  And my first two skin marks ever appear below on diagonals on each side.

Tuesday, June 12, 2012

8 lb, 4.5 oz of baby

Assuming accuracy of ultrasound weights (yes, I can hear you laughing from here), the girls now outweigh Trajan's birth weight collectively.  I was not surprised by this as I also have a bit of stretch mark for the first time ever.  Right now it's just two little red marks, but I bet that's just a start.

Righty, our presenting baby, came in at a petite 1719 grams (3lb, 12.6oz).  Lefty is now our bruiser coming in at 2038 grams (4lb, 7.9oz), two kilos!  So together they are 3757 grams (8lb, 4.5oz).  Righty is at the 37th percentile while Lefty is at the 56th.

The margin of error at this age/size is about 300 grams for each of them, so their weights may not be as far apart as they look.  It' a 15.7% size discordance and they apparently don't start to pay closer attention until 18-25%, so golden on that front as well.  Today was 31 weeks, 6 days and those weights correspond with 31 weeks, 4 days and 32 weeks, 2 days, so the weight difference is only equivalent to 4 days growth of the fetus that is the perfect 50th percentile.

Both girls aced their BPPs as well which was reassuring as Lefty didn't get a reactive fetal strip in the appropriate amount of time this morning.  She eventually did, but not within the time parameters for it to count as reactive. 

Tomorrow is 32 weeks, so I think based on almost all measures, we have achieved big baby territory!  Also, while their going breech-breech is a bit of a downer as it equals c-section for sure, one nice feature is being able to find each of their heads REALLY helps me to be able to discern what motion belongs to which baby which is reassuring and happy.

As requested, belly pictures demonstrating the collapse down into beer belly:

And yes, my stomach is very oddly veiny!

And a couple of the boys just because I like them:

Monday, June 11, 2012

I got nothing...

I didn't mean to be dramatic by not posting, it's really just a question of I've really got nothing to say.  And when I do say something, it seems to inappropriately tempt fate and I've developed an unhealthy superstitious attitude.

Still hanging out in patient.  Was pretty much positive we were delivering within 24 hours last Monday.  Dilated more, regular 2-3 minute contractions for hours and the like, but then it all stopped.  OB, nurses, other OB and the like were all also convinced, so no clue what really happened, but I like it.

Good news is that the event that we think precipitated that preterm labor episode was the movement of Lefty from transverse to breech.  And in the process, she seems to have fixed her cord issue.  Free your leg and your heart will follow... We actually have not seen any of the recurrent variables or bradycardia episodes since that day and that has us at a week now.  This is good news!

But with two cervix changing episodes to date and an irritable (the medicos for some reason don't agree with the term bitchy or even whiny) uterus that throws fits at such things as lying flat on back, too much fetal movement and not having a sufficiently empty bladder, they've still got me hanging here even with the improvement in the fetal strips. 

We should have a growth ultrasound with their BPP tomorrow and I'll try to remember to be a good person and update with that.  Because notoriously accurate ultrasound weights are fascinating, right?  Does sarcasm convey in writing?

Other news is the movement on Lefty and then Righty deciding to get in the game and become breech as well (breech-breech for the win) has resulted in belly dropping from it's round ball appearance to looking like a true, sagging beer belly.  Kinda fun.  They are definitely bigger than I was when Trajan was induced at 38 weeks and this is pretty amazing to me.

Still getting a lot of work done for work here and I think that's crucial to my sanity.  Seeing the boys and exercising half-hour wheelchair privileges with them to go on "adventures" is even more crucial to my sanity.  An amazing and patient doctor plus some truly wonderful humans as nurses also can not be underappreciated.

So, life is going well.  Not ideal, but good and we are blessed to be experiencing it.

Last thought: it's really starting to look like we may end up with four children.  Four children living in our house.  Four kids, really?!?