herveryown

Bridges

Going into preterm labor prior to viability is a bit like having a rickety rope bridge start to unravel when you're over the deepest part of the ravine.  You can't go back and you can't run fast enough to reach the other side safely, so you just cling to the ropes and keep inching along, hoping everything will hold together until you're close enough to make a leap at solid ground.

Today is 34w0d, or thirtythree weeks completed.  We've finally gotten to the point where the doctors are asking about future Birth Plans instead of scrambling to come up with Don't Give Birth Plans, which is kind of nice (in the same way that winning the kajillion dollar lottery would be 'somewhat pleasant').

The problem, and believe me, this feels like the most absurd kind of "Dahling, should we have Dom Perignon or Cristal with dinner tonight?" kind of problem to have, is that I no longer have any kind of solidified birth plan in mind.  Before shit started going wrong, I had a plan.  I wanted a crunchy granola low intervention birth, not because I necessarily wanted to Experience Bla or Feel Empowered By Whatnot, but because major abdominal surgery and having my junk sliced and diced sounded somewhat less than optimal.  Come to think of it, it still doesn't sound that hot.

After shit went wrong, my plan abruptly went from "...and mood lighting" to "Everybody Gets Out, Nobody Gets Dead."

I would still like to avoid a C-section, mostly because I don't think I can handle racking up much more recuperation time in bed without permanently crossing the line and starting to babble incoherently about yellow wallpaper.  After eleven weeks on bed rest (so far), I'd like to go for a goddamned walk sometime after delivery, you know? 

Sam, ever the wordsmith, said "You know what's going to happen if you don't have to have a c-section?  Right after you give birth, the cops are going to be getting APBs to be on the lookout for a tiny naked woman who escaped from The Big Fancy Perinatologist Place and is now running around yelling 'Whoopee!  I'm freeeeeee, I'm freeeeeeee!'  Be advised that she has Totally Lost Her Shit and is unarmed, but extremely squirrelly."  I'd argue with him on this, but after eleven damned weeks, running around naked (or being outside at all) sounds pretty darned tempting.  If anyone from Seattle's Finest is reading this, all I can say is when you tackle me, please be gentle. 

The good news is that The Big Fancy Perinatologist Place (a facility with cutting edge studies and modern technology falling out of its ass) has a twin C-section rate that is about half that of Evil Insurance Company, Inc.'s (a facility that frequently brags about its crunchy granola approach to pregnancy), so at least I'm in the right place.  While we're on the subject, Millbarge is also in the right place, which is 'still enthusiastically headbutting my cervix'.  Fitz-Hume remains breech, but The Big Fancy Perinatologist Place is perfectly happy to just reach up and drag Fitz-Hume out by the feet if need be.  I think they're perfectly happy about this approach because they're not the ones who are going to end up with a doctor's arm up their junk practically ALL THE WAY UP TO THE ELBOW, but whatever. 

We do kinda sorta have a vague tentative plan in place, made jointly by yours truly and a small armada of doctors who not only know my complete medical history, but also attend twin births and perform breech extractions frequently enough to consider them no big deal.   We're still not counting chickens over here or considering any plans iron clad, and I can't really claim to be excited about the whole process, mostly because hey, did I mention that whole ALL THE WAY UP TO THE ELBOW, OH MY GOD thing?

I'm still resting somewhat comfortably at home, and I feel like we're all in good hands with TBFPP.

Incidentally, I love comments more than fun sized butterfingers (which of course I can't have right now because of the stupid Gestational Diabetes), but please keep in mind that I have already heard my quota of Horrible Birth Stories and read endless debates on The Best Way To Give Birth, so if you're considering offering up any tales of dread about the potential error of my ways, everything that can possibly go wrong during birth, or how I am already totally screwing up Fitz-Hume and Millbarge through my deficient parenting skills, please take a deep breath and refrain. 

Two Minds, Two Fetuses

32 weeks, 6 days, 69 days on bed rest.

