Becca Meets Baby James

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An Open Letter to My Uterus

Dear Uterus,

You have been amazing.  You have done a great job sheltering and nurturing this little boy for nearly 10 months now.  You have performed admirably, and I am very proud of you and your buddy, the cervix of steel.  Even while the rest of my body has tried to work against this pregnancy, with blood pressures rising and all, you have held strong and created a safe home for this booger.  While so many women with prior pre-term births constantly have to worry about contractions and whether this or that twinge is the beginning of early labor, you haven't tensed at all.  You are one calm, cool and collected uterus, you are.

But here's the deal: you're about to get sliced open.  Like, the doctor is going to cut you.  Open.  And pull a baby out of you.  And it won't be pretty for either of us.  (But then again, what way of extracting a human out of another is actually pretty?)  It will do, and the designated butcher is quite a good surgeon who will be very gentle with you and the other layers of me that have to be cut through in order to get to you (7 layers in all, I believe), but still...you gonna get cut.  On Monday.  That's five days from now.  Sliced.

But you have an out!  We are 38 weeks, 2 days pregnant now.  That's a lovely time to have a baby.  I know 39 weeks is better; I've seen my March of Dimes graphics and everything.  I know Baby James' big old brain could use another few days cooking inside before he meets the big, wide world.  So I'm cool waiting another few days.

But if you don't start doing SOMETHING soon, there's going to be no way for you to avoid the big c-s.  I mean, something!  You've been so mellow this entire pregnancy that I have never even felt a single contraction.  Some uteri are gettin' all busy by now, at least with those Braxton-Hicks contractions.  But you, no, you are one cool cucumber.  Or maybe more like a very mellow hollowed out watermelon at this point.  I mean, I know I'm generally in the business of asking uteri NOT to contract so as to keep their precious contents safe, but, really, it's about time for you to pep up.  So c'mon, give me a squeeze or two, just to let me know there's a CHANCE you might decide to pop this baby out on your own before Monday.  Seriously, if you and Ms. Cervix of Steel show us a little action, we might be able to put off the surgery in hopes that you will end things on your own terms.  But right now, you're giving me nothing.  So we are set to be sliced.

And if that's how we have to go, that's fine.  But I'm just saying that I *think* you'd probably prefer to avoid the scalpel.  I mean, I could be wrong, but who wants to be sliced open at 7:30 in the morning?  I mean, really.  Still, I can't complain about you.  Even with Becca's clusterf*&^ of a pregnancy, you performed admirably.  So we're cool.  Buuuut...I want you to go into this process fully informed.

Ball's in your court, uterus.  Quite literally.  How you gonna play it?

Sincerely,
Nancy  

First Visit to L&D

I had an appointment on Monday, and after looking at my blood pressure numbers from the weekend, Dr. Sizemore decided that it was time to send me over to labor and delivery for some more extensive monitoring.  I was officially admitted to Williamson Medical Center for the first time since I broke my pinky finger in 1990.  :)

They hooked me up to the monitors (tracking contractions - none - and Baby James' heartrate - perfect) and took my blood pressure every 10-30 minutes for a few hours.  At first, when I was lying flat in the bed, my numbers were ridiculously low.  Like making me look like a hypochondriac low.  One of the readings was 116/66.  WTF?  Then I sat up in bed - not even all the way, something like 45 degrees - and the numbers bumped back up where they had been, somewhere around 140/mid-80's.  I at least felt validated then, like I wasn't totally crazy.  :)

They checked my pee for protein, still negative.  They ran bloodwork again, still fine.  At the moment, we are dealing with a diagnosis of gestational hypertension (similar to pre-e, but without the protein indicating that my kidneys are failing).  It may yet end up being pre-e again, but who knows.  There's not that much longer in the pregnancy for pre-e to develop!

After seeing my blood pressure level out, even though it was still up, they decided that I could go home, but I have to be stricter about my bedrest.  I'm still only on "modified" bed rest, meaning that I can get up to go to the bathroom, to shower, to move from the bed to the couch to the kitchen table (sitting in a chair, not lying on the table, silly), but I really don't need to be taking care of Becca on my own, and it was time to officially go on maternity leave and stop trying to work from home.

So that's where we are now.  Sitting around.  But that's okay.  Church has been great with my leave time, so with the vacation time I've saved up, I should still be able to spend James' first 3 months in the world at home with him, which is good.  We have decided to go ahead and bump up his delivery to 39 weeks, assuming he doesn't decide to come before then and that I stay stable enough that we don't have to take him before them, just so that I don't use up another week of my leave waiting for the possibility of going into labor and attempting a VBAC, especially since there is no indication that I would even go into labor before my due date.  (Cervix of steel, I've got.  One complication we don't worry about.  :) )  So I'm a little sad to probably have to let go of the possibility of a VBAC, but it wasn't like my life depended on it or anything.  In fact, my life may depend on not holding out for one.  It did last time around!  :)  It would have been nice to possibly have that experience and labor not be something else that prematurity took away from us, but, wow, we've gotten to experience SO much more normalcy in this pregnancy that I can certainly deal with not having to deal with contractions, etc.  I hear they aren't much fun, anyway.  :)

Update - in John's Words

It's actually still me typing, but John sent such a lovely and concise update to the church staff after our appointment yesterday that I thought I'd let him do the talking for once.  Here's what he said:

Hi everyone,

Just wanted to give you a quick update on Nancy. Her blood pressure is elevated (150s/80s), but her labs came back normal and there is no protein in her urine (sorry for the detail). This means that, as of now, she does NOT have pre-eclampsia (yay!), but the elevated blood pressure is still worrisome. It could be the result of the steroids she is taking for her lungs, it could be a pre-cursor to pre-eclampsia, or it could be that she will just have elevated blood pressure near the end of her pregnancy.

