So, an interesting weekend. We begin Thursday afternoon, right after I put up my last post. I had awakened Thursday morning with that "I must have slept with my mouth open" dry sore throatiness that usually goes away over the course of a day. I was so focused on Thursday's ultrasound that I didn't think much of it. However, by Thursday night I was in a lot of pain. Mostly on the right side. No fever, no other symptoms. Aha, you say: she has strep throat. (But of course.)
An aside here on medical groups. Since we became very close to our OBs during the pregnancy with D (I did see them daily on their rounds for months, after all) we were hesitant to change doctors when we moved up here to Siberia three weeks after D was born. So, despite the drive, we decided to stay with the practice for any subsequent pregnancies. This means I must also see a primary care physician who participates in the same medical group. I have one I've seen maybe once in three years. It's a 45-minute drive.
Friday morning I am in severe pain and we call my primary care physician (let's call her Dr. Doolittle) and get an appointment that morning. I figured one office visit co-pay, one in-office rapid strep test, one antibiotic prescription and a trip to the pharmacy on the way home and my entire weekend needn't be hellish, right? You can see where this is going.
Dr. Doolittle did a careful exam and decided it was a viral throat infection, localized to one side. She said there were no white spots, no fever... she didn't think it was strep. Apparently my look of absolute disbelief registered on my face since she added, well, it is Friday... so I'll do a swab for a throat culture and write you an antibiotic prescription just in case. But, before you fill it, call me on Sunday for the results of the culture (she said she was on call all weekend and could access the lab results online) and don't start the antibiotic unless it comes back positive. Fine, I said, not wanting to take anything while pregnant unless absolutely necessary. She handed me a prescription for amoxicillin. Skeptically, I asked if this wouldn't cross-react with my penicillin allergy. Oh, no, she assured me.
Two hellish days later, I called Sunday around 10:30 for the lab results. She promptly returned the call to let me know she didn't have the results yet and would call me by 6. No call. The next morning (Monday) I called her office. Oh yes, the receptionist said soothingly (to an admittedly quite irate me), she'd have a nurse call back right away with the results. That call came through today at 10:30, nearly 4 days after the throat culture, and the morning after my first lecture of the summer session. Let me tell you, talking loudly for two hours through a raw throat was just a treat.
Well, you can guess. A "heavy growth of group A Streptococcus" and I should "start antibiotics immediately." No fucking shit, people.
It gets better. I broke all speed limits over to the pharmacy and handed the assistant at the register the prescription, carefully mentioning that I was (a) pregnant and (b) allergic to penicillin, and that I had doubts about my doctor's choice of antibiotic in this case. She consulted the pharmacist, who agreed wholeheartedly and immediately got my doctor on the phone. I left shortly thereafter with Azithromycin, safe for use in pregnancy and for people allergic to penicillin. The pharmacist seemed shocked that any physician would prescribe amoxicillin to someone allergic to penicillin and asked me if I had mentioned the allergy to her. I said I had told not only the woman who checked me in and took my blood pressure, but also asked the doctor outright about her choice of amoxicillin when she handed me the prescription, saying, "And this won't cross-react with my penicillin allergy?" The pharmacist sighed and shook his head. After I mentioned the 4-day wait for the diagnosis he also wondered aloud what kind of doctor's office doesn't offer a rapid strep test to someone presenting with my symptoms. An office about to have one fewer patient, I replied acerbically. I chugged my antibiotic in the parking lot with the last of my morning's forbidden delight, the mocha frappucino.
What do you think? Just change doctors, or dash off an angry letter as well? Am I overreacting? Let me mention that I have been absolutely miserable. I'm normally pretty stoic and this has had me in tears several times. I'm living from dose to dose of Tylenol and specifically mentioned my acute discomfort to Dr. Doolittle in her office Friday and again on the phone Sunday.
In other news, we told my mother-in-law about the pregnancy. We’re out of the closet! Hooray for optimism!
Tuesday, June 19, 2007
Thursday, June 14, 2007
Perfect
Well, today's scan was just about perfect. Our RE clearly didn't have anywhere pressing to be, so we got the full treatment. Heartbeat: nice and fast. Length: measuring 8 weeks 5 days, or 2.1 cm. Yolk sac: still appropriately sized. Arm buds: present and waving. Umbilical cord: nicely visualized. The embryo twitched and wiggled about. We got a bunch of different views.