Every time I've gone into the hospital, they've said "Small goals.  First let's see if we can stop the contractions today.  If the contractions stop, let's see if we can get another day, or another two days.  If we get through a few more days, let's see what happens next week."  On bad uterus days (like bad hair days, but with far more disturbing explody potential), the goals are even smaller: "If I can get through the next fifteen minutes without having another goddamned contraction, I don't have to call Labor and Delivery for the brazillionth time."

Because of this narrow focus, it should come as no surprise that I tend to concentrate on minutiae and lean towards navel gazing (or would if my navel was still sufficiently north of the equator to remain visible).  The big picture tends to creep up on me every so often and startle the everloving crap out of me.

Ten weeks is a long time on bed rest.  I say this as a woman tremendously grateful for every single day that Fitz-Hume and Millbarge have stayed inside, but also as a woman whose muscles have atrophied, who misses fresh air and sunshine (okay, it's Seattle; I even miss the clouds at this point), a woman who comes perilously close to Losing Her Shit on a daily basis due to extreme cabin fever.  Long term bed rest sucks a truly indescribable amount of ass, but at the same time you cherish every moment, because at the beginning, middle and end of the day, all you want is more of it.

I am rapidly approaching a date where The Big Fancy Perinatologist Place will no longer even attempt to stop labor if it starts up again, which, uh, holy crap.  I've heard women wax poetic about gestation, about how they miss pregnancy because they cherished the feeling of keeping their babies safe inside them.  Since I have never had any degree of confidence in my body as a magical safe haven, I must confess that I will be more than a little bit relieved if Fitz-Hume and Millbarge manage to make it out of me alive in a timely manner and can be safely delivered into the hands of a qualified NICU staff.  You know, people who actually know what they're doing.  At the same time, I would love to keep them in there as long as they care to stay (for fairly obvious reasons).

I've never managed to get past the apprehension.  A family member recently said (regarding the as yet unknown sexes) "Oh, I can't wait to see what they are!"  I had to bite my lip to keep from saying "I can't wait to see if they live!"

I can't wait, but I can wait.

It Doesn't Work, Except When It Kind Of Does

Hmm.

Although I believe my doctors are telling the truth when they tell me that bed rest has no proven scientific basis, I am forced to admit that it does seem to kind of be working in my case.  Maybe.  Possibly.  I don't know.

Here's what I do know:

1. I have been on bed rest for 9 weeks (the length of a house cat's entire pregnancy).
2. I am still pregnant at 31w6d (32w on Thursday).
3. Every decrease in cervical length has been accompanied by unpleasant clusters of contractions (as opposed to pleasant clusters of contractions, which I suspect do not exsist).
4. Generally, the more immobile I am, the fewer contractions I have.
5. My cervix has been mostly stable for quite a while now.
6. The cat is thoroughly sick of me.

Today's ultrasound had somewhat mixed results.  Fitz-Hume and Millbarge's growth has gone from being 'right on target' to being 'slightly small, but not alarmingly so'.  Millbarge is both head down and firmly wedged in my pelvis, making future flip flopping extremely unlikely.  Fitz-Hume has decided that a standard placenta just isn't fancy enough and has grown this nifty little extra semi-attached placental doohickey off to one side. 

Fitz-Hume and Millbarge both have a significant quantity of hair.  This prompted me to turn to Sam in the middle of the ultrasound, tenderly take his hand and say "Samuel, if they have that much hair, there's just no freaking way they're yours." 

"Bummer."

Sweet

One of the things that I haven't been talking about during this pregnancy is Gestational Diabetes, mostly because I have a sneaking suspicion that it is one of the most boring conditions known to (wo)mankind.  I couldn't think of a single way to spin it to make it entertaining (that hadn't already been covered by Julie), nor did I have much to say about it other than "This sucks," so I decided to just skip it.  After all, I found the experience tremendously dull already; I had no desire to relive it online.

