Today was a good day - Last pregnancy today was a horrid day

Today is 21+6 weeks. I have a bunch of random stuff going through my head- so this post will be jumbled- sorry.

1) Sprout had his heart check number 3 today (for a reminder - I have anti-ro antibodies and this can cause fetal heart block). The fetal echos check valve function, ventricle function, structure- all those good things. In heart block - they can pick up on certain indications in the second trimester. So far.....

SPROUT LITTLE HEART IS ALWAYS MEASURING IN NORMAL RANGES!!!

It is so comforting that the techs always tell me - gosh we could have been done 20 minutes ago but this little boy just won't stay still :) It makes me picture a nice big placenta feeding him nicely and causing him to grow big and strong. I started freaking out at 18 weeks with Vincent because it seemed like he just didn't move- nobody listened though - and I am sure there was nothing they could have done anyway. The other good news is that if heart block will show up it will do that by 28 weeks - so 3 more fetal echos (assuming I reach the fabled third trimester) and this will be one more high risk potential complication knocked down!!! Woo hoo!

2) I went on a searching mission for a company that offers free dopplers for moms who have experienced a loss to use during subsequent pregnancies. It was hard because the only place I found it was on my expecting club on I.Village. Obviously the September 09 EC was no longer there. I did manage to track down the post I needed and victoriously retrieved the information. If anyone wants to check it out it is :

http://tinyheartbeats.org/index.htm

I decided not to use a doppler - but still which I got it sometimes!

The odd thing is I looked at the September 2009 playgroup - they named their children the "Sprouts". I found this so very odd - and comforting as well.

3) Now the way back machine:

April 27th - it was a Monday - I was 21 + 6 weeks pregnant with Vincent. I was on hospital day 5. It was time for the big ultrasound to determine whether blood flow was holding steady. We got to the ultrasound room - little boy wasn't moving much. They threw on the dopplers and everyone was silent. I wanted to look away from the screen - but felt I couldn't - afterall, this may be the last time I saw him alive.

I stared as they did the uterine artery doppler. The peaks all pointed downwards and I just silently cried watching my little boy for the last time. A very special doctor, actually the one that just put me on bedrest last week, came in to break the news. She looked at me and said 'it looks like you know it is bad" - I replied "it doesn't take a genius to see the flow is going the wrong way". She just patted my arm. They didn;t give me a picture that time. I wish I asked for one.

I got back to my room, after waiting an hour for transport. My hubby was getting pissed because here are all these happy pregnant women walking by us to get an u/s - and I am just crying in the damn wheelchair knowing it was all over. A whole team of doctors was waiting for us. They explained the reverse diastolic flow was pulling blood away from the baby. There was virtually 0% chance he was not severely brain damaged due to this flow. My body had failed.

We discussed options.

• I could try to hold on for 2 more weeks and have a C-section to try and save him. The chance I would be able to hang on for 2 weeks was very low - especially since my kidney function kept going down hill. In addition, the baby would not be able to make it due to the reverse flow. His chance of survival was less than 1%. He had severely low amniotic fluid to the point where his heartbeat was no longer able to picked up on the doppler. The doctor brought in an ultrasound and he was curled up in the tiny pocket of fluid that was left. That was a horrible sight.

• It was recommended I terminate the pregnancy with a D & E. I just couldn't do that.
• The third choice was to wait and talk to a neonatologist the next day and find up what we were up against.

We choose option 3. We were meeting with the NICU attending the next morning, but knowing the odds were not in our favor. We were also giving a less than 5% chance Vincent would make it to 24 weeks - my body was slowly killing him. It just sucked.

All of us have had that feeling at one point or another - it just sucks and isn't fair.

2 days in one post

Well it is been a rough day and a half. I have just been worried. Not specifically about Pre-eclampsia (which is odd since that is the thing I worry the most about and have the most reason to worry about). I have been worrying about horrid acronyms - most of which I have never experienced. I experienced IUGR (intra-uterine growth restriction), but I am also worrying about foreign things to me; such as: IUFD (intra-uterine fetal demise), IC (incompetent cervix) and PROMM (pre-mature rupture of mucus membranes). See since I have never had those happen - how the hell do I know if they do now? I know it makes no sense - but I have been debating whether to ask my doctor to check my cervix. I know he will look at me like - what the fuck is wrong with you, but that's my problem, I don;t know either.

It doesn't help I have been catching up on baby loss blogs recently. I am so emotional - I cry even easier than I would have non-pregnant, but if you have been there you know, reading is like therapy. You remember their baby, you remember your baby and you remember this is not the life you are supposed to have.