H took a very deep breath and visibly relaxed. Our RE got H to talk a little about his nervousness and H said he was still feeling especially anxious since a friend of ours recently had a miscarriage at 9 weeks, after seeing a good heartbeat. Our RE calmed H down considerably by telling him that in his experience, you usually have some sign if that's going to happen in a pregnancy as extensively ultrasounded as ours has been. Either the yolk sac is a little too big, or the heart rate is in the normal range but at the low end, or the gestational sac has an odd shape... something is just a tiny bit off. He said with us, everything has been spot on once we got the dates sorted out. He feels very confident that we will safely emerge from the first trimester.
(I know; knocking wood, throwing salt over my shoulder, etc.)
So, our worries have officially been transferred from another first trimester miscarriage, to another second trimester preterm labor fiasco. But that won't be a concern until the baby gets big enough to start putting some pressure on my cervix. Probably 18 or 20 weeks-ish. So, for now, we are starting to unwind a bit. I need to call my OB and get on their schedule. Next Thursday should be our last visit to the RE's office. I can't believe it.
I can also quit the Metformin, cold turkey. I'm frightened of gestational diabetes, but not so much that I'm not grateful to jettison those three pills a day. Progesterone continues for another week and a half or so. And my thyroid still needs to be monitored. The RE office checked it in January-- I had a TSH of 1.2 or something similar. Then they rechecked it after I got my first positive beta for this pregnancy, in May, and it had crept upwards into I believe the low threes. Should have written those numbers down. Anyway, still in the normal range, but climbing. He said to make sure my OB rechecks it fairly early in the second trimester. He'd rather have my TSH at the low end of the normal range because he says it's healthier for the baby. I need to read up on this a bit.
Anyway, it was really great. I have about seventy nine million things I ought to be doing while D takes her nap, so I'd best be off. Time to clean house.
H took a very deep breath and visibly relaxed. Our RE got H to talk a little about his nervousness and H said he was still feeling especially anxious since a friend of ours recently had a miscarriage at 9 weeks, after seeing a good heartbeat. Our RE calmed H down considerably by telling him that in his experience, you usually have some sign if that's going to happen in a pregnancy as extensively ultrasounded as ours has been. Either the yolk sac is a little too big, or the heart rate is in the normal range but at the low end, or the gestational sac has an odd shape... something is just a tiny bit off. He said with us, everything has been spot on once we got the dates sorted out. He feels very confident that we will safely emerge from the first trimester.
(I know; knocking wood, throwing salt over my shoulder, etc.)
So, our worries have officially been transferred from another first trimester miscarriage, to another second trimester preterm labor fiasco. But that won't be a concern until the baby gets big enough to start putting some pressure on my cervix. Probably 18 or 20 weeks-ish. So, for now, we are starting to unwind a bit. I need to call my OB and get on their schedule. Next Thursday should be our last visit to the RE's office. I can't believe it.
I can also quit the Metformin, cold turkey. I'm frightened of gestational diabetes, but not so much that I'm not grateful to jettison those three pills a day. Progesterone continues for another week and a half or so. And my thyroid still needs to be monitored. The RE office checked it in January-- I had a TSH of 1.2 or something similar. Then they rechecked it after I got my first positive beta for this pregnancy, in May, and it had crept upwards into I believe the low threes. Should have written those numbers down. Anyway, still in the normal range, but climbing. He said to make sure my OB rechecks it fairly early in the second trimester. He'd rather have my TSH at the low end of the normal range because he says it's healthier for the baby. I need to read up on this a bit.
Anyway, it was really great. I have about seventy nine million things I ought to be doing while D takes her nap, so I'd best be off. Time to clean house.
Wednesday, June 13, 2007
Ahh, Wednesday.
I feel better today. I'm trying not to freak out about this. Pregnancy symptoms come and go. Who was it that came up with the blue fingernails pregnancy indicator idea? The minute your pregnancy starts going south, your fingernails would turn bright blue. Wouldn't that be nice...