When Dr. Twelve ordered a one hour Glucose Tolerance Test at my first pants-on appointment, I wasn't worried about it.  I drank the orange soda.  I got poked an hour later.  I went home.  No big deal.  When the nurse called and asked which pharmacy I wanted my blood sugar monitor and test kit called in to, I was more annoyed than anything else.  My what now?

"We'll want to get this under control," the chipper nurse said.  "After all, we don't want that baby to get too big, do we?" 
"I was just in the hospital for preterm labor and there are two of them in there, so I don't think 'too big' is really a pressing concern, but okay.  Wait a minute.  I thought when you fail the one hour test, then you took some other test, right?  Isn't there some other test?" 
"Yeah, there is, but see, you really failed the one hour test, and given your risk factors, Dr. Twelve doesn't want to waste time with further testing.  So where do you want to pick up your monitor?" 
"What do you mean, really failed?" 
"It was 200." 
"Okay.  What's it supposed to be?" 
"Under 140." 
"Well, crap.  I overshot that by a week and a half, didn't I?"

I picked up my test kit, made an appointment with a dietician, and began the endless cycle of poke, eat, wait, poke, damnit.  It was ridiculously tedious.

I modified my diet and my blood sugar stayed within acceptable levels.  I suspect that my 'bitching about it' levels went right off the charts, especially when The Food Channel started playing almost nothing but Christmas baking specials.  You'd probably have to ask Sam about that.

When I went into the hospitals for mag and steroids, the numbers went completely crazy, but I was assured that this was to be expected.  What I did not expect was the persistant effect that stress had on the numbers.  Imagine how annoying it is to be told to just relaaaax for years and years and then finally have that be sound medical advice.  What's next, vacations curing the common cold? 

The dietician I talked to explained the stress connection by saying that when you're under stress, whether physical or emotional, your liver (trying to be helpful, she swore) dumps whatever sugar it can scrape together directly into your bloodstream.  This would be helpful if you were in a situation where you needed to lift a Yugo off of a puppy.  In every day life, however, it's kind of a pain in the ass.  "What do you know, honey?" I said to Sam.  "My liver's response to stress is the same as yours: 'Honey, you look like you're having a bad day.  Would you like some ice cream?'  My liver is the fat husband of my body."  Sam thought this was a hoot and immediately offered me ice cream, which of course I couldn't have.  Jerk.

As my pubic bones moved further and further away from Ellensburg, I began to repeatedly fail my morning tests.  I changed what I ate for breakfast.  Fail.  I reduced my total carbohydrate intake.  Fail.  I modified my evening snack (changing it from 'pretty darned tasty' to 'feh').  Fail.  I noticed that I was waking up every morning semi-coherent from the pelvic pain and barely able to walk.  Fail.

Hmm.

When I went to my regular appointment this week, I'd had just about enough of this crap.  When the Doctor In Training came in, I asked what my other options were.

"What are you doing for the pain?"
"Crying, mostly.  I have Vicodin available, but I'd rather not be groggy all day."
"Oh.  Well, your numbers look fine for the rest of the day."
"Yeah, because I'm hardly eating any carbohydrates.  I don't think I can stand any more hard boiled eggs and salads.  I'm not gaining weight anymore.  In fact, if you check my chart, you'll see that I've started losing weight and I'm getting concerned about the whole situation.  I think it's time to try something else."
"But your numbers look fine."
"...because I'm barely eating any carbs.  I've had to severely restrict my diet.  I think it's gone too far, and I don't think this is healthy.  I need a new plan."
"But your numbers look fine.  I mean, except for the fasting numbers.  Would you like to see our dietician?"
(single eyebrow raise)

This is where Sam piped up.  "If her blood sugar is too high in the morning, when she hasn't eaten anything for eight or ten hours, exactly what do you think the dietician is going to be able to do about that?  Tell her what kinds of foods not to eat when she's not eating?"  After a brief verbal scuffle with the Doctor In Training, Sam said "That's okay.  We'll just talk to the other doctor about it."