I have been sleeping with a teddy bear (a panda) I got at my ultrasound over 3 weeks ago. I have never been able to sleep with a stuffed animal, but for some reason I hold unto this little panda for dear life. It has a little box inside that has a recording of Sprout's heartbeat in it. So when we play it - I hear his heart beating away. I have wanted to add Vincent's hospital blanket to the things I cuddle - but I haven't done that since the hospital. There is a spot of ink on it from after his footprints were taken. I am terrified I will rub the spot off- now it is like tangible proof he was here.

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So at 11 something when I started this I was 21 + 4 weeks pregnant. I am now technically 21 +5 weeks. I decided to combine the two days together since not much happens over the weekend in the hospital.

Back to 4/25/09. It was a Saturday. It was also the first day I met Dr. M - who has taken care of me this pregnancy. I thought he was a douche. Sometimes he still is - but not to me so I don;t care!. He came in the room Saturday and told me my 24 hour urine came back and I had PE. It was around 650 mg. I was not leaving the hospital anytime soon. He was in and out of the room. After, I justified that he was just seeing a patient he had never met on a Saturday. I was probably too quick to judge him as a douche for not reassuring me. Now I now, there was nothing to reassure. ... and I do love him now so it's all good.

4/26/09 - Sunday. Nothing happens on Sundays in the hospital. Something happened inside of me though. I awoke crying from a dream I had. I have only shared bits of pieces of this dream with most people who are even aware of it. The hubby and my best friend are the only ones who know the whole dream.

Basically, I had a dream I had my little boy and was walking with him through different stages of his life. Holding him when he was a baby, watching him go to school, walking on a beach with him when he was older. I stopped and looked at him - he looked just like my husband at 19. Just gorgeous. Then I asked him "you aren't coming now are you?" and he just smiled and shook his head. Then I started breaking down in the dream and telling him all the fun things daddy and I had planned for him, how badly we wanted him. He just smiled at me. I said good-bye and I love you, then I called him a name that wasn't Vincent. My dream ended with me waking up as I was thinking why did I call him xxxx - his name is Vincent. When I woke up - I knew it was over. I knew Vincent wouldn't be coming home and was stuck just waiting for the doctors to confirm what I already knew.

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It been a long day in a long journey :sigh:

21 weeks 3 days

***These titles will stop once I reach the end of Vincent's journey. I am sorry if seeing them causes anyone any pain. This will be done in less than a week...unfortunately

with Vincent, 21 weeks and 3 days was a Friday. I finished the dreaded 24 hour urine and just kind of waited for the next round of doctors. I saw a nephrologist because I had a positive ANA at 1:40 and anti-ro antibodies. This caused questions about whether maybe I had lupus. Kidney doctor said nope (thankfully!). My liver enzymes returned to normal - so the blood draw in the morning was the last blood draw done unless I started to have issues.

Next in came a new round a dr.s. A new MFM and new staff. The MFM told me **IF** I left the hospital pregnant - I ABSOLUTELY could not return to work until the baby was born. There was one more ultrasound I needed to have - the one with dopplers to check on blood flow to the baby.

Then Dr. Smith came back and explained the doppler results to me. Flow through the umbilical artery can either be present, absent or reversed. Present means that blood is pulsing through the artery, as it should, when your heart is pumping and when your heart is resting. Absent flow is when blood does not flow through the artery to the baby when your heart is at rest. Reverse flow is when your heart stops between pumps, the blood flows out of the baby - very very bad.

My first u/s showed absent to reverse diastolic flow. This was not best case scenario - but I was assured we could try to hold out for a few weeks to get baby bigger. We needed to look at the flow again after the weekend. Basically we were in limbo at this time. would the baby survive? Would it not? What the fuck were we going to do? The only decent part of the day was that my hubby brought me up some clothes and I was able to get out of the hospital gown. It stared the next three days of waiting.....

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Today - at 21 +3 weeks with Sprout, I woke up and decided to really listen to the doctors about bed rest. Since I don't have an official order from my MFM , I figured I would go in today - monitor my pressures and take it from there. Over the night though, on my many many bathroom trips. I decided I really can't make it through an 8 hour day. My feet would swell enormously. I would be ready for a nap at 11 am and not get one until I got home. My BP would absolutely go up a bit (I decided this last night when after food shopping - an hour later- my BP was 135/85 and I had some severe pitting in my legs).