D usually goes to a baby sitter's on Thursdays. This gives me a day to prepare my lectures, do my grading, and more recently, go to the RE for ultrasounds without committing that most serious of faux pas: bringing your toddler into the waiting room of the fertility clinic. I got a call this morning from one of the other moms whose son goes to this baby sitter's. Did you hear about the pinkeye, she said? Yes, pinkeye. Running rampant through the population that goes to this sitter. Now the sitter has it. She was closed today and will be closed again tomorrow. So, now I've got a friend of mine attempting to take her 19 month old and my 20 month old to a local amusement park tomorrow morning while H and I go to the RE for our scan. I have instructions to get out of that office as soon as humanly possible and zoom up the freeway to join them at the park. I REALLY hope nothing goes wrong tomorrow. I hate having anything else planned for later in the day of an ultrasound. I like to protect that time for crippling grief, all the while thinking that if I make the time to sob all afternoon, it won't actually be required. i can't imagine anything worse to do after not seeing a heartbeat than heading out to a Southern California amusement park in June.
Sigh. Pinkeye. Fabulous.
D usually goes to a baby sitter's on Thursdays. This gives me a day to prepare my lectures, do my grading, and more recently, go to the RE for ultrasounds without committing that most serious of faux pas: bringing your toddler into the waiting room of the fertility clinic. I got a call this morning from one of the other moms whose son goes to this baby sitter's. Did you hear about the pinkeye, she said? Yes, pinkeye. Running rampant through the population that goes to this sitter. Now the sitter has it. She was closed today and will be closed again tomorrow. So, now I've got a friend of mine attempting to take her 19 month old and my 20 month old to a local amusement park tomorrow morning while H and I go to the RE for our scan. I have instructions to get out of that office as soon as humanly possible and zoom up the freeway to join them at the park. I REALLY hope nothing goes wrong tomorrow. I hate having anything else planned for later in the day of an ultrasound. I like to protect that time for crippling grief, all the while thinking that if I make the time to sob all afternoon, it won't actually be required. i can't imagine anything worse to do after not seeing a heartbeat than heading out to a Southern California amusement park in June.
Sigh. Pinkeye. Fabulous.
Monday, June 11, 2007
Ugh
I thought I'd dodged this bullet. Constant waves of mild yet thoroughly debilitating nausea. At least it means there's still something going on in the ol' uterus. It's nice to have the reassurance that I am still pregnant.
Why do they call it morning sickness if it lasts all day? And isn't 8 weeks a little late for it to join the party?
Bleh.
Why do they call it morning sickness if it lasts all day? And isn't 8 weeks a little late for it to join the party?
Bleh.
Thursday, June 07, 2007
Starting to Believe
It all went perfectly. Gestational sac, embryo, and yolk sac are all appropriately sized, with a good heart rate. We saw the skull. It's empty (as it should be at this point). Apparently my task for the next 7 days is to grow some brains in there for the embryo. It measures 7 weeks 6 days, plus or minus 3 days. If you go by my last period, I'm 8 weeks tomorrow, if you go by suspected ovulation, then I'm 8 weeks on Sunday. Both within the margin of error.
I'm starting to think this might be okay. At least the first trimester miscarriage thing. I'm not even thinking about second trimester preterm labor stuff. It's just... well, the only other pregnancy I've had that made it this far resulted in my daughter. I guess that was a bigger mental milestone than I thought. My husband, on the other hand, is getting more freaked out the further we get. I think for him, the more real it starts to seem, the more we have to lose. He told me he was really nervous as I sat, pantsless, on the exam table waiting for the PA. The last couple of weeks we have only discussed this pregnancy while at the fertility clinic. The rest of the time it's just not mentioned. This is odd for us; we usually talk about stuff quite a bit. I guess there's just not much to say. It's either going to continue or it's not and there's absolutely nothing we can do either way.
But, for now, all is well.
I'm starting to think this might be okay. At least the first trimester miscarriage thing. I'm not even thinking about second trimester preterm labor stuff. It's just... well, the only other pregnancy I've had that made it this far resulted in my daughter. I guess that was a bigger mental milestone than I thought. My husband, on the other hand, is getting more freaked out the further we get. I think for him, the more real it starts to seem, the more we have to lose. He told me he was really nervous as I sat, pantsless, on the exam table waiting for the PA. The last couple of weeks we have only discussed this pregnancy while at the fertility clinic. The rest of the time it's just not mentioned. This is odd for us; we usually talk about stuff quite a bit. I guess there's just not much to say. It's either going to continue or it's not and there's absolutely nothing we can do either way.
But, for now, all is well.
