Friday, March 27, 2009

I Guess I Could Post a Picture of My Cervix

I went in yesterday for a checkup and a follow-up sonogram. While I have sonograms every two weeks (primarily to check cervical length), taking a peek at the baby and seeing how she's grown is always very exciting. It's amazing the difference in a gestating infant from one appointment to the next. At yesterday's appointment, though, the doctor checked my cervix -- and nothing else.

It was so frustrating to be so close and not to at least take a peek at our growing daughter. When he was examining my cervix and cerclage, I saw a little foot flash by on the screen, so I know it would have taken little more than a flick of the wrist to show us the whole baby inside. But, no -- a quick cervical check was all he was up for. Then, to make matters worse, at the end of the appointment, he handed me a picture of my cervix. Seriously? Am I supposed to add it to the scrapbook?

Anyway, moving on...

My cervix looked great on the scan and so far the transabdominal cerclage seems to be doing its job. That was especially good news since we're leaving in the morning for a long kidless weekend away. I think we were both worried that I'd be put on restriction and we'd have to cancel our trip, but not only do we not have to cancel, the trip is now physician-approved. Yay!

I think the next two or three appointments will be the most telling for me, though. My next sonogram will be at 22 weeks -- the gestational age my cervix failed during my pregnancy with Zachary, and a week later than it failed with Gracie. I'll see my perinatologist for that appointment, and fortunately, he always spends extra time answering my questions and calming my fears. The appointment after that (at 24 weeks), I'll be at technical viability, and the appointment following that (at 26 weeks), I'll be at the gestational age where we would choose life-saving measures over respite care, were I to deliver prematurely. I think after all of those visits, I may allow myself to let this pregnancy settle in. I may begin to prepare.

Speaking of preparation, I bought a crib yesterday. I'm not really ready to begin buying things for this baby -- particularly not the big-ticket items -- but we stopped by a local thrift store on the way home from a baby clothes swap with a friend, and there it was. It's a beautiful white convertible crib that I took home for $27 plus tax.

Originally, the crib was marked $44.95 (still a very good deal), but the colored sticker indicating a potential sale price was nowhere to be found. I asked an employee in the furniture department if he knew its sale status. He said it had just been put out, so it wouldn't be on sale yet, but he could let me take it home for $30. Of course I agreed, and he handed me the sales ticket marked "Crib: $29.99." At the register, they were having some random sale where mothers took an additional 10% off their total purchase, so after all the discounts, I spent $27 plus tax for the baby's new bed. I'll scrub it down when we get home from our trip, and we'll assemble it later after we find bedding and decide on room decor for the two girls.

Cross Posted on Mandigirl Muses

Wednesday, March 25, 2009

Wherein the Dog Caused Me to Contract

I'm twenty weeks pregnant now. Here's another glorious image of my increasing roundness -- such torture to post! There's something magical about moving out of the teens and into the twenties, gestationally speaking. I feel like my pregnancy is more valid here in the twenties. Still, if I had my way, I'd fast forward through the next ten or twelve weeks. I'd like to just skip the next few months, thank you very much.

On Friday, I had a bit of a scare and considered going to Labor and Delivery. Our dog escaped out the front door (again!) and I ran out after her. I chased her a bit down the sidewalk, and as she stopped to smell a mailbox, I reached out to grab her. As my hand touched her back, she took off and pulled me down to the ground. It all happened so fast, but not fast enough that I couldn't turn mid-air to land on my side instead of hitting the sidewalk face first.

I took the impact on my hand, elbow and hip, and scraped up the side of my leg. Bub, who was chasing the dog after me, was worried, asking again and again if I was okay. The dog even knew she'd messed up and stopped running to cower. I drug her home to her crate and closed myself in my room to cry for a while. James called to tell me he was coming home early about the time I shut my bedroom door. After I answered the phone still sobbing, he's made it all the way home faster than ever.

I soaked in a warm bath to clean up and calm down, but I began contracting not long after my fall. I had five or six contractions an hour for the first couple of hours. They were obvious enough and uncomfortable enough that I considered going to L&D. However, after lots of water and plenty of rest, they went away. I had no other threatening symptoms and the baby sounded fine on the doppler, so I stayed home instead of spending the evening at the hospital. If the dog escapes again, I'm not chasing her -- she can just run until she finds herself a new home.

As for the present, I'm still taking injections to prevent preterm labor, and despite the discomfort of the shots, I'm glad they've been ordered. The nurse comes every seven days, but by day six each week, I'm having some definite uterine irritability with a contraction or two here and there. I've mentioned them to the nurse and they're very common among her other PTL patients right before injection day. I've mentioned them to my doctor and he's unconcerned, provided I'm not having five or more and hour. I'm not having even two an hour -- in fact, it's rare that I have more than three in an entire day -- and they're always resolved with water and rest. The post-fall contractions I had on Friday were two days after my injection. I can only imagine how bad they would have gotten had my uterus not been medically forced to relax.

Other than that, I have a checkup and repeat sonogram in the morning. Even though I'm scanned every two weeks, I'm still excited to have an ultrasound. Time between appointments passes so slowly. I really don't know how people have only one or two sonograms over the course of an entire pregnancy when one or two a month is still not enough! James and I are both very curious about cervical measurement since my cervix changed dramatically in both of my previous pregnancies by 21-22 weeks. I'm anxious to see this transabdominal cerclage doing its job. Updates to come...

