Bump in the Rump (and BPP #4)

Thursday was Baby G2's fourth Biophysical Profile and Non-Stress test. They also did a second set of growth measurements. He passed everything with flying colors--again. In fact, he's currently at the 79th percentile of growth, up from the 64th at our last growth scan at 32 weeks. There is a large margin of error when measuring growth by ultrasound at this point in a pregnancy, but at minimum, we are assured that the little guy is not experiencing any growth restriction due to his wonky umbilical cord. I also realized I may have to kiss my hopes of an 8 lb. baby goodbye and come to terms with the idea that pushing out a second nine-pounder could well be in my future. We joked that maybe instead of monitoring for growth restriction, we should be making sure he doesn't get too massive.

Thursday was also supposed to be my the first meeting of my final class at Augsburg. I raced from the clinic to Lydia's school, picked her up, brought her home for a snack, and then loaded her in the car again. (Robin was not able to get home in time, so our plan was to meet at Augsburg and hand her off so that I could get to class.) Note, I said "supposed to be." As we were driving down Lyndale and about to merge onto Interstate 94, I felt a sudden jolt. We were not moving due to bumper-to-bumper traffic, and I was caught pretty off-guard; Lydia was also very confused as to what had happened. The man driving the pick-up truck behind us rolled by and pulled into a parking lot, and I got out. He immediately began blaming the incident on the person behind him--the cars lights weren't on--spewing profanity and racial slurs (because obviously the person's lights weren't on because of their ethnicity and obviously, he rear-ended me because there was a car behind him without headlights, and obviously, the presence of a three-year-old warrants excessive use of every potentially offensive word known to human-kind) and at no point apologizing or asking if I was okay, despite the fact that I am visibly pregnant and had a three year old in the car. I could tell right away that the car was fine and Lydia was fine, and I got on my way as quickly as possible. Lydia was very upset that the person hadn't followed driving directions; "You're not supposed to hit a car with another car!!!" She also later told Robin her hip hurt because "car accidents make your body hurt."

I called the clinic immediately, hoping they would say, "Just monitor movement and make sure you're not experiencing contractions or leaking fluid," but to my dismay, they asked that I come in. Commence four more hours of non-stress testing (and obviously, missing my first class meeting). (Conversations with my midwife and knowledge of fellow mamas' previous experience with similar protocol definitely made me feel like complying with their recommendations was the way to go.) Baby was moving all over the place, putting on his best NST performance ever. His heartrate appeared on the monitor like a roller-coaster track.

I was more interested (and a little caught off-guard) by contractions that I wasn't feeling. The midwife asked if I could feel them and didn't seem too concerned (and I noticed that when I dozed off they stopped immediately, so I'm wondering if they had more to do with my fatigue and stress than anything.) Moreso, I'm realizing that the baby might actually come before February 19 (or after--here's hoping). Thus, Robin was left at our house with a very strong request to actually finish the crib he is building, and I made a Target run to pick up things we will definitely need. Project for tomorrow will be to pack a hospital bag. I'm not term for another week and a half, and the Forty Week mark is still a month away, but at least to ward off Murphy's Law, we're going to try to be a little more action-ready.

I took the next morning off because I was fairly confident that a 5:30 wake-up time following my one-in-the-morning bedtime wouldn't be such a great mix and would mean that my students would be better off with a sub than me, and by the end of yesterday, any achiness and tension in my back and neck had mostly subsided. Now I'm just left hyper-sensitive of any tightening in my belly after watching my uterine activity for 240 glorious minutes.

BPP #3 plus a Birth Plan!

On Thursday I kept my usual date with the HealthPartners midwives and went in for our third Biophysical Profile and Non-Stress Test. Baby G2 set a record, scoring an 8/8 on his BPP in 5 minutes and whipping through the Non-Stress Test with no problems. I have learned to ask for iced apple juice before even starting the NST, and this seems to get him moving more than quickly, resulting in a great NST reading immediately; I recorded thirty movements in 30 minutes and Baby G2 gave us an ample amount of heart rate accelerations--the thing they look for on an NST. I don't remember Lydia ever being as active as this baby in utero. What does this mean for his personality once in the outside world?!?! Lydia keeps us on the go as it is!

