Friday, August 30, 2013

After the scare is over - the final trimester continues

I ended up spending two nights in hospital. I thought they were going to keep me in another day at least, so I was pretty happy with being discharged early.

Once I was admitted to hospital the bleeding settled down and thankfully I had no new bleeds. Every time they ran a trace on mini matty he was as happy as a baby swimming in the perfect amount of amniotic fluid can be. Kicking and swooshing away. They also did six hourly observations on me, where they did an ultrasound of mini matty's heartbeat too.

On the first morning I woke up and was looking at my patient information white board. It contained the name of the current midwife, frequency for my observations, frequency for the baby trace, my condition and there was a little section for things my doctor wanted me to do. Written there was ICN tour.

ICN tour. ICN tour. I remember my ob said he'd like us to do a tour of the nursery. The IC nursery? The penny drops - the intensive care nursery. It's 6am, I've barely slept being pumped full of steroids and full of worry. Thinking about going to the intensive care nursery I start to cry. I keep thinking about mini matty being born now and how little he would be. I don't want to get myself unnecessarily worked up. I text hubby to tell him I'm awake and am pleased with his reply that he has packed my bag and will be heading back to the hospital shortly. Not long for me sit on my own and over-think the tour.

When Matt arrives we decide it is time to call our families and let them know we are in hospital. It is hard to tell your family when this stuff is going on as you don't have a lot of information and can't reassure them.

When my ob visits in the morning he again feels my tummy and asks questions about whether I've had any tightening or additional bleeding. All good on both fronts. He says he is going to have me sent for an ultrasound, but that they might not be able to do it that day as it is a Sunday. He says getting the ultrasound won't make any difference to the outcome (that is, if I'm going to go into labour, it is going to happen whether I've had an ultrasound that day, or the next). The ob says we definitely aren't going to our antenatal class that day either. Resting is the order of the day. He says bed rest doesn't mean I can't get up and go for a walk. A walk around the ward is fine, even into the hospital grounds, just don't be going down to Southbank (that would be about 1 kilometre from the hospital).

Matt pops down to the antenatal class and tells the midwife we aren't going to make it to the second day of classes as we were instead trialling the facilities.

I'm all washed out with terribly dark circles under my eyes so we decide after we've had the first trace that we will go to the cafe in the hospital foyer and sit in the sun while having a coffee. It is a beautiful day outside, a bit of sun on the skin is a delight. Matt goes back to the car to get something sorted out with the parking and I head back into the hospital.

Being in the hospital is pretty boring for Matt, but as a patient I feel relatively busy, with all the regular monitoring, meals and snacks arriving every couple of hours. Being hooked up to the trace for 30-45 minutes twice a day sucks up a lot time just watching what baby is doing.

Matt trying to rest on the hubby day bed
One of the downfalls of the monitoring is that it gets you hooked on monitoring. I know this from our early pregnancy issues. You don't believe everything is okay until you are getting the ultrasound. The post ultrasound happiness and confidence wears off in a few days and you find yourself counting down to the next ultrasound, to be reassured the baby is still okay.

I quickly got obsessed with the monitoring. I wasn't worried about my observations, just mini matty's. What his pulse was doing, how much he was moving. If he was quiet for a little bit during the day I'd be looking at the clock counting down to the next trace or baby heartbeat ultrasound. I could sense I was getting a little too into it. I started on the self talk to get myself back to earth - you can feel him moving - he is okay. He is moving as much as he was before the incident - he is okay. All the monitoring has shown he is okay.

On the Sunday we finally are ushered off for the intensive care nursery tour. I've confessed to Matt during the day that I'm nervous about going to pieces during the tour. When we get to ICN the team leader asks questions about how many weeks we are and if we've been told an estimate of the baby's weight. When we say 30 weeks and 1.7 kilos, she says that's great, he's a good size. Another couple joins us at this point for the tour - they are 28 weeks and don't know an estimate of their baby's weight.

The nurse explains the different nursery rooms to us and starts our tour in the most intensive care room. We have to disinfect our hands before we go in. She points out to us a tiny little baby that was born at 29 weeks, and weighs about what our little fella would. Baby is in an incubator, with a feeding tube in his nose. The nurse explains he isn't on a respirator, but is breathing for himself with a CPAP machine (like people with sleep apnea use). The baby is so tiny and so cute. The room is so quiet, with 8 - 10 of these incubators with tiny babies in them. One of them is glowing blue, which the nurse explains is a treatment for jaundice babies.