Wednesday, June 06, 2007
Unwelcome Surprises
Nobody tells you how much bleeding is normal after you give birth. The nurses on the postpartum floor supply you with pads that seem appropriately sized for, oh, a hippopotamus, which gives you a teeny clue. But, every woman is different, blah blah blah. They do warn you that nursing causes your uterus to contract and that you'll probably bleed more while actively breastfeeding.
I spent the majority of my time the first 5 weeks after D was born trying to breastfeed. It did not go well. I had a low supply, my nipples were absolutely trashed, and D didn't use her tongue properly to draw the milk out. Instead she used more of a chewing motion. Fun for everyone. I did discover that nursing her certainly increased the rate of my postpartum bleeding. This was an item of rather minor interest until one afternoon when I was attempting to feed her and felt... well, let's just call it a large clot. I stood up to discover I had bled through my pad, underwear, pants, and done significant damage to the cushion of the armchair I had been sitting in. I set D in her bouncy seat, dashed upstairs (we had been living in our brand new house for about 2 weeks at this time) trying desperately not to drip blood on the new carpet, did a quick cleanup, and put on my oldest, ugliest maternity underpants, and a pair of workout shorts. I went back to get D, checked the new pad, and decided a trip to the emergency room was in order. I called my husband (at least an hour away at work) and a couple of friends, one of whom left work instantly, came to my place, and assumed care of me and D. She dropped me off at the ER and took D to her house to look after her.
H met me in the ER, where I was given an ultrasound and diagnosed with "retained products of conception." The bleeding had stopped, so after talking to my OB, the ER doc on call discharged me and said my OB's office was expecting me first thing the next morning for a D&C. On the drive home, the bleeding resumed. I was attempting to get my OB on the phone, when I apparently passed out from loss of blood and scared about 15 years off my husband's life. He called 911 and the paramedics arrived.
So there I was. 5 weeks postpartum after nearly three months in bed, eating mostly See's Chocolates and Wheat Thins. (Let's just say I was not at my slimmest.) I hadn't showered that day. I was clad in nothing but a breast milk-stained tank top, the aforementioned maternity underpants, and my workout shorts. There was also a fair amount of blood involved. I was untidy.
Well, they scooped me up and brought me back to the hospital, where I was admitted by the same doctor who had sent me home not an hour earlier. Deemed too unstable to be ambulanced down to the hospital where my OB-Gyn group had privileges, I had the D&C done there at about midnight that night by a doctor who heard my history and promptly tried to get me to leave my current group and come to his local practice. I think his pupils actually turned into dollar signs as he looked at me.
D was, at this time, very hungry. She didn't react well to the abrupt transition from bring breastfed (albeit very poorly) to being bottle fed formula, which her stomach kept violently rejecting. It was a long night for everyone. Eventually, though, I was deemed likely to live, discharged, and sent home, where D was very happy to be reunited with my breasts.
Did I mention this all happened on my husband's birthday? Every day I am amazed that he ever recovered enough from all of this to agree to try for another child. Later I learned that he followed the ambulance to the hospital in his car, hoping all the way that the lights and siren would just stay off. As long as they were off he was managing to keep it together. Poor guy.
Anyway, we're braced for tomorrow's ultrasound. 9:30. Let's hope there aren't going to be any unwelcome surprises.
I spent the majority of my time the first 5 weeks after D was born trying to breastfeed. It did not go well. I had a low supply, my nipples were absolutely trashed, and D didn't use her tongue properly to draw the milk out. Instead she used more of a chewing motion. Fun for everyone. I did discover that nursing her certainly increased the rate of my postpartum bleeding. This was an item of rather minor interest until one afternoon when I was attempting to feed her and felt... well, let's just call it a large clot. I stood up to discover I had bled through my pad, underwear, pants, and done significant damage to the cushion of the armchair I had been sitting in. I set D in her bouncy seat, dashed upstairs (we had been living in our brand new house for about 2 weeks at this time) trying desperately not to drip blood on the new carpet, did a quick cleanup, and put on my oldest, ugliest maternity underpants, and a pair of workout shorts. I went back to get D, checked the new pad, and decided a trip to the emergency room was in order. I called my husband (at least an hour away at work) and a couple of friends, one of whom left work instantly, came to my place, and assumed care of me and D. She dropped me off at the ER and took D to her house to look after her.
H met me in the ER, where I was given an ultrasound and diagnosed with "retained products of conception." The bleeding had stopped, so after talking to my OB, the ER doc on call discharged me and said my OB's office was expecting me first thing the next morning for a D&C. On the drive home, the bleeding resumed. I was attempting to get my OB on the phone, when I apparently passed out from loss of blood and scared about 15 years off my husband's life. He called 911 and the paramedics arrived.