The other substantial part of this appointment involved talking with the midwife about my hopes for birthing. I was very nervous about this conversation, as I'd gotten the impression that the Single Umbilical Artery would be cause for continuous monitoring throughout labor and would require us to go in to the hospital earlier than I would like. I'd done lots of research and had only found one article indicating that SUA automatically warrants these things, so I was prepared to ask lots of questions and request some compomise. To my pleasant surprise, I had misunderstood their prescriptions for my labor. It seems as though I'll be monitored somewhat more frequently than a patient without any diagnosed anomalies, but they are not automatically planning on having me be continuously monitored. I also was mistaken in their suggestions for when to come to the hospital; they're asking me to arrive at the same time anyone else would. (We did discuss my history of fast labor and delivery, so keeping that in mind, we will probably err on the side of caution within their suggestions.) I had originally hoped for a water birth this go-round, but that has been ruled out due to the SUA. The rules, restrictions, and qualifications for hospital water births are quite strict, I've learned. I was comforted in this conversation, though, learning that I should have access to the shower should everything progress normally; I had been worried that even the shower would be off-limits for more than teeny stints of time, and my worries were thankfully unfounded. All of these things are very important to me in my hopes to birth this baby with minimal medical interventions or medication as I did Lydia. (She was born roughly an hour after arriving at the hospital, and I had no interventions or pain medication. It was the single most empowering experience of my life, and you can read about it here.) All-in-all, I'm feeling as if my midwives (whom I trust greatly) are treating my labor as if it will go normally and smoothly--exactly the reason I chose midwives in the first place. I left feeling confident and calm.

I did talk to the midwife about actually writing down a birth plan and have decided to do so. I had nothing really written with Lydia, though I had conversations with both our doula and my OB in Austin. Because I was at the hospital for so little time before delivering Lydia, any communication about this birth plan didn't happen. Fortunately, most of what I would have asked for happened, but this time, we'll likely be at the hospital before I'm 10 cm dilated--hopefully. In writing, I am borrowing heavily from the birth plan of a high school friend as well as the book Natural Hospital Birth by Cynthia Gabriel. (I highly recommend it to anyone hoping for a drug-free birth in a hospital.) Nothing too detailed--just basic information and wishes and probably 2/3 of a page at most.

Three down, six-ish to go. All in all, a good visit!

BPP #2 and a Sneak Peak

We had Biophysical Profile (BPP) and Non-Stress Test (NST) #2 today, and Baby G2 again passed with flying colors--a perfect 10/10. We again had to work to get him moving during the NST, even though I had loaded up with a coffee beforehand. Once I got some cold liquid in me, he did his thing quickly. One nurse commented, "This seems to be a pattern..." and when , true to form, I worriedly asked the midwife if the baby's not-so-immediate performance was an indicator of anything problematic, she said, "Oh, no! Sometimes we'll have people hooked up to these for two hours!" The problem isn't that his heartrate doesn't accelerate in response to his movements, it's that he seems to have a party during the BPP and then just want to hang out during the NST. (An NST looks for baby's heart rate to accel in response to movements or contractions at least twice during 20 minute period.)

In other news, Baby is still head down and today, we got the bonus of a 4D Ultrasound pic. He sailed through the BPP ultrasound quickly, and turns out this is what you get to do if there's extra time and the baby cooperates! I've always thought 4D ultrasounds were kind of cheating, and I still don't think I would pay out of pocket for one (apparently some people will elect to have them done and pay out of pocket around 26 weeks just for the great pictures), BUT something about this image helped me put back in perspective that all of these extra appointments and labor and everything is for a baby that will be ours before too long. Robin and I both agree that he looks a lot like Lydia looked as a baby. Lydia favored Robin a lot as an infant and slowly came to look more like me or at least more like a blend of the two of us as she hit three or so months. This baby definitely has the Ganser nose while we're pretty sure Lydia has mine, but there's something about those cheeks that shows the two are siblings, especially considering Baby has seven-ish more weeks to pack on more chub.