I know 135/85 doesn't sound bad - but I like the 120/80 I average moving as little as possible! I decided I need to do what I need to for Sprout. Plus, my hubby really helped my decision by saying he thinks I am unable to grow a healthy baby when I work. He wishes he could support us so I don't worry about work - he wishes pregnancy wasn't so hard for me. But also, he wants me to grow a healthy baby and make that my priority - NOT WORK. So I am home. I am kind of worried I may lose my job later on. But hey, everything will be taken in stride. I am going to work on some crocheting later - just relax :) :) :)

21 weeks 2 days

I think this will be one of the hardest post to write - so I am going to get it out of the way early.

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April 23rd, 2009 - 21 weeks + 2 days pregnant with Vincent. When I went to sleep the night before I had a pit on my calf from grant standing on my leg for a few minutes. The 20 pound dog left a perfect paw indentation that lasted 2 hours. Then I fought through the gray haze of vision to go to sleep. I woke up and my vision was fine! But my foot was still extremely swollen.

My hubby looked at my feet and told me to take the day off. I figured I should go in- because I wanted to run by my OBs office for a check up. See - I was already high risk. My BP was borderline going into pregnancy at 130/80 - but just crept up consistently during the pregnancy. Amazingly I look back at my records and see at this point I had BPs of 160/100 for 1.5 weeks - and was still allowed to work on call. :sigh: can we say negligence? anyway.... I was supposed to see a high risk OB on Monday - it was Thursday. Everything had to be fine somehow. Yet as I was getting ready for work, I grabbed my OB card and some reading material .

I left the house with the hubby, it was the last time I would be in the house with Vincent alive. I walked into work - without ever thinking I would be there for over a week - the joys of working in a hospital. My boss asked me how I was doing. He is a nephrologist (kidney dr.). I mentioned I was really swollen - he knew about my BP issues. He asked to see my feet - took one look at them and told me to call my dr. ever the scientist I asked him how to classify the swelling - he said moderate and it was only 9 a.m. - call now.

Of course the OB office wanted me to come in. I knew what was going on- but I still had so much hope.

I got to the office and they quickly called me back away from all the happy smiling pregnant faces. Urine showed a +2 protein - BP 198/110. Yep, everything just got royally fucked. My OB came out and met me at the BP area- I didn't even get a room. She told me to get to labor and delivery now.

I called my hubby and told him to leave work. I had done my research - I knew this was severe pre-eclampsia. I cried telling him we were going to lose the baby. He told me to wait and see what the dr.;s said - but I knew.

I cried on a bench just waiting for him to get there. When he showed up - we drove the 5 minutes to the hospital. Got through admitting. Got settled into a triage room in L&D. First round of blood work was drawn and BP measurements were taking constantly. I was giving fast acting meds to lower my BPs that the hubby said were occasionally as high as 200/120. A nurse sat in the corner just watching the readings. 30 minutes later my labs came back with elevated liver enzymes. Now the show started and first the resident and the MFM attending came in. The resident was telling me we were trying to stabilize me and if I could stabilize we could try to eek out a few more weeks. The MFM gently piped in that a few more weeks wouldn't be enough- we had a long way to go still. Of course if they couldn't stabilize me - I would need a c-section that day. They kept telling the hubby that this was life threatening for me as well as the baby.

The next set of labs showed my liver enzymes were trending downwards. Now the OB on the admitting floor came in to tell me there was a great chance the baby wouldn't survive. All the doctors were very gently when delivering this news. But this doctor kept his hand on my knee and just let me cry for a few minutes. Then he told me I was off to get an u/s - start a 24 hour urine and be admitted in teh antenatal unit.

The ultrasound quite frankly sucked. The tech told me I was having contractions - WTF? My fluid was low and baby was measuring 2 weeks behind. It was hard to hear that news.

I got settled into my room around 7 pm. I was to have BP checked every 4 hours, baby heart rate as well - except night when I could sleep 6 hours without BP checks.

Every doctor was very kind, very compassionate. They weren't gloom and doom, but they were not offering any false hope as well. I layed in the bed wondering how the fuck this happened. We wanted thi sbaby so badly, I did everything right, now we were losing him slowly.... and there wasn't a damn thing we could do.

The hubby went and got my drinks for the night and stalked my refrigerator with gatorade and ginger ale and brought me magazines - and even hid teh ones he noticed with pregnant celeb articles on the front.

The awful beginning to the end.

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Today I am 21 weeks - 2 days with Sprout . We are having a relaxing day me and him. Watching some home renovation shows to see if there is anything I can do on bed rest. Reading some of teh new King book - very very good and preparing for a bath. Today is a good day :)

First L&D trip

Wow - 21 weeks and 1 day. I celebrated my 21 week mark with a trip to Labor and Delivery. My BPs had slowly been creeping up - and last evening's BPs were high averaging 145/95 :o

I'll cut right to the chase - BPs were good at L&D after my next dose of meds. Labs looked good too. Potassium was low and they supplemented it- but that was the cause of my pounding heart.