So there I was. 5 weeks postpartum after nearly three months in bed, eating mostly See's Chocolates and Wheat Thins. (Let's just say I was not at my slimmest.) I hadn't showered that day. I was clad in nothing but a breast milk-stained tank top, the aforementioned maternity underpants, and my workout shorts. There was also a fair amount of blood involved. I was untidy.
Well, they scooped me up and brought me back to the hospital, where I was admitted by the same doctor who had sent me home not an hour earlier. Deemed too unstable to be ambulanced down to the hospital where my OB-Gyn group had privileges, I had the D&C done there at about midnight that night by a doctor who heard my history and promptly tried to get me to leave my current group and come to his local practice. I think his pupils actually turned into dollar signs as he looked at me.
D was, at this time, very hungry. She didn't react well to the abrupt transition from bring breastfed (albeit very poorly) to being bottle fed formula, which her stomach kept violently rejecting. It was a long night for everyone. Eventually, though, I was deemed likely to live, discharged, and sent home, where D was very happy to be reunited with my breasts.
Did I mention this all happened on my husband's birthday? Every day I am amazed that he ever recovered enough from all of this to agree to try for another child. Later I learned that he followed the ambulance to the hospital in his car, hoping all the way that the lights and siren would just stay off. As long as they were off he was managing to keep it together. Poor guy.
Anyway, we're braced for tomorrow's ultrasound. 9:30. Let's hope there aren't going to be any unwelcome surprises.
Wednesday, May 30, 2007
One-Eighties
When I was pregnant with my daughter, despite having had a miscarriage just prior to her conception, H and I were pretty laid back during the first half of the pregnancy. Once we saw her heartbeat, we really relaxed (ha! just relax!) about the whole thing, and we made a lot of plans and remarks that assumed a good final outcome. Looking back, I can't believe how naive we were, but in our defense, I suppose most people are that way unless they've been through hell during their efforts to build a family.
Anyway, we looked forward to the 20-week ultrasound as a chance to discover her gender, rather than dreading it as a chance to discover what horrible thing was going to happen to us next. And for the most part the ultrasound turned out that way. They told us they were pretty certain she was a girl, we got some nice profile pictures, they measured my cervix as long (greater than 3 cm) and closed, and that was that. The only problem was that she went to sleep partway through the ultrasound and wouldn't move, so the technician wasn't able to get a good shot of all four chambers of her heart. Everything else looked perfect, though, so the technician sent us home.
Dr. Favorite duly reviewed the footage and called to tell us it all looked good, but for completeness' sake she wanted us to return in a week or two for a follow-up to get that last image of the four heart chambers. So we returned. The technician got the shot of the heart, and then she said that since we were there, she'd take another look at my cervix. Once she did, her demeanor changed markedly and she said she'd just hop out of the room for a second to ask the radiologist something.
Well, still being quite naive, H and I weren't too concerned. Eventually she returned and said the radiologist saw a lot of funneling in my cervix (note: this is very, very bad) and wanted me to go home immediately and lay down, and he'd have one of the physicians from my OB group call and tell us what to do next. The technician said she thought they'd have me get a cerclage, or a stitch placed into the cervix, to hold it closed and keep the baby in. For some reason we thought this sounded reasonable and manageable and we didn't freak out. After all, the demonic pregnancy book that we owned included a brief discussion of cerclages, so they couldn't be that big a deal, right? (Note: at 24 weeks I was past the latest point at which they like to place cerclages.)
So, we went home and I called into work (I was teaching two courses that semester) and explained the situation. My lab associate drive down from campus to pick up the exams I was due to give each of my classes that evening, and said they'd found people to cover them, no problem. I assured her that I'd be back in a few days at the most.
A comedy of errors ensued with the OB on call that day, and he didn't get a hold of me until nearly 5 PM. He wasn't overly concerned with the radiologist's opinion that there was severe funneling since it was a radiologist speaking and not an OB, and since I already had a checkup scheduled for the next morning, he told me to take it easy overnight, and then they'd look at my cervix the next morning.