Baby G2 at 33 Weeks, 2 Days

Lydia at 10 days old

Baby's First A

As I mentioned in an earlier post, Baby G2 decided earlier on he didn't want to blend in with the crowd, so rather than grow a nice, normal two-artery umbilical cord, he decided he only needed one. Maybe he was trying to be thrifty, or just sleek and chic. Anyway, this anomaly, known as Single Umbilical Artery, or SUA, is the last remaining leftover from our September scare.

Yesterday, we began weekly monitoring appointments that will continue until Baby's delivery: a biophysical profile and a non-stress test. Yesterday's appointment also included a growth scan, but I'm under the impression that the growth scan won't happen weekly. The biggest risk with SUA is interuterine growth restriction--the baby doesn't get enough nutrients through the one artery and can't grow enough. Also, with one artery, there isn't the same wiggle room should something in the umbilical cord become comprised. With this said, everyone I know in the medical field has assured me that SUA is generally not a big deal. In fact, yesterday as the nurse was getting the non-stress test going, she asked what exactly prompted this extra monitoring, and when I told her SUA, she said, "Oh. That's it." While anything abnormal causes stress and anxiety for me, the message we've constantly received is that while the doctors want to make sure everything is okay, everything will be okay.

As far as the monitoring yesterday, Baby G2 passed with flying colors. He is measuring at 4 lbs. 11 ozs, or the 64th percentile--about 5 ozs. less than Lydia was at this point, though there is a margin of error with ultrasound growth measurements. No growth restriction. (For those that weren't around or don't remember, Lydia was monitored for the opposite problem; she was huge.)

Biophysical profiles are ultrasounds that assess fetal movement, muscle tone, amniotic breathing, and amniotic fluid paired with a non-stress test. Baby scored 8 out of 8 on the ultrasound portion and did his thing on the non-stress test, though I needed to down some apple juice in the middle to get him moving--seems he tuckered himself out kicking away during the ultrasound and wanted to lay back and relax during the non-stress test, not giving them the movements and, more importantly, heart rate accelerations, they wanted to see. Once I got a little sugar in my bloodstream, he got moving and things didn't take too long. Biophysical profiles end in a score out of 10, and Baby scored 100%--his first A.

I am not thrilled that this will be a weekly event until Baby's debut, but after going through one appointment, I have less anxiety about the 8 or so to come. I am going to take a fellow mama's advice and listen to Hypnobirthing meditation CDs during the next appointment; I think that might ease my peace of mind while waiting for the ultrasound tech and nurses to count all of the things they are looking for. For the first appointment, I wanted to be able to listen and ask questions, but in the future, I think keeping anxiety at bay during the two hours at the clinic might be more important; they'll tell me what I need to know.

One down. Eight to go.

Panic City: An Update

First of all, the amazing support I received after my last post was humbling. I feel so grateful to have an amazing network of people in my life: family members, coworkers, high school classmates (Laura and Andrea!), and friends from college and beyond contacted me to affirm my feelings, to say they'd been in similar situations, and shared what they did to address the fear that comes with a pregnancy that isn't textbook. For me, one big take-away was that trying to deal with my pregnancy-related anxiety on my own is not productive and not necessary. Thank you for helping me feel supported, understood, and for sharing resources.

Yesterday, I went in to see my midwife. I shared with her my anxiety and what's been going on inside my head. I asked her, again, to tell me about her experiences with single umbilical arteries (SUA). She said, "I see them all the time." I asked her how frequently they're a problem. She said, "I've never seen one become a problem." I heard the exact same thing from a friend who's a sonographer (Susan!), so my up-til-now irrational mind is beginning to actually process and trust this information, which feels like progress. I've committed to NOT going online about SUA anymore; I know what there is to be learned online, and it doesn't help my fears.

We then talked about plans to manage anxiety from here on out. I shared with her the ideas that had been shared with me, and we determined that the biggest first step for me will be increasing my circle of support, especially in regards to pregnancy. I'm going to begin my search for a doula this week and will begin going to prenatal yoga. I'm also going to invest in the Hypnobabies materials to simultaneously prepare for the drug-free delivery I'm hoping for and reframe my thoughts on pregnancy. If these things don't seem to help, the next step would be a counselor who specializes in medical anxiety, and finally, anti-anxiety meds. In general, the conversation was wonderful because 1.) my care-takers now know that I'm struggling with this, 2.) I know they take my feelings seriously, and 3.) I have their help in finding resources.