The Doctor In Training took another stab at it.  "Well, if you started eating a more reasonable amount of carbs, what would happen?"
"My blood sugar would go back up.  That's why I cut back in the first place."
"Well, if you went ahead and did that and your blood sugar was too high for a couple of days, then we could do something about it."
"Eh, no."
The DIT seemed confused by this response.
"Keeping my blood sugar under control is important for lung development, right?"
"Yes."
"And nobody can tell me when I'm going to deliver.  It could be next month.  It could be tomorrow.  Every day counts, right?"
She nodded.
"So do you see why I don't really feel like screwing up my blood sugar 'for a couple of days' just to prove a point?"
She did not.

Luckily, the perinatologist and the dietician both did (offering up such gems as "You know, it's just going to get worse from here on out" and "You really need to eat more carbs during pregnancy than you're currently taking in", respectively), so we're going to try something else.

In other news, I cannot believe that I hit thirtyone weeks today.  After eight weeks of bedrest, my primary emotions other than depression are 'sheer amazement at still being pregnant' and 'constant gratitude for the same'.  I occasionally throw in 'curious about how many yeast infections one woman can rack up in a single gestation' and 'slightly embarrassed by the trashiness of my current Netflix queue' just for a little variety, but mostly I stick with amazed and grateful.

According to those fun pregnancy websites, I may start to experience Braxton Hicks contractions at thirtyone weeks.

Remind me to keep an eye out for those.

Always Look On The Bright Side Of Bedrest

It's been five days since I've been anywhere but the bedroom and the bathroom.  The other day Sam came into the house smelling like rain, and I snorfled up and down his neck as if he were a truffle in the woods. 

Last night when Sam asked me what I wanted for dinner, I burst into tears because what I really wanted was to go make my own dinner.  Make no mistake, I'm quite committed to following all instructions, even the ones that have weak factual support.  I am extremely grateful to have made it from 23 weeks to 30 weeks, 4 days, and I'd much rather be on bedrest than the alternative.  Furthermore, Sam is such an outstanding partner when it comes to both the practical and the compassionate aspects of confinement that, were the postage on little fat men not prohibitively expensive, I would recommend that he be cloned and shipped to the bedsides of women everywhere. 

Despite that, it is extremely frustrating to be on my 53rd straight day of forced immobility.  Bedrest just sort of sucks.  It sounds kind of nice and relaxing and like it might involve bonbons and catching up on (insert pleasurable leisure activity here), but the reality is that most days go more like this:

Am I drinking enough?  Water, I mean.  Let's see.  Mustn't get dehydrated, as that leads to contractions.  Mustn't allow bladder to get too full, as that leads to contractions as well.  Do I have to pee right now?  No, wait, that's a contraction.  Breathe...breathe...breathe...okay, it's been a minute...two minutes...three minutes...seriously, uterus, you could unclench any fucking time now, and that would be great.  Sixty second contractions, my ass.  Okay, that's better.  Now, where was I?  Oh yeah, worrying about my bladder getting too full and causing contractions.  Hrmph.  Better get up to pee.  No, wait, give the uterus a couple of minutes to settle down.  How about now?  Sure, why not?  Remember, when you lever your ass out of bed, don't use your stomach muscles too much or your uterus will just have another conniption.  It's such a fucking drama queen.  Okay, that was a fun walk.  Remember to refill your water bottle and grab a snack on the way back to bed, because it's a long trip.  Yeah, yeah, it's all of twelve steps, making me officially a gigantic pussy.  I'm aware.  I hope my back doesn't seize up again before Sam gets home.  What, another contraction?  Goddamnit.  Am I drinking enough? 

It's truly an exciting life I lead.