 

The doctor has placed her on modified bed rest (shouldn’t work or do anything strenuous, but doesn’t actually have to stay in bed all day) at least until her pressure comes down. We will continue to monitor it closely at home and go to the doctor twice a week now for testing. If she develops pre-eclampsia or her blood pressure gets higher (into the danger zone of 160s/100s), then she’ll be admitted to the hospital and likely have a c-section soon thereafter.

 

So, right now, we are more or less in a holding pattern to watch and make sure she doesn’t get any worse (and hopefully even gets better!).

 

Thanks for all the prayers and support!

36 Weeks + A Little Excitement

As of yesterday, I am 36 weeks pregnant!  We haven't measured him lately, but Baby James should be about 6 pounds now.  Becca was around 6 pounds at her first Christmas, at 6 months old.  You could say he's got a head start on his big sister.  I'm not going to know what to do with this giant kid.  Bizarre. 

I am feeling appropriately uncomfortable and perfectly happy to be sore, tired, worn out and achey.  James has dropped, so he's in position, head-down, to make an arrival in the next few weeks.  I'm dilated a centimeter, which apparently means nothing, but hey, at least something is happening.  One more week, and we're full-term!  Even at this point, though, we are likely to avoid the NICU.  Woohoo!

But this week is not without a little bit of excitement.  Last week, Becca passed her cough on to me, dear child, and with my asthmatic lungs and pregnant immune system, it has hit me harder than it did her.  By Friday, I was ready for a trip to the pulmonologist, and picked up a round of antibiotics and steroids (prednisone) on the way home.  By Saturday night, my blood pressure, which has been really good lately, had bumped up to the "you're not going to die but you should call the doctor" range.  I gave it until Sunday morning, and called the doc during Sunday school.  He said to keep taking it and let him know if it went up further.  He thought the steroids *might* be to blame but didn't want to initially blow it off. 

Sunday afternoon, I rested, took it again, numbers were about the same.  I probably should have called the doctor then, but that night we were going out for our anniversary, and Super Dad had a Super Date planned for us, complete with a night at the Union Station hotel, where we spent our wedding night.  Knowing that my numbers weren't dangerously high, just possibly heading that way, we went on our date and had a great time.  By Monday morning, after a night off from work and parenting, they were down again.

Monday afternoon, at work, they bounced back up, so I went in to have the nurse run them.  Now they were up to 151/82 - highest I've seen since my pregnancy with Becca.  They considered keeping me overnight in L&D, but I convinced them to let me go home and rest.  They ran some lab work (which came back okay, thank goodness) and set me up for the super-fun 24-hour urine collection.  I'm nearly done with that now, and have spent the day at home on my butt (mostly).  Blood pressure has come back down to the 130's (sometimes upper) over 80's (sometimes upper), so we are still watching it.  I'll turn in my pee jug tomorrow morning, keep checking numbers and sit on my butt until I see the doctor tomorrow afternoon, when they will have results from the 24-hour collection.  (They are looking to see if my kidneys are spilling protein in my urine - the other classic indicator of pre-eclampsia.) 

If they don't like the results from that, or if my blood pressure bumps up too high again, I'm guessing they will put me on bedrest for the duration of the pregnancy.  I don't know how long that will be - I'm guessing they would wait until at least 37 weeks (next Monday) to take him (unless I get really sick, of course), so that he would be full-term, but I don't know if they will want to give him until 38 or 39 weeks or what.  At any rate, none of those weeks is very far away, thank goodness!

There's still a good chance that the urine test will come back negative and the blood pressure will normalize as I finish my run of steroids.  (It's a 9 day run - 3 days on 60 mg, 3 days on 40 mg, 3 days on 20 mg - and I'm on day 2 of the 40 mg.)  In that case, I'm back to the plan I outlined in my last post (I think). 

So, like I said, a little excitement, but we are so so so so so so so so happy to be looking at these issues at 36 weeks and not 26!  Such a world of difference! 

Stuff and Things and Nancy Rambles

I'm officially more pregnant than ever!  On Monday, for the first time ever, I got to say that I was/am 29 weeks pregnant!  Wohoo!  So that's awesome.  But the blood pressure is still bouncing around, so I'm trying to take it easy, etc.  But it's a total mind warp.  Take today, for example.

I got up and immediately feel gross.  Nausea is back, generally felt icky.  I take my blood pressure, and the systolic (top number - at least I think that's the systolic) was 138.  (Remember, 140 on the top or 90 on the bottom sustained warrants a call to the doc, a visit for monitoring and possible admission/bed rest.)  I lie back down for a while, take it again, and it's 142.  So I call John and tell him that I'm taking a sick day rather than wrangle our precious and oh-so-cooperative nearly 4-year-old into clothes, into the car, into the office to work alongside me (as our super babysitter is out of town this week).  Becca and I spend the day playing some and watching a lot of movies.  Sorry for rotting her brain today.  My pressure comes down below 140 (hence no call to the doctor, whom we are seeing tomorrow anyway), but hangs out in the high 130's.  At last check, it was down all the way to 131/81 - much better apparently, though really not all that different...but I guess 9 points below the magic number is better than 2 points above.  And Becca's taking a nap at this point, so that probably helps.