The dr. I saw was one who saw me when I was admitted with Vincent - she was adamant I go back on bed rest... and she is a dr. who never prescribes bed rest. She wants me to get to a "safe" point to deliver before going back to work if everything is looking o.k. Her safe point is 32 weeks. She informed me how the NICU at the hospital has comparable survival rates at 28 weeks as for full-termers - but the rate of long term disability drastically decreases at 32 weeks.

So - YIPPEE!!!!

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Now to reminisce though. When I was at 21 weeks and 1 day with Vincent - was April 22nd. It was a Wednesday. I worked on-call shifts Friday, Sunday and Tuesday... and I actually got called in for all of them. They way on-call works is we do our Mon-Fri 40 hours, then the day you are on-call you are responsible for a 24 hour donor shift for any deceased donors and those work-ups take ~ 13-16 hours each.

Friday I left work at 11 pm... got paged at 12:30 am to come back. I cried when my pager went off that night. I was just so fucking tired and felt like shit. Worked until my relief came in at 8 am Saturday - actually I had to stay until 9a.m. because we had so many donors going on I wanted to finish one completely off for him so there would be one less for him to worry about. The hubby picked me up- we went to breakfast and I feasted. Then I went home and slept for 13 hours.

Sunday morning I saw I had another donor consented for some point in the day. So I slept and slept until my pager went off at 2 pm telling me a donor was coming. It didn't show up until 9 pm and I finished up around 8:30 am on Monday and went home to sleep. Since I worked all night Sunday - I had Monday off.

Someone had asked me if I could switch shifts with them and pick up Tuesdays on-call. I didn't figure I would get hit all 3 shifts. I get hit alot - but come on - 3 shifts in a row? So I got in Tuesday at the normal time - 8 am. and did not leave until Wednesday morning at 7:30 am. During the night at one point I had the idea I should go to L&D for a check up. I felt so out of it. Then I started feeling Vincent moving like crazy. I was so excited and thought he was just getting to his really active point. Little did I know he was in crisis. He was moving so much because my BP was through the roof and he wasn't get enough blood. Those last frantic movements were him trying to get help. That has always sucked to look back on.

I must have looked like shit. The senior tech who saw me int he morning commented that I was running myself ragged and he was glad I had a break for a week and a half before my next shift. I got home and one foot was like 5 inches bigger than the other - it was ridiculous. I went to sleep - and woke up craving milk at around 3 pm. I went to the store and by the time I got back my foot was swollen again. I rested it and watched the Se.x and the C.ity movie. The swelling went down. I loaded the dishwaher - the swelling was back.

Around 11 pm I know shit just hit the fan. My vision fucked up. It looked like I was looking through a gray haze. Nothing would focus and all I saw was outlines through the haze. I KNEW this was a sign of severe PE. But I was only 21 weeks and 1 day. I was scared. What did I do? I went to sleep. I even told me husband I was so scared to go to sleep in case I died. Like a normal person, he thought I was over-reacting.

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That was the 21 +1 day of my pregnancy with Vincent.

Today, is my 21+1 day with Sprout. Today I am laying around. Catching up on bad T.V. on my DVR. I did a load of dishes and no elephant foot ensued. I am about to start the new Stephen King book (thanks mom) and I am avoiding my BP machine even though I know I shouldn't be scared of it. I will take it soon... maybe....

The next week and a half I am going to be writing alot about where I was with Vincent vs now. I avoided writing much about Vincent's pregnancy because it was too depressing to think off - but that is where I am now. I am thankful Sprout is in his own situation now.

Thing I Like..

It occurred to me that there used to be other things to occupy my time and mind besides Pre-Eclampsia and loss and pregnancy and worry. I will be back there someday - so I wanted to reminisce on the things I used to love and take some time to enjoy them.

* SHOES! I love shoes. The higher the heel the better. Not a fan of peep toes on me though - I think my toes are too ugly. Pointy toe works well on a really high heel. I went through my shoes the other day and it will feel like Christmas when my feet fit in them again ( no hurry Sprout... no hurry at all little boy)

* Coach bags. I love all bags - but something about a nice Coach bag - they last forever. It's like a comfortable old T-shirt- always perfect. With how much I love coach - you would think I would have visited the coach outlet near me... I am getting to it. I am sure I would love the pricier labels as well - but have tried to stay away out of respect for my bank account.

* Bar Harbor Maine. It is the hubby and I's happy place. We will move to Maine some day. It's beautiful and just feels so amazing and right when we are there. First visit was the honeymoon - back every year (at least once) since - except this year - too sad this year.