Cross Posted on Mandigirl Muses

Monday, March 16, 2009


I'll be 19 weeks pregnant tomorrow, and that's my official halfway mark. Even though I'm still hardly willing to acknowledge I'm pregnant, at the MFM appointment last week, James had the audacity to talk birth plans with the doctor. The doctor said we'd deliver sometime between 36 and 38 weeks, provided there are no complications or hints at uterine rupture before then. He suggested an amnio around 36 weeks to check lung maturity followed by delivery if all looks well. I'm sure my OB, though, will want to wait until 38 weeks if there are no adverse symptoms (something about hospital standards). They'll work it out -- someone just needs to let me know where and when to show up.

Last night as I was praying, I realized I still feel like I'm holding my breath. Though in my heart I feel at peace, in my bones I still feel so unsure about this pregnancy. I've been working upstairs the last few days and I was walking up yesterday, I had this flashback to two years ago. Two years ago, I felt just as secure and sure of an ending, and everything I thought I knew was wrong. I felt tempted to stop what I was doing and to stick my head in the sand, but instead, I pressed on. I finished the task at hand, and I intend to continue doing that.

I will prepare for this baby instead of living in fear of what could be.
I will love her in spite of the pain it could cause.

Cross Posted on Mandigirl Muses

Monday, March 2, 2009

On Injections and Being 16 weeks Pregnant

I'm now 16 weeks pregnant (17 weeks tomorrow), and am still as shocked as ever that this is my life. Please enjoy (if you can) a very rare profile picture of my ever-expanding midsection. Moving on...

I saw the doctor a couple of days ago, and while my MFM does an ultrasound at every visit, the OB didn't plan to scan me at every visit until 18 weeks. With all the early complications, I had scans at every visit, but the 16 week appointment was scheduled to be routine. Instead, I came to the appointment just sure that there had to be something wrong with my cervix. I had no actual proof that there would be anything wrong -- just an overwhelming sense of dread. 16 weeks is the magic number for a lot of people with cervical incompetence to begin having problems, and while I now have the transabdominal cerclage that should make IC irrelevant in this pregnancy, it's difficult to move out of that old mindset. This is my first second-trimester on the TAC -- I'm not used to this new normal.

When I had the TAC placed, I was the only person my OB knew who'd undergone the procedure. Nearly two years later, he has another TAC patient who is just as pregnant as I am. He didn't bat an eye when I asked to have my cervix scanned because evidently the other patient is freaking out in the same way I am. He indulged her a few days before, and he indulged me right away.

As I might have known, my cervix was fine and has lengthened even more. The baby, since she's bigger, is closer to the cerclage, but there's plenty of length on the internal os, as well as on the cervix below the cerclage. From now on, even despite the positive report, I'll be scanned at every visit. Not only is it important to continue watching the cervix and how it may or may not change as the baby gets heavier, it's also important to stay on top of potential complications that may lead to uterine rupture. The risk of uterine rupture is the primary complication with the TAC, but with close monitoring, the overall risk is actually quite minimal. And for someone like me whose cervix will not stay closed even with a cerclage, it's a risk worth taking.

Another milestone this week is the beginning of my 17P Hydroxyprogesterone injections. Progesterone injections are routinely given to women who have a short cervix or a history of cervical incompetence. They're also part of routine care in more than 60% of women with the TAC.

According to medical studies, 17P injections significantly reduce the rate of preterm delivery at less than 37 weeks' gestation, and since both children I've birthed were born before then, I'm a candidate on that basis alone. I also have a naturally short cervix, a history of cervical incompetence, and a TAC in place, and with all of that, there's no avoiding the shots.

The medication is compounded and then overnighted to me once a month. I store it and a home health care nurse comes once weekly to administer the injections. The nurse and I connected by phone today, and after talking for a bit, we both realized she's the nurse who gave me the injections for six weeks of my pregnancy with Zachary. It was so hard to hear her voice on the phone today and to schedule her for Thursdays, the same day she always gave me the shots before. So much of this current pregnancy mimics my pregnancy with Zachary, and that's just one more thing on the pile of pregnancy stress. When I hung up with the nurse, I called James to cry.

I know this pregnancy is not Zachary's pregnancy, and I know that even with some similarities, they're not necessarily destined to end the same way. I'm still struggling to determine if this current course of events is a happy coincidence or not. No matter what, it's quite hard. Obviously, I'm in the season where I'd normally begin to think about the last days before my loss. In just a few days, we'd remember the anniversary of moving into this house -- the house we bought because we were having a baby. We'd remember hearing, "It's a girl -- No wait, it's a boy!" We'd remember painting rooms and hanging baby clothes. We'd remember Easter and that dreaded, dreaded cough. In April, we'd remember going Galveston for one last getaway. We'd remember an appointment that was supposed to be uneventful and some really bad news. We'd remember attempts at salvation that didn't work out, and we'd remember that Zachary lived and then died.

Instead of having time to dwell on all those things, I'm busy being pregnant once again. I'm sleeping and eating and hunting for a heartbeat. I'm going to doctor's appointments and scheduling sibling classes and talking about baby showers with dear, dear friends. I'm growing bigger and more uncomfortable and feeling movement from time to time, and even if I somehow go all the way to my due date with this little baby, I'll face Zachary's birthday and dying day with newly-filled arms. I certainly couldn't be happier about that.

cross-posted on Mandigirl Muses