So then my mind starts going...if you haven't already picked up on it, I've got issues with being "enough" - good enough, a hard enough worker, etc., so I tend to carry lots of guilt around because apparently being "enough" is the same as being "perfect" - which I'm obviously not.  So I start thinking, "Maybe I shouldn't have taken the day off.  Maybe I'm just being lazy.  I keep wanting the doctor to tell me to take it easy...maybe that's because I'm so slothful I just want to lie in bed and watch t.v. all day long.  Maybe this is all in my head.  See, my blood pressure is better.  So I should have gone to work, right?"

I wear myself out taking it easy.  I mean, first off, my logic is flawed.  You can't use the afternoon's good reading to say that I should have gone to work.  Sure, I might have just been running high because I wasn't feeling good (Zofran helped that), but what if - this is crazy! - taking it easy today actually did what we intended for it to do and helped lower my stress and blood pressure?  Perhaps I made the right choice and was seeing the positive consequences from it.  But, no, I must have made a mistake and everyone at work thinks I'm a slacker.  (The last bit of which, I can tell you when I'm in my right mind, is not the case.  They like this kid, too and want him to stay put.)

But I do want the doctor to keep telling me to take it easy.  Is that because I'm lazy?  Is it because of residual issues from my first pregnancy, when NOBODY told me that I should stop working my crazy, stressful and physically demanding schedule (which, we all now agree, I should have, hindsight being what it is and all)?  Is it because I want to check out of all responsibilities?  Well, probably a little bit of yes to all of that and definitely some yes to the second reason.  Yes, because of the guilt I carry about (unknowingly) screwing up Becca's pregnancy (or at least not doing all I could have to unscrew it up), I want to make sure I am doing EVERYTHING possible this time to keep the kiddo cooking.  So maybe I am overreacting, at least some.  But maybe I'm okay with that.  Whatever happens, I don't want to look back and regret anything.

And that's probably why I keep wanting the reassurance from the doctor that I *should* be taking it easy...because I don't want the choices we make in this pregnancy to come from a place of (somewhat false) guilt surrounding Becca's pregnancy.  Now, Dr. Sizemore seems to be happy to provide that reassurance - he agrees that taking it easy does seem to be helping, and there's certainly evidence that it can help...but I guess I still worry about whether I'm being selfish because we can't *prove* that I need to do it.  I mean, there's no control group on me.  We're seeing what happens when I do take it easy, but we can't see what would happen if I kept running at full tilt...'cause I'm not.  Know what I mean?  But I feel like our families and friends and the world is judging me for being lazy...as if the world doesn't have other things to worry about.

I think where all this emotional neediness comes from is a need to justify inaction or inactivity in our society.  I mean, in my circles, it's easy to justify some amount of "self-care," downtime, contemplation, etc...but not a command or an inclination or a neurotic hunch to really, do less.  I guess in particular because when I do less, other people have to do more.  Super Dad has been (predictably) awesome (though sometimes I think he thinks I'm crazy), we've got someone coming tomorrow to clean the house, I've got an awesome assistant at work, and my biggest work task at the moment is being handled by some stellar Vacation Bible School chairwomen.  Some of what I'm *not* doing didn't really need to be mine to do, anyway.

For example, the weekend that my doctor first told me to "take it easy and only do what you have to do at work," I was scheduled to attend the church softball games on Friday night (as a function of my being married to one of the players and enjoying such activities, not as part of my job description or anything), participate in CPR and First Aid training all day Saturday (a good thing for a children's minister to have but not ESSENTIAL to my function at work), go to a Sounds game (Nashville's minor league baseball team) with a group from church that night, and participate in/lead all my normal Sunday morning activities.  In talking to my doctor, I realized that all I really *needed* to do for work was my Sunday morning stuff.  Sure, I was *expected* at the other bits, but they could proceed just fine without me.  (And to that point, if I needed to *not* be at church Sunday morning, folks would have stepped in and made do just fine without me.)  So all I did was my Sunday morning routine.  Oh, and I attended the softball games after making sure some other (very special) spectators were willing to chase the #1 Cheerleader around while I sat.  

Anyhow, I don't know where I'm going with all of this.  I guess I'm just trying to process.  Out loud.  Get surprised.  So I guess I'll just leave it there.  That's the update.  Baby boy (who I think has a name!) is doing well, still, growing and moving and all.  I'm doing okay-ish, growing and trying not to move more than necessary for day to day functioning.  We go back to the doctor tomorrow and will do bloodwork again.  Hopefully we won't be back in the business of collecting 24 hours of pee.  Ew.

Pretty Boy!

Guess who is already THREE TIMES HIS BIG SISTER'S BIRTHWEIGHT?  This sweet boy:

(Okay, yes I know he is sideways, but I have to go to a church event now; I'll try to rotate him later.)

Appointment today was great.  Blood pressure was down; I've been instructed to keep doing what I'm doing.  Wohoo!

Bits and Pieces

I feel like there is a lot to update you on, but my mind is not at all organized at the moment...so you'll get bits and pieces.

First off, I am now 17 weeks and 4 days.  17 was a bad, bad week for us in Becca's pregnancy.   In fact, it's the week that they told us she was going to die.  So even though we weren't scheduled for a visit this week, I called the doctor to see if we could come in and get a glimpse to make sure everything looks good.  Fabulous doctor that he is, he worked me in, and we saw him on Wednesday. 