In talking with coworkers at conferences tonight, I was reaffirmed in the value of sharing my feelings; upon receiving the very first Facebook messages and texts in response to my last post, I instantly began feeling less frantic. Thank you to all who read, responded, and listened. I know that I will probably deal with this anxiety for the remainder of this pregnancy, but I already feel more equipped to move forward without the panicked spinning that I've been doing for the past few weeks.

Bundle of...

a.) joy
b.) nerves
c.) both

C would be most accurate.

Baby #2 is due in February--February 19, to be exact. Unlike with Lydia, we kept this news quiet, not announcing to our parents until the first trimester was nearly over. We wanted Lydia to be the one to share, and we didn't want to share with her until we had passed the window when miscarriages are most common. She did indeed share the news, announcing to both sets of grandparents, "Mommy has a baby in her tummy and I'm going to be a big sister!"

As I've blogged before, my biggest fear with Lydia was whether or not I would love her--would love being a mom. That fear quickly vanished, and Lydia is definitely loved, not just by me but by many. This round, I am in a different place, am a few years older. This time, my constant fear has been that something would go physically wrong. I waited on pins and needles to hear a heartbeat, to receive clear first trimester and quad screens, and when all of that happened, I told myself it was time to relax and just be excited about the baby that will join us in February. I knew my anxiety hadn't been normal.

And then...

...a lot happened. A huge bleed at 18 weeks, a diagnosis of placenta previa, a hospital stay due to bleeding and tightening of the belly that presented as possible preterm labor, and an ultrasound that showed three soft markers for chromosomal disorders. Two weeks followed, and as we waited on amniocentesis results, a Level II ultrasound, and I spent a week on bedrest followed by a week of minimal activity at work and home, every step forward I had made with pregnancy-related anxiety vanished. At the ultrasound the morning of the bleed, the tech asked if we wanted to know the sex of the baby, and because Robin wasn't there, I asked her to print the photos and put them in an envelope to be opened with Robin later. This happened before news of things not "normal" beyond the placenta previa, and the envelope stayed sealed in my purse for two weeks as we waited on ultrasounds and test results. So much felt in question that I didn't feel like that envelope could be opened with excitement, and so it stayed closed until we had several questions answered. I felt like all of my anxiety and fear had been some sort of premonition--that my feeling that something would go wrong had been confirmed.

Those with whom I spent time during that week will attest to the train wreck of emotions that I was. Emails were sent out with vague information, and we were on the receiving end of an amazing amount of kindness and goodwill, not to mention prayers and positive thoughts. The babysitting, food deliveries, and kind words went miles.

Preliminary amnio results came back "great," followed by a totally normal complete report, received the morning of a Level II ultrasound that showed a healthy baby. Even more exciting (and surprising) was the placenta that, two weeks previous, had completely covered my cervix had now cleared the cervical opening by 3 cm. I no longer have placenta previa! The one remaining anomaly--the one that we knew would most likely not be rediagnosed--is a single umbilical artery. (Most umbilical cords have two arteries; this baby has one. This condition can be associated with poor growth in utero and requires extra monitoring to insure that the baby is receiving adequate nutrition, though our baby is currently measuring right on track.) In happy disbelief, we made calls to our parents and headed to lunch where we finally opened the envelope that told us this baby was a boy. We made the obligatory penis jokes, celebrated that so much of the fear of the past two weeks was over, and went on with our day.

Now, I can't seem to kick the fear. Everything triggers panic: the news that the umbilical cord anomaly will require weekly monitoring after 32 weeks and the perinatalogist had suggested extensive monitoring when in labor (despite assurance from nearly EVERYONE I know in the medical community that this is rarely an issue), the words "high risk" coming out of my midwife's mouth (even though I know that anything not completely normal in a pregnancy can throw someone into the "high risk" category), little twinges and back pain (that come with most pregnancies), any other sign that something might possibly be wrong (even though everything "wrong" is either no longer an issue or in most cases, doesn't pose a problem).

This baby is so wanted. Since Lydia was born, we wanted a second, 3-4 years after her. This baby is due exactly three weeks before her 4th birthday. His name was picked out before he was a bundle of cells. We have a nursery color scheme, and a plan for Robin to build his crib is in place. If I wasn't so invested in this child, I don't think I would be emotionally capable of such panic. We have always planned on stopping at two children, so this pregnancy will be the last one, and here I am, so nervous I'm having a hard time enjoying myself.