At last week's appointment at TBFPP, I was handed a questionnaire on depression.  I managed to contain my laughter until I had filled out all five pages of it, and then Sam and I had a good chortle, mostly over the sections where I was asked to rate my current symptoms of depression (crying jags, lack of interest in things, absent attention span, abnormal fixation on cheesecake, etc). 

"Gee, honey, I'm no expert, but you do appear to be somewhat depressed," Sam said.

"Yeah, I noticed that.  I'm not totally sure how they expected me to fill it out.  I mean, if the bedrest wasn't driving me a little bit crazy by now, I'd have to be...you know, a little bit crazy."

"True.  Well, the good news is that depression makes you want to sit at home doing nothing, which is coincidentally exactly what you're supposed to be doing."

Finally, depression is serving a useful purpose.

How Many Refills Do You Get With That?

Although every doctor I've spoken to is very upfront about the fact that bedrest hasn't been proven to do any good, they still give directions for bedrest and I still follow them to the letter.  Part of it is that if they told me to wear a purple monkey suit for the remainder of the gestation, I'd be wrapping myself in fuschia fleece without an argument.  The other part of it is that in this situation, you really want to do everything you can to minimize regrets later on, even when all you're doing is intentionally not doing anything for no damned good reason.  Did that make sense?  I can't tell anymore.  My brain is continuing to morph into cottage cheese.

Anyhoo, because of this, I carefully read the updated New and Improved Bedrest Directions (Now with even more nothing!) when I was discharged from the hospital, and asked for clarifications and specific examples when possible.  I also refrained from saying "Boy, these are very detailed instructions for bullshit, aren't they?" although I couldn't resist snickering occasionally.

"Hmm.  'No orgasms'," Sam said, reading over my shoulder.  "Bummer."
"And look here," I said.  "'No sex.  No douching.  DO NOT PUT ANYTHING ELSE IN THE VAGINA UNLESS IT IS PRESCRIBED BY A DOCTOR.'  Anything else?  Like what?"  I looked at the nurse curiously.
"Well, they have to put that on there," she said primly.  "Just...in case."
"Yeah, I get that, but jeez, I haven't seen my vagina in months.  I can barely reach it.  I'm not sure what the hell I'd be doing with it at this point, using it as a vase and arranging flowers down there?"

We kind of lost her at that point.

This morning Sam rolled over in his sleep and snuggled up to me companionably, something I missed terribly while I was in the hospital.  I did, however, notice a common male morning situation, prompting me to yell "Hey, watch where you're pointing that thing, buddy!  Do you have a prescription for that penis?!?"

fF(un)N(y)

I fully admit that as a random schmuck with no formal medical training (other than being a living medical experiment, which is more like an obstacle course than a formalized training regimen), my grasp of the fFN test is somewhat limited.  If I understand the doctors and the Internet correctly, fetal fibronectin is kind of like a glue that adheres the amniotic sac to the uterine wall.  If that glue breaks down and starts to pass from the uterus to the chooch, this indicates that labor may occur in the next one or two weeks.  Or not!  The fun thing about a positive fFN test is that it's not really very valuable for predicting imminent labor.  A negative fFN test, however, is considered quite nifty and valid and and has a frequently quoted 97% reliability rate for ruling out labor in the next seven to fourteen days.

At my last visit with The Big Fancy Perinatologist Place, they declined to continue routine fFN tests because of (choose one, or all that apply)

• the questionable value of the test, if positive
• the idea that fFN testing is usually done during episodes of threatened pre-term labor in order to determine a course of action or treatment, and since I've already been in preterm labor and am being treated and watched like a hawk, a positive or negative test would not change my treatment plan one iota
• the fact that I'm already being seen by the best Peris in about a four state area, which is worth mentioning only because a positive test would not be used to transfer me anywhere bigger, better, or fancier for future treatment (as is sometimes the case in other hospitals in the immediate area)

Because of this, when we showed up at The Big Fancy Perinatologist Place's Labor and Delivery triage area, I was a little surprised that the doctor on call was interested in running a fFN at all.  However, since I was strapped to a monitor and having contractions every three minutes (and insanely curious about the results), I was not really in a position (either literal or figurative) to argue against the test, so I said "Oooh, yes, by all means, lets!"  Actually, I think I said "Ggggggggggguh...nnnnnnyern...huhhhhh," or something equally witty, but humor me, here.