The next day I saw Dr. Favorite, who measured my (now incredibly shortened) cervix, told me to get dressed and sit right there in that chair, and was across the hall in her office on the phone with a perinatologist in about fifteen seconds. To summarize a lot of panic in a few sentences, within minutes I was admitted to the hospital, gowned, IV-ed, and being treated with the most drastic tocolytic (anti-labor) drug they have, which is IV magnesium sulfate. They gave me two injections of the steroid beta methasone over the next 24 hours to hasten the baby's lung development in preparation for a possible premature delivery. This last fact was what really brought it home to us that after 24 weeks and 4 days of pregnancy, I was in active labor, and there was a good chance our daughter was about to be delivered as a micropreemie.
That week was the worst that it got. One of the NICU neonatologists came to my room and had a frank conversation with me about the baby's chances, were she to be born. There was a 50% chance she would die immediately. If she survived, there were horrifyingly high chances that she would have lifelong disabilities as a result of her prematurity, including blindness, paralysis, and cerebral palsy. He gently questioned me about whether we would want the neonatal team to take extreme measures to preserve life at all costs, or if there was a point at which my husband and I would prefer to let her go.
(I should note that the IV magnesium sulfate (aka "mag") I was on at that point works by relaxing the uterus that is, after all, simply a large muscle. It has the rather fortunate side effect of relaxing every other muscle in your body as well, and also made me pretty loopy. If you're going to deal with something like this, doing it while on mag is the way to go. My poor husband had to deal with all of this stone cold sober. Poor lad.)
Anyway, I responded well to the mag. Things stabilized. The perinatologist Dr. Lunatic (another favorite of mine- I like a wild sense of humor) did an ultrasound where he identified a small area of bleeding between the placenta and the inside of the amniotic sac, called a subchorionic haematoma. This, he believed, is what kicked my irritable uterus into active labor. A normal uterus would not have reacted in such an extreme fashion. We waited ten days and eventually weaned me off the mag and onto some oral medications with similar uterus-relaxing properties. I was discharged and sent home, there to remain on strict bed rest, and with instructions to call day or night if I had more than 6 contractions in an hour. After we had to return to the hospital for contraction monitoring three times in a week, and despite additional medications at increased dosages, my cervix shortened even more and I was readmitted to the hospital, put back on the mag, and there I remained for all but the last three days of my pregnancy.
I was sprung from my perinatal prison ten days after an amnio done at 34 weeks showed that the baby's lungs were starting to make some surfactant. So one Saturday morning, we had the ceremonial turning off of the mag. They thought I'd deliver within 24 hours. The next day I was still contracting away, but it didn't seem to be going anywhere. So, at last I was sent home, with strict instructions to return with all possible haste if anything changed, so as to avoid giving birth in the car. Thursday at about 4 AM I woke up in the middle of a painful contraction, and we were off. By the time we got to the hospital, got checked in and onto the labor and delivery floor, I was 7 cm dilated. A couple of hours (and just two pushes) later, we were handed our scrawny little troublemaker. After 11 weeks of bedrest, I had my girl just three days shy of 37 weeks and being considered a full term infant.
-------------------
Today: after a week of thinking I was experiencing miscarriage #3, we saw it. Instead of an empty gestational sac, we have a perfectly round, 4 mm by 4 mm yolk sac, and a little blob of a fetal pole with a flickering heartbeat. I can't believe how quickly everything can change.
Anyway, we looked forward to the 20-week ultrasound as a chance to discover her gender, rather than dreading it as a chance to discover what horrible thing was going to happen to us next. And for the most part the ultrasound turned out that way. They told us they were pretty certain she was a girl, we got some nice profile pictures, they measured my cervix as long (greater than 3 cm) and closed, and that was that. The only problem was that she went to sleep partway through the ultrasound and wouldn't move, so the technician wasn't able to get a good shot of all four chambers of her heart. Everything else looked perfect, though, so the technician sent us home.
Dr. Favorite duly reviewed the footage and called to tell us it all looked good, but for completeness' sake she wanted us to return in a week or two for a follow-up to get that last image of the four heart chambers. So we returned. The technician got the shot of the heart, and then she said that since we were there, she'd take another look at my cervix. Once she did, her demeanor changed markedly and she said she'd just hop out of the room for a second to ask the radiologist something.