I am beyond thrilled to say that this week 17 is going much, much better than our last one.  The baby is measuring right on target, though the head is a little bigger than the legs (which just makes the baby a Hill - have you met my short genius of a husband?).  At this point, Becca was already 2 and a 1/2 weeks behind.  There was a 4 cm fluid pocket already; when we went for our amnio with Becca in week 18, they couldn't even find a 1 cm pocket and almost weren't able to do the amnio.  Dr. Sizemore said that they could amnio this fluid all day long; I told him that I'd prefer that he not.  The baby was moving - dancing, really, which was adorable.  And we think we saw some bits and pieces...

...as in, little boy bits and pieces!  It's still pretty difficult to tell on the office's super basic ultrasound machine, but we're pretty sure we saw his little penis, and when he started grabbing at it, we decided it was definitely acting male...already sticking his hand down his figurative pants.  But - we're not painting the nursery blue yet or anything (actually, we're not painting the nursery at all because when we moved in and painted we went with a gender-neutral green, smart kids that we are), but the doc is 85% sure it's a boy.  We ought to know for sure at our full anatomy scan (at the high risk doc with the better machine) the Tuesday after Easter. 

So that's that.  I feel so so so much better after this appointment.  Oddly, it's nice to be where things started to go wrong.  I had thought that my anxiety would only increase as we got further along, and I'm sure it will some, but it feels great to be at this point and be reassured that what happened last time is not happening this time.  I'm still at high-risk for complications, and there is still a very good chance that I will develop pre-eclampsia, but whatever happens now, I know we're not experiencing a total repeat of last time with the double whammy of super-severe IUGR AND severe, early-onset pre-eclampsia.  Again, the kiddo could stop growing at any time, and my blood pressure could shoot up, particularly as pre-e is an unpredictable disease, but we are ahead of where we were last time.  Phew.  In CPE terms, I think it's helping me differentiate this pregnancy from my first one.  I really am starting to believe that things might be different this time.  Like I said, it feels good. 

[Sidenote: as I talk about my first pregnancy, I want to be clear that I don't regret a minute of it.  Of course I would have chosen for it to go differently, but in the end, we got the best kid in the world, and I love her just the way she is.  I would do it all over again in a second to have her.  Or to have this itty bitty boy.  But we're open to an easier ride for everyone this time.]

Okay, I got so busy writing about the little boy booger that I forget what the other updates need to be...so...um...don't forget to donate to our March for Babies team and/or order your t-shirts (I'm sending in our order on Monday!)...and if you want to buy some Usborne books AND save some babies at the same time, shop at www.myubam.com/HOS216155.  I'm giving my entire commission on purchases made through this link to our March for Babies team.  And I haven't forgotten about the second Disney post.  It will come.  Eventually.  :)

Oh, and some adorable Becca sayings as of late:

• I'm da wine weader!  (while running to get in front of everybody)
• Her name for the baby: Kolkai Booger
• I'm Madewine!  I'm Madewine!  I'm tall!
• Actuawawy... (translation: actually)
• I want to go on adbentures!  Yet's go on [pauses while she counts her fingers and raises them] five adbentures!  (Adventures = errands or anything else we can come up with to do away from home or church)
• Awl da something or other (As in, who was your favorite character at Disney?  "Awl da charawcters!"  Who do you want to invite to your birthday party?  "Awl my fwiends!"
• I will give you a kiss to feel you better, Mommy.  (and)  I'm sorry you're sick, Mommy.  (and) I'm gwad you're better, Mommy. 

Okay, that's all the randomness I can reign in at the moment.

A Mother's Love

The true test of my love for my unborn child is not whether or not I willingly endure the shots, the vomiting, the bajillion appointments, the pills, the tests, the blood pressure monitoring, the discomfort, the fatigue, the anxiety...

No, the true test of my love is whether or not I can manage to keep from eating the brownie batter in the bowl in front of me.

This kid is loooooved.

Test Results

The test results from the blood taken at my last appointment are in.  I'm not even sure what the test was - if we did the AFP, the Triple Screen or the Quad Screen - but they all look for the same things - elevated risks of Down's Syndrome or neural tube defects (like spina bifida).  Remember, the abnormal results on this test were the first indication that some was askew in Becca's pregnancy.  I'm happy to report that this go 'round, the results were completely normal! Now, that's not an indication that everything is going to go swimmingly or anything, but it's a great sign that this babe and its placenta are developing normally, which is a BIG step in the right direction!  Wohoo!

It's a...

Girl
Boy
Girl
Boy
Girl
boy????


If I could make that font even smaller, I would.  Here's how the gender search went:
Dr. S.: Look at that!  See those lines?  That looks like girl to me!
N and J: giggle giggle giggle
Dr. S.:  Let's look around...placenta looks great...size looks great...very active, good movem-
[PAUSE]
N: Yes?
Dr. S.:  I think I saw a penis.  Let me look again.

He looks again and again and again - we seriously spent 10 minutes just looking for fetal genitalia, and we have decided that the baby is one of two things:
1.  A boy
2.  A girl with a strategically placed umbilical cord

We really don't know.  (Thanks to you 3 people who said we wouldn't find out; you cursed us!)  Dr. Sizemore is putting it at a 60% chance that it's a boy.  Given that it started with a 50% chance, we haven't clarified much.  I threatened to come up with some problem that would send us to the specialist upstairs (with the high-powered ultrasound machine), but figured I'd end up with enough time with specialists as it is.