* Mint chocolate chip milkshakes with vanilla syrup - mmmmm

* speaking of mmm - thai food. I love it.

* I love my job ( hopefully it will be waiting for me when Sprout comes along!).

* my superbly flashy oakley's. they are gold and scream stare at me - my hubby hates them!

* outfits consisting of chocolate brown and baby blue (hmmm - maybe a nursery theme there).

* lemon poppy seed muffins

* music - I totally love Pico vs. Island trees , Ben Harper and my chemical romance right now

* vodka - I love vodka - Belvedere especially

* running and playing in the leaves with the daschies

* comfy amazing jeans with amazing shoes

* a night of drinking with the boys from work - too bad those days will never really be as frequent as they once were

* getting paged in to work up on organ donor

You know, I really really like my life. a child will be a wonderful addition - one I have worked very hard for - but all in all my life rocks. So much depends on my job though. I love my job. Thankfully even if I am out 6 months a replacement takes at least 1.5 years to train - so not worth it :p. I love how it feels to work a 24 hour shift giving out organs - I love the over time and double time.

* I LOVE my hubby is going to make cookies right now

* Autumn - my favorite season ever. The crispness of the air. Pumpkin Spice lattes. Early Darkness (yes, I actually enjoy this!).

Calculated Risks

Well, I guess I have more time to blog now since the bed rest order is official. Hopefully, I have months and months on my ass! Well, I have been meaning to post for a while because I know some people have wondered whether I decided to go forward with the dreaded...

AMNIO....

Well, the recap - with added comentary:

My first trimester screening results were:

NT= 2.0 mm

PAPP-A = 1.31 MoM (multiples of mean - this means I have 1.3 times the average amount of PAPP-A or 133%)

HgC = 1.61 MoM

maternal age of 28, overweight and caucasian gives me a first trimester screening result of 1:1400 for a child with Down Syndrome.

Relief kicked in. Would I terminate a DS pregnancy - pretty sure the answer is yes. I know this may seem awful, but the hubby and I do not have what it takes to raise a child with severe disability. We are not very financially stable. We would need one of us to be a full time caregiver. We would have a life of worry about how our child would live without us. If money was more stable and we could get all the help we needed - I guess then we would have a different outlook on things.

Now fast forward to the second trimester:

Sprout has an EIF (echogenic intracardiac focus) on ultrasound. This is a soft marker for Downs - meaning it is seen more commonly in babies with DS than "normal" babies. I think the percentages were something along the lines of 10-20 % of Down Syndrome babies have EIF and 5-8% of "normal " babies have one. I read up on a lot of opinions on EIFs. Some doctors feel they are VERY wea soft markers and DO NOT recommend amnio at all for the isolated finding of an EIF. Astrailia doesn't even consder EIFs soft amrkers anymore.

Anyway, I went and met with a genetic counsellor (and grilled my best friend since she is one!) - and this is what I came away with.

My odds of down syndrome are now 1:700. Some studies I read would actually increase me to closer to 1:466. Both genetic counsellors said they do not agree with this. So my result is 1:700.

Normally children with Down Syndrome have high levels of HgC (which mine are approaching high but not quite there) and low levels of PAPP-A (which mine are high!).

Bottom line for me was the risk for the amnio is 1:400 to miscarry. This risk is almost twice as high as Sprout having Down Syndrome. Vincent had an EIF - and he was chromosomally normal. A 1:400 chance of miscarry - just because I needed to know , it's worth it to me.

Especially facing the other odds. Now don't quote me on these numbers specifically! From what I have been told and researched :

I have a 60% chance of PE re-occurance

I have a 20% chance it will strike early like with Vincent and I will have another loss, I have a 20% chance I will hold off a while longer and then Sprouts chance of disability gets slightly lower every week. 20% chance it comes out toward the end and I get a take home healthy baby.

Let me tell you - the odds of PE striking again are a hell of alot more scary than a child with Down Syndrome. The odds my baby won't make it home are greater than my risk for DS. The odds my baby would have a severe disability is scarier than DS to me.

Either way, the hubby and I have made some choices. No to the amnio. If our son has down syndrome - we will do the best we can to give him a good life. If my son doesn't survive this pregnancy - at least we gave it our all. If my son has a severe disability due to prematurity - we will love him all the same and try to make life as good as we can for him.

With all the odds we are facing - 1:700 doesn't sound too scary. 1:400 for something we place upon ourselves does. We wouldn't be able to get over losing our son due to an amnio. At least not with the risks as they currently stand.