Well, still being quite naive, H and I weren't too concerned. Eventually she returned and said the radiologist saw a lot of funneling in my cervix (note: this is very, very bad) and wanted me to go home immediately and lay down, and he'd have one of the physicians from my OB group call and tell us what to do next. The technician said she thought they'd have me get a cerclage, or a stitch placed into the cervix, to hold it closed and keep the baby in. For some reason we thought this sounded reasonable and manageable and we didn't freak out. After all, the demonic pregnancy book that we owned included a brief discussion of cerclages, so they couldn't be that big a deal, right? (Note: at 24 weeks I was past the latest point at which they like to place cerclages.)
So, we went home and I called into work (I was teaching two courses that semester) and explained the situation. My lab associate drive down from campus to pick up the exams I was due to give each of my classes that evening, and said they'd found people to cover them, no problem. I assured her that I'd be back in a few days at the most.
A comedy of errors ensued with the OB on call that day, and he didn't get a hold of me until nearly 5 PM. He wasn't overly concerned with the radiologist's opinion that there was severe funneling since it was a radiologist speaking and not an OB, and since I already had a checkup scheduled for the next morning, he told me to take it easy overnight, and then they'd look at my cervix the next morning.
The next day I saw Dr. Favorite, who measured my (now incredibly shortened) cervix, told me to get dressed and sit right there in that chair, and was across the hall in her office on the phone with a perinatologist in about fifteen seconds. To summarize a lot of panic in a few sentences, within minutes I was admitted to the hospital, gowned, IV-ed, and being treated with the most drastic tocolytic (anti-labor) drug they have, which is IV magnesium sulfate. They gave me two injections of the steroid beta methasone over the next 24 hours to hasten the baby's lung development in preparation for a possible premature delivery. This last fact was what really brought it home to us that after 24 weeks and 4 days of pregnancy, I was in active labor, and there was a good chance our daughter was about to be delivered as a micropreemie.
That week was the worst that it got. One of the NICU neonatologists came to my room and had a frank conversation with me about the baby's chances, were she to be born. There was a 50% chance she would die immediately. If she survived, there were horrifyingly high chances that she would have lifelong disabilities as a result of her prematurity, including blindness, paralysis, and cerebral palsy. He gently questioned me about whether we would want the neonatal team to take extreme measures to preserve life at all costs, or if there was a point at which my husband and I would prefer to let her go.
(I should note that the IV magnesium sulfate (aka "mag") I was on at that point works by relaxing the uterus that is, after all, simply a large muscle. It has the rather fortunate side effect of relaxing every other muscle in your body as well, and also made me pretty loopy. If you're going to deal with something like this, doing it while on mag is the way to go. My poor husband had to deal with all of this stone cold sober. Poor lad.)
Anyway, I responded well to the mag. Things stabilized. The perinatologist Dr. Lunatic (another favorite of mine- I like a wild sense of humor) did an ultrasound where he identified a small area of bleeding between the placenta and the inside of the amniotic sac, called a subchorionic haematoma. This, he believed, is what kicked my irritable uterus into active labor. A normal uterus would not have reacted in such an extreme fashion. We waited ten days and eventually weaned me off the mag and onto some oral medications with similar uterus-relaxing properties. I was discharged and sent home, there to remain on strict bed rest, and with instructions to call day or night if I had more than 6 contractions in an hour. After we had to return to the hospital for contraction monitoring three times in a week, and despite additional medications at increased dosages, my cervix shortened even more and I was readmitted to the hospital, put back on the mag, and there I remained for all but the last three days of my pregnancy.
I was sprung from my perinatal prison ten days after an amnio done at 34 weeks showed that the baby's lungs were starting to make some surfactant. So one Saturday morning, we had the ceremonial turning off of the mag. They thought I'd deliver within 24 hours. The next day I was still contracting away, but it didn't seem to be going anywhere. So, at last I was sent home, with strict instructions to return with all possible haste if anything changed, so as to avoid giving birth in the car. Thursday at about 4 AM I woke up in the middle of a painful contraction, and we were off. By the time we got to the hospital, got checked in and onto the labor and delivery floor, I was 7 cm dilated. A couple of hours (and just two pushes) later, we were handed our scrawny little troublemaker. After 11 weeks of bedrest, I had my girl just three days shy of 37 weeks and being considered a full term infant.
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Today: after a week of thinking I was experiencing miscarriage #3, we saw it. Instead of an empty gestational sac, we have a perfectly round, 4 mm by 4 mm yolk sac, and a little blob of a fetal pole with a flickering heartbeat. I can't believe how quickly everything can change.
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