We go to the next room. There are more mothers in this room and the babies are in a mix of incubators and cots. A mother kindly let's us look at her little baby who is in a cot. He is now 4 weeks old, having been born at 29 weeks and weighing around 1.5 kilos. He has gained 500 grams and looks absolutely adorable, although tiny. He is wrapped up tightly in blankets and is making this cute squeaky sound. He looks perfect. He still needs a feeding tube, but is being trained to moving to sucking for his food. I thank the mum for letting us see him and congratulate her on her cute baby.

We then move onto the last room. This room has loads of people in it. It is the last room the babies go to before they go home. We can't go in as it is already so busy. The nurse tells us that from here, the parents then come back to hospital for a couple of nights and have the baby room in with them and they have the same type of support as women who have their babies at full-term do, to help them get used to taking care of the baby on their own. She tells us that babies are usually the equivalent of about 35-36 weeks before this happens (quick mental calculation - mini matty would be about 5-6 weeks in ICN if born now).

The tour is over and we head back to my room. It was a lot better than I thought it would be. A lot more comforting. A lot calmer. I thought there would be beeping machines and wailing mothers. But no, it was all very quiet and all those tiny babies looked so cute. But still, we want mini matty to stay put!

We have a few visitors on Sunday afternoon. Matt goes home again overnight. I have my second baby lung maturing steroid injection and settle in for the funniest baby trace ever, with mini matty going at full speed pumped up on steroids. They ended up having to leave the trace on a really long time to get a base rate where he wasn't moving.

Mini Matty's roid rage trace. The black squares on the bottom trace indicate when he moving!

Monday was about the same as Sunday, with the only thing to break up the day being the ultrasound, that didn't happen until after 4pm. Mini matty looked perfectly fine during the ultrasound. They did all the measurements again - and again he had a 97th percentile tummy! They did an internal scan to try and measure where the placenta was in relation to the cervix, but the bleed was in the way, so they couldn't really make out the edge of the placenta. The best thing about the scan was the 3D face images. I usually hate ultrasound images especially the 3D images. I always think it they make the baby look wrong. The last one I'd had at 20-weeks, the baby looked like voldemort! Here we were at 30 weeks and finally picture of mini matty's face was quite cute. He looked like a baby. 

Mini Matty's face, with his arm behind.
A couple of hours after the ultrasound our ob arrived and explained the result of scan. The scan had confirmed the diagnosis of a placenta edge bleed. Although they couldn't quite tell where the edge of the placenta was due to the remaining bleed, that will slowly clear, we didn't have any big nasty bleed clots over the cervix that would be cause for concern. So, would we like to go and rest up there for the week instead of in a hospital bed. We are advised about what to do if more bleeding occurs - come back to the hospital - if it is a big bleed call an ambulance and come back to the hospital. Rest is the order of the week. Don't venture far from the hospital. Don't do too much. My ob encourages Matt to spend the week at home so that someone is around if anything goes wrong.

Hooray. Of three bad things and one good thing that could happen, we are looking like we are going have the one good thing happen - nothing!

At home I get a chance to really rest - including having a much better night's sleep in our own bed. We made it through seven days with nothing else happening and both of us started to breathe a little easier. We missed out on a family wedding in northern New South Wales, as the ob thought just in case anything did go wrong - it was too far from the hospital.

In fact I'm now an amazing 32-weeks pregnant! Mini matty is still in utero having a lovely time swishing around. I'm not worried about the monitoring, because our baby moves and moves. I know some people don't love it, but I LOVE my baby moving. The bigger the better. I love it when I can see my whole tummy wobbling with mini matty swooshes and kicks.

Wednesday, August 21, 2013

When my awesome pregnancy takes a tricky turn

I didn't really get around to writing about the start of this pregnancy. I was too busy globe trotting, visiting family and friends in Hong Kong and England to keep up with it. It is probably worth mentioning that as with nearly all of our pregnancies, I had a scary bleed around week 7. I was in Hong Kong and beside myself when I saw the bleed. I thought it was the beginning of end and despite following up with health providers in Hong Kong who said the baby was still viable I was very surprised to make it back home and do a scan around week 9 that confirmed the pregnancy