I spent the rest of the night being crammed with Nifedipine and mag and limited my queries to "So, when's the Nifedipine going to start working?" (Answer: "Um, it's not, so they're going to put you on mag."), "So, when's the mag going to start working?" (Answer: "Um, it's not, so they're going to increase it.") and "Could somebody please unsnap this gown and cut my shirt off before I chew the seams apart?", so it didn't occur to me to pester anybody about the results of the fFN until the next morning.  Sam asked about it, but was casually brushed off.

Morning brought a small herd of doctors (What does one call a small herd of doctors?  An Arrogance?  A Minor Deity?  A Malpractice Suit?) to my bedside, and when none of them brought up the fFN test, Sam did.

Everyone got quiet. 

The Alpha doctor made a funny face.  "Well," Dr. Alpha said, pursing her lips, "that test wasn't supposed to get run in the first place..."

Okay.

"...which I told the doctor on call, because there was no way it was going to come back negative, so really, what was the point?  There was no value in running it at all.  You just don't see negative fFNs in situations like this."

Okay.

"Not that it mattered if it was negative, because we still would have admitted you and done exactly what we've been doing, so it wouldn't have influenced our decision making process at all, which is why it was useless.  Actually, I kind of chewed out Dr. OnCall about running it and said that if it did come back negative, I'd buy everybody in the room a [moderately expensive prize].  That's how sure I was that it would be positive."

Poor, poor Dr. Alpha.  Clearly, she had never come up against my uterus and its gift for statistical improbability. 

Of course it was negative.  Several doctors and at least one nurse have already announced their intention of taking her up on her offer. 

Dr. Alpha hemmed and hawed and tried to cast aspersions on the test itself and its dubious value and suggested that it may not be meaningful in multiple gestation (the Internet does not concur).  She also mentioned the ethereal aspect of treating preterm labor and the widely acknowledged lack of concrete answers, but in the end, she doesn't know why my fFN was negative.  It shouldn't have been.  Realistically, my body was making some sincere and concerted efforts to eject Fitz-Hume and Millbarge on Friday and did not cease those efforts voluntarily or without a fight.  If TBFPP had not made a pretty convincing medical argument that my uterus needed to cut that shit out immedidately, my cervix would have continued to thin and dilate, and I would have gone into full blown labor.

Under those circumstances, common sense dictates that the fFN would have to be positive, or if negative, falsely so.

So, what does my most recent negative fFN test suggest?

Nobody has any damned idea.

I have not been cheerfully stamped with an expiration date two weeks hence, as was the previous response after negative fFNs.  By contrast, I have been released under instructions for bedrest that is bedrestier than ever before.  To make matters creepier, rather than return directly to TBFPP in the event of further similar episodes, I have been urged to head for the nearest ER with an attached NICU, where I can be transported to TBFPP in the appropriate medical custody.

All I know is that if I had a buck for every time a qualified professional said "Well, we just don't know..." I could probably finance a round of IVF for the entire greater Seattle area, or maybe even reimburse Evil Insurance Company, Inc. for their projected financial outlay on this pregnancy.

Pants Accomplished

Although I will miss having an entire kitchen on call (and I loved how they ended every phone call with a solicitous "Are you sure you wouldn't like another starch?  An extra beverage?  A little dessert?"), I am very glad to be home.

Sam, being a goddamned genius, has rearranged our bedroom to be significantly more efficient and navigable than the hospital room and has also generously agreed not to wake me up twice a night to take my temperature and blood pressure.  I knew I married him for a reason.