So there you go.  The Booger is a beautifully-developing, perfectly healthy little...booger.

Gender Guesses?

As I mentioned yesterday, we have an OB appointment tomorrow.  In addition to the AFP/Quad Screen tests that we'll draw blood for, we'll have another ultrasound.  (We have ultrasounds at each visit to check for growth.  So far, so good.)  There's a pretty decent chance that we'll get a glimpse of the wee one's wee parts tomorrow...so make your guesses now: boy or girl?  Vote at the poll to the right.

Just so you can make an informed decision, Becca is 100% certain that the booger is a girl because it's growing in MY tummy.  If it were a boy, it would grow in Daddy's tummy.  Which makes perfect sense.

Though this is an exciting ultrasound (aren't they all?), the more important one comes up at 18 weeks, when they will use the better machine to do a full anatomy scan, counting heart chambers, etc.  If we don't find out the gender tomorrow, we'll most likely find out then - but at that point, I'll probably be more concerned about all the organs being present and accounted for.  :)

MFM Appointment

Yo.  It's Sunday night, which means that this children's minister is super duper tired (and in the habit of saying things like "super duper"), so I'm gonna be brief.  At least for me. 

We saw the MFM doc for the first time last Monday.  Well, the first time for THIS pregnancy, of course.  We were able to get in to see Dr. Carpenter, who is one of our favorites in the Vandy MFM group.  She's oddly hilarious in the way she throws around technical jargon but super friendly, and once again, we decided that we are very, very lucky to be fairly bright people, given the amount of medical information we have learned to digest over the past four years.  (Seriously, I don't know how anyone without an above-average-ish IQ can keep up with these doctors, let alone wade through the massive amount of paperwork dealing with insurance, SSI, special ed., etc.)  So we learned some new technical things, but the gist of it is that she really likes Dr. Sizemore (my regular OB, whom she helped train), agrees with everything he is doing, trusts him to monitor me closely, and doesn't need to see me back until/unless there is a problem.  Fabulous!  We like doctors and all, but we see plenty of them, really. 

We did get some pretty shots of the gummy bear on their fancy schmancy ultrasound machine...that I apparently cannot scan on our fancy schmancy printer.  I'll send SuperDad in here to see if he can do it.  There's a really cute one wherein the little Booger is waving at all the Itty Bitty Hill readers!

Yeah, Yeah...

...I know I have been slacking on my blog, even with my promises to my mother, but I can't bring myself to feel bad about it.  Because I'm already feeling quite bad on my own.  Of course, feeling bad in this case is a good thing, but, wow, I've been feeling b.a.d.  Apart from not feeling like sitting in front of the computer and typing, I haven't posted because I don't want to whine (too much), and, well, that's about all I have to say.  I feel like shit most of the time, death occasionally and okay every once in a while.  Yesterday was horrible - couldn't keep anything down and finally christened the toilets at church with a little (or a lot) of baby-induced vomit - but today has been an okay day.  Not good, but okay. 

I feel guilty that I'm allowing my physical dis-ease to color my life so much; I mean I'm supposed to be overwhelmingly joyful.  I'm finally pregnant, after all!  Wohoo!  That's awesome! And great!  And wonderful!  But it's hard to think about all that when you're working really, really hard to figure out a way to get out of bed without losing the midnight snack you had to eat in order to choke down your nine pills.  I know that I am excited and grateful; I just don't feel excited and grateful.  I'm trying to get over the guilt associated with that lack of enthusiasm, but, darn, feeling physically bad makes everything seem worse.  There have been several days in the past few weeks that I've either had to stay home from work (and in bed), cancel plans and/or *gasp!* cancel Becca's therapy appointment because I couldn't handle leaving the house.  It's been pretty bad.

And it hasn't exactly helped my anxiety, as the feeling I most associate with Becca's pregnancy is nausea (and lots of vomiting - remember, I was puking for the entire 7 months).  So that has flashed me back into a discouraging place at times.  And then the anxiety doesn't exactly help the nausea, either.  And so it goes. 

But the good news is that the nausea is a little different than in Becca's pregnancy (more overwhelming and incapacitating disgustingness and less vomiting than with Becca), so the good Dr. Sizemore's theory is that we're experiencing normal "placentation" (that would be the formation of the placenta, which controls the hormones that affect the nausea and was "total crap" in Becca's pregnancy, causing her to be Itty Bitty), so maybe everything's going to be normal-ish this time and maybe, possibly, I'll have a more traditional course of morning sickness that ends as we enter the second trimester.  Who knows.  I know plenty of people with functioning placentas who are sick the entire pregnancy, but maybe at least it'll lighten up.  I noticed today that I can get an extraordinary amount of work done on days that I feel halfway human now, which is great, because I got next to nothing done yesterday. 

So that's the answer to the, "How are you feeling?" question, which, frankly, I'm sick of answering because then if I happened to possibly be thinking about something other than the fact that I feel like crappola (as my dear dad would say), I am reminded of it and have to explain myself (to varying degrees, depending on who is doing the asking).  But then again, I do love a good pity party every now and then, so sometimes I like the chance to whine. 

Okay, end of sob story.  Which is actually a happy story.  But you know what I mean.  (If you don't reread the above paragraphs until you get it.  If you don't get, shove off.  I'm hormonal.)

On to the technical stuff - the official due date is set for September 3, 2012.  I'll be thrilled if we make it until August.  I'll be super thrilled if we make it until August without having to go on bedrest, especially because 3 of my oldest friends in the world are getting married (not to each other) in June and July, and I really, really want to be there.  And Becca's first ballet recital is June 23, and I've gotta be there, right?  So, yeah, pre-eclampsia, back off.  I've got a fun summer planned.  And you're not invited. 

Anyway, that makes me 10 weeks pregnant tomorrow (which, incidentally, is when the pregnancy hormone levels peak, so theoretically if I AM having a typical course of morning sickness (which we know is all day sickness), it should start to abate in the coming days and weeks).  The babe is somewhere between the size of a kidney bean and...small plum, according to my pregnancy book.  I don't think I've ever seen a plum that is anywhere close to the size of a kidney bean, but whatever.  Maybe it's a teeny, shiveled organic plum that cost 3 times as much as the genetically-engineered stock I would buy if I ever bought plums.  I think the "official" length as of tomorrow is just over an inch.  What the hell kind of plum would that be?  Save your money and get a decent-sized plum in a few weeks. 

We have our first appointment with the maternal-fetal specialists on Monday.  We've going with the Vandy MFM (maternal-fetal medicine - learn the acronymn now because I'm about to be too lazy to type it out) because, even though there are other doctors that are closer and much easier to deal with, logistics-wise, if this baby is born early, we want him/her to be born at Vanderbilt, whose NICU is ranked in or near the top ten in the country (depending on the year).  There are other Level III NICU's in town, and we have friend who have had positive experiences at each of them, but the sickest kids always get transferred to Vandy anyway, so why not start there?  Besides, we still have some of "our people" there.  I want to be among my people.  So we'll deal with their obnoxious schedules and long waits.  On Monday, we'll have another ultrasound and see Dr. Carpenter, who is one of our favorites in the group.  Way back when I started trying to get pregnant, she was enrolling patients in a pre-e study.  I'm guessing the study might have already been concluded, but still, it's nice to know she really is on the cutting edge of research in the area.  I feel good about seeing her. 

We go back to Dr. Sizemore on Wednesday for another ultrasound and brief appointment.  All my labs have come back normal, including the protein levels from the oh-so-fun 24-hour urine collection.  Delish.  So we've got normal baselines for everything.  Even my blood pressure is behaving; at the pulmonologist today (routine appointment; all is well), it was something crazy-normal like 116/72.  Suh-weet! 

I think that's all I've got on the baby front.  I'm going to try to continue to stare at the screen and pound out a few Becca posts so that you know she is still alive and well and as sassified as ever.  No promises, though.  But it helps that the office is right across from the bathroom. 

And I'll leave you with that image. 

First & Second Visits

Okay, I promise this blog isn't going to be only about the pregnancy, but, frankly, I feel like crap and have no energy so for the time being, I'm just hitting the highlights that may prove relevant to the overall story...and maybe in a few weeks I'll be back to raving about Becca and her ridiculous adventures.  Right now most of my conversations with her go like this:

Becca:  Mommy, you want to pway wif me?
Me:  Baby, I'd love to play with you, but I don't feel good right now. I need to lay down.  Do you want to see if Daddy can play with you?
Becca:  Aw, Mommy.  Are you sick?
Me:  Kind of.
Becca:  I'm sorry, Mommy.  I give you a kiss.  Dat will feel you better.  (Kisses me super-sweetly)  Do you feel better now?
Me:  Of course I feel a little better now.  I love your kisses!  But I still need to lay down.
Becca:  Mommy, you want to pway wif me now?

She is soooo sweet and compassionate...and persistant. 

So there's your Becca fix.  On to the doctor...

I saw Dr. Sizemore last Wednesday, when I was 6 weeks, 3 days (or so) pregnant.  His nurse, Liz, is awesome - she knows our whole story and has really been pulling for us.  She asked me if I wanted him to come in and talk to us first or just go straight to the ultrasound.  Of course I wanted the ultrasound immediately - I HAD to see that heartbeat!  She said, "Oh good; I didn't think I was going to be able to wait!"  So sweet.  So - we did the ultrasound, saw the teeny tiny heart beating, everything in the right place, etc.  Looks great.  And there's only one, which is good for my risks (and probably my sanity as well).  They didn't give us an official due date, as he wants to wait until 8 weeks and actually measure the baby and set it from there, but he saw everything he expected to see at 6 and a half weeks.

We talked over my treatment plan and changed a few things.  By this point, I was feeling really nauseas (WHY is my spellcheck not working?!), so we decided to nix the Metformin, as the, um, intestinal distress it caused combined with the aching tummy was too much to handle.  I think that's the only medicine change we made.  We did decide to co-manage with the Maternal-Fetal group at Vandy, and he's setting up my first appointment with them.  I haven't heard back, so I don't know when it will be, but he thought they'd like to see me fairly soon.  They gave me the supplies to do a 24-hour urine collection (hooray!) so that we have baseline numbers for protein in my urine.  I've been putting it off...but if you at church in the next few days, be careful when opening refrigerators.  :)  They took 10 vials of blood in order to get baseline numbers for a million other things, and that was in addition to the blood panel that my PCP had just run the week before.  Good thing my blood supply is increasing so much!  We are, of course, hoping to go full-term and pop out a big ole baby, but the good doc and I (and poooosssibly my overly-optimistic husband) agreed that a good, realistic goal will be to have a take-home baby, one born around 34-35 weeks who gets to go home from the hospital when I do.  It may be earlier; it may be later, but it's probably wisest for us to shoot for this age and be somewhat prepared (at work, etc) to see this babe a few weeks early, at least.  Dr. Sizemore is, as I've said before, AWESOME and wants to see me back in 2 weeks for another ultrasound and the official setting of the due date (da dada dA!)...but he said he'd be happy to give me another ultrasound this week if I needed to see that everything was okay again.  You'd think he knows me or something.