I do intend to talk to my midwives about this. This anxiety has reached a level that does not feel like me, does not feel rational, and does not feel healthy--for me, Baby G, Robin, or Lydia.

So here's my request: if you're the praying type, please pray for peace for me and health for our little one-artery-cord baby. If you're the positive energy/thoughts type, send it our way. If, like me, you've struggled with anxiety associated with pregnancy or medical situations, let me know. I feel like a crazy person, and I'd love to hear 1.) that I'm not alone and 2.) what you've done to address your medicine-related anxiety. We have 18 weeks to go, and as currently, my anxiety frequently overrides my excitement, something's gotta shift.

Just Call Me M.D.

Lydia has had a cough for a week or so along with a stuffy nose. She will cough really violently and then gag a little bit. It's not her most becoming behavior.

On Saturday evening, I felt like it was getting worse, so I called our MedLink line to talk to doctor, so I would know what to watch out for and at what point we should be concerned. They patched us through to a nurse, who asked us to check Lydia's respiratory rate--how many breaths she was taking in a minute. She told us that 20-25 was normal, and if she was above 35 breaths per minute, we should take her to the Emergency Room. She wasn't at 35, so she went to bed and slept well.

On Sunday, she was still coughing, and after talking to the nurse, I was checking her respiratory rate and found it to be in the high 30s and low 40s. Granted she had been playing and was a bit worked up, so I called the MedLink line back, hoping to get a different person on the phone. I have gotten sketchy advice from a nurse over the phone once before and was able to call back and talk to a doctor, so I was hopeful that I could get some more clear, less extreme advice.

No luck. The same nurse gave me the same information, basically telling me that we needed to take Lydia in to Dell Children's ER. After looking in our handy copy of Baby 411 (only the best baby resource book ever), I started to doubt her advice. According to Baby 411, a normal respiratory rate for a child between 2 and 12 months old is 24-38. Lydia was showing no signs of being uncomfortable or a struggle to breathe. She was smiling and playing, but all I could hear was the nurse on the phone: "RSV is going around, RSV is going around, RSV is going around." (My one real freak-out during this whole thing was when I was trying to convey all of this to Robin while looking for information about respiratory rates and signs of RSV on the computer. He asked me what RSV was. Big mistake. "RSV?!?! Haven't you read the books?!?! Why am I explaining this to you? You can read them, too!) I was under duress. Consider this my public apology to Robin.

I called the person I always do when I just don't know what to do with Lydia--my doula, Kristin. She affirmed my hesitation of bringing Lydia in to the ER, but didn't have specific advice about normal respiratory rates for a baby her age, so she suggested I call Dell Children's and talk to them over the phone. As she pointed out, they wouldn't want me bringing a perfectly healthy baby in to the ER and using up their time, just like I didn't want to bring Lydia in and expose her to the for-real scary stuff that is in hospitals.

The nurse at Dell Children's seemed a little confused with what I was saying. Granted, I was spewing numbers and may have forgotten to tell her what I was talking about. She was like, "So is your baby showing any other symptoms?" "Ugh, no..." I felt like a bit of a fool. She told me that if Lydia's Respiratory Rate got over 50 breaths a minute to bring her in, but otherwise she was fine.

I was so glad I listened to my hesitation. We brought Lydia in yesterday just to get her checked, and she has a cold. Today she coughed twice. I told Dr. Bell about the nurse and she was incredibly apologetic that we were not put through to a pediatrician. So apologetic that she gave me her personal number to call if we ever are in a similar situation. (She told me she knew we wouldn't abuse it, and this made me feel like a cool, calm, collected mom. I used to search for coolness in record stores, clothing boutiques. Now my mark of cool is the pediatrician giving me her cell phone number to call in case of emergency. What does this mean?) I doubt we will ever have to use the number, but I was pretty amazed that she went that far. I wasn't even upset that we talked to a nurse; I just wanted a not-crazy nurse.

So next question: when do I get my honorary MD? I think I'm doing pretty well so far, right?