But...we actually ended up with another ultrasound just 2 days later.  I have been spotting some for the past couple of weeks, but I know that can be normal, and I had some similar spotting with Becca.  But on Friday morning, I woke up with more significant bleeding, so we went in to take another peek.  Everything still looked fine, and in the absence of any anomaly in the ultrasound and/or significant cramping, the doctor (this time Dr. Sizemore's partner, Dr. Didier, whom we also really liked) chalked it up to the blood-thinning effects of the baby aspirin and the Lovenox.  He figures that any bleeding I do have is going to appear more significant because, well, there's going to be more of it because the meds are doing their job...which hopefully means that the placenta will form without clots.  I talked to him about my nausea (which had gotten so bad tht I stayed home from work on Thursday), and he gave me a prescription for Zofran, which has heped some.  So, all is well.

And all is well...but I'm having trouble remembering that.  I'm feeling pretty awful now (with a pretty bad cold on top of tummy troubles), and I think the nausea is reminding me so much of Becca's pregnancy and everything that went wrong with it.  My anxiety has been really high lately, so I'm not planning on dropping my Zoloft dose anytime soon.  Sorry, baby...Mommy's got to take care of herself, too.  But my new mantra is, "Nothing's wrong until something is wrong...and nothing is wrong [yet]."  I don't have much patience for people who tell me that everything is going to be fine because, well, they have no idea a) what we've been through, even you know the story; and b) that everything IS going to be fine.  They just really want it to be fine, and that's sweet and all, but hold the bullshit.  You don't know that, so don't try to convince me of it.  Still...nothing is wrong until something is wrong.  And there are a million things that could go wrong.  But nothing is wrong now.    

Initial Plans

In the name of not re-inventing the wheel or some other time-sucking and energy-draining analogy, below I'm posting the e-mail that went out to our parents after my initial conversation with my OB.  It outlines the basics of my plan of care, and I'll update/fill in more another day.  But now I've got to put the first plus sign to  bed.  :)

Sent 12/28/11 (or so):

So - I talked to Dr. Sizemore, who has been my OB/GYN for the past year and a half or so.  He also delivered Becca when he was a resident at Vanderbilt.  So you could say that he knows my case inside and out.  Literally. Because of my history (namely, severe pre-eclampsia and HELLP syndrome before 28 weeks), I've got significant risks.  (Duh.)  The most significant change we've made in my care is to, oh not be in the job I was in when I was pregnant with Becca.  No overnight on-calls, no rushing to the bedside of dying pregnant women, no skipping meals because I'm the only chaplain in the hospital.  The most stressful thing I have to deal with is my 5th and 6th graders...and working with the likes of Paul Bonner and Mark Price.  While the effect of stress on a pregnancy can't be measured, I think it's obvious that my work situation definitely did not play in our favor with Becca's pregnancy. So I think that might go a long way towards a healthier pregnancy. 

We're also handling my medicines very carefully.  Here's the run-down on those, starting with changes to my regular meds:
- Zoloft - which I've been on for over a decade now for anxiety/depression - we're dropping my dose, leaving it for a few weeks, and then POSSIBLY dropping it again to see how low I can go and still feel okay.  Since my last pregnancy (when they were handing Zoloft out like candy), they have determined that there is some risk to taking Zoloft in the 1st and 3rd trimesters, so they want me as low as possible - but there's also a great deal of risk with a depressed and/or anxious mother, so we're looking for the balance. 
- Prilosec - thankfully, I get to keep it!  That is very exciting because, even though I am only, oh a couple of hours pregnant, the pregnancy heartburn has already begun.  Yuck. 
- Zytec - I get to keep it!  Breathing is a good thing.
- Symbicort and albuterol - Speaking of breathing, my inhalers are good to go.  Very few inhalers are considered risky, I think because they don't act systemically. 
- Trazadone - my beloved sleep medicine - it's gotta go.  It's also an antidepressant and in the same category as the Zoloft, so it's out.  So far, I've tried to replace it with Ambien, which makes me totally panicked and worthless the next day, and Tylenol PM, which was like taking a sugar pill.  Or a caffeine pill.  Next up is Unisom...so we'll see how that goes tonight.  I really, really love to sleep, and my body really, really needs it right now, but I really, really can't sleep without help...so cross your fingers that the Unisom or something else does the trick.
- Baby aspirin (81mg) - I've been taking this for over a year so that I would be on it when/if I ever did get pregnant.  Some studies have shown that this can help prevent pre-eclampsia in subsequent pregnancies.  The science isn't clear on it, but there's plenty of anecdotal evidence that it works, and it's certainly not going to hurt.
- Vitamins - I've been taking over-the-counter prenatal vitamins since before I was pregnant with Becca (as should every woman of childbearing age), but now I've switched to Rx ones, specifically one called PreQ10.  It claims that it can also be effective in preventing pre-e, but, again, the science is kind of soft on it.  But it's certainly not going to hurt, either, so as long as I can get those, I'll stay on them.  (Unfortunately -- and very stupidly -- our insurance doesn't cover prenatal vitamins, so staying on these depends chiefly on my ability to get samples of them - and they don't sample these a lot.)

We're also adding some new ones:
- Metformin - I had actually just started taking 500 mg of this, prescribed by my PCP for a number of reasons.  This is the drug that helped me get pregnant with Becca (but I JUST started it, so it's not to blame for this adorable blastocyst in my belly).  Women with PCOS have a higher risk of miscarriage (even apart from my crazy history), and there is some evidence that Metformin can help sustain a pregnancy through the first trimester.  So what the heck.  I'll take it.
- Prometrium - which is just progesterone - the brilliant Lauren McCormick, APN, suggested that I take this through the first trimester, also to help sustain a pregnancy by giving it bonus progesterone.  During the 1st trimester, it's up to my body to produce progesterone, so if I'm low, these little pills should help compensate.  After the 1st trimester, it's up to the placenta to produce progesterone, but it's not making it then, there's not much we can do (and we have SUCH good luck with placentas...).  Anyway, Lauren started me on it, and Dr. Sizemore thought it was a very wise call.  (Good job, Lauren!)
- Lovenox shots - yep, I get to give myself a shot everyday now.  Becca and I can do them together, I guess.  Last time, I tested borderline positive for a clotting disorder in pregnancy, so I eventually started the shots then.  We're going to be proactive and go ahead and start them now.  Anything we can do to help the placenta (again, our best friend/worst enemy in Becca's pregnancy) is a good thing, and while we're not sure it will help, again, it won't hurt, so I'll certainly do it! 

Dr. Sizemore will see me soon after I get back in town, right around 6 weeks, and they'll do an ultrasound (hopefully visualize a heartbeat) and run a BUNCH of baseline tests.  There are lots of levels that we will have to keep checking throughout the pregnancy (liver enzymes, protein in my pree, blood counts, platelets, etc), so they will want some baseline readings to compare then to.  I've still got my blood pressure meter, so I'll be checking that regularly at home.  We'll formally decide which specialists I want to see at my appointment - I know Dr. Sizemore likes the guy just above his office at Williamson Med, but they only deliver at Centennial for Level III NICU care, and, while I've got friends who have had positive experiences there, it's not Vandy.  And I know enough about the NICU's around here to know that the absolute best care a preemie can get in Nashville is from being IN-BORN at Vandy - not getting transferred there later.  So I think we'll co-manage with Dr. Sizemore and the Maternal-Fetal group at Vandy (the only high-risk folks who can deliver there).  Like John said yesterday, I'm just not going to be comfortable going anywhere else.  And my being comfortable is half the battle here.

Emotionally, I am doing okay.  Of course, I am OVER THE MOON excited, but I'm also anxious.  It would be impossible not to be, given our experiences.  I had a moment today when I was at the pharmacy to pick up my Lovenox shots when they told me that I'd have to come back tomorrow because they had to order them.  I started to freak out about waiting a day to start them and was trying to think of a way to demand that they get them to me (crazy preemie mama coming out)...but then I realized that one day is probably not going to make a difference, and besides, the doctor wasn't 100% sure we needed to do them anyway.  But of course I'm going to freak out a little bit.  Not only am I facing trigger after trigger for the former trauma, I have very real risks that I have to take seriously.  So I'm trying to give myself some grace and let myself freak out when I need to...but then come back around to the really good plan we have in place.  It sounds cliche, but I am finding it easy to really and truly experience every day that I am pregnant as a blessing.  It was damn hard to get here and there's not telling how long it will last, but at the moment, today, I am pregnant, and I am loving it - the pregnancy and the little bitty poppy seed itself. 

Physically, I am (predictably) exhausted.  And really hot.  And somewhat heartburn-y.  And really hungry.  And when I get too hungry, I start to feel faint and just a touch nauseous, so I'm afraid that the nausea may be on its way.  Cross your fingers on that one, too.  (I was very sick the entire pregnancy with Becca.  I could give you a tour of most of Louisville, just showing you all the restaurants and roads I throw up in and on.  It was a rough 7 months.)  There's a chance that the extended nausea I had with Becca was linked to the placental issues, so maybe if we avoid the big stuff, we will also avoid the puking.  Of course, I will take puking for 9 months if that's what it takes, but it would be nice not to feel awful the entire time. 

So that's what I know.  I'll keep you posted.  (Yes, Mom, I will.  See?  I am.)  I'm hoping there won't be much to talk about.  And like I said, I'll probably switch to the blog format soon to keep our adoring public happy.  :)  But for now (and then), we'd appreciate all the kind and healthy thoughts and prayers you can conjure up! 

Well....

I have dreamed of writing this post a million times.  Sometimes I even had it down, word for word, in my brain.  But now that the time to write it has finally come, I'm so overwhelmed with emotions (joy, excitement, and terror, to name a few) that I can't even be creative about it.  So I'll just go ahead and tell you what we found out on Christmas day and actually started believing when we saw a heartbeat this morning:

I'm pregnant.

Yep, there's a baby in there.  An embryo, actually.  But a healthy-looking blob of an embryo with its heart all a-flutter and everything.  I'm 6.5 weeks along, putting the technical due date somewhere around September 2.  I'll give you more details later, along with my (extensive) plan of care, but for now, let's just revel in the news...there's another Itty Bitty Hill in the mix!  Though there will always only be one Itty Bitty...so maybe this one is Eensy Weensy Hill.  Let's try that on for a few days.  :)  Please join us in praying for a very loooong and healthy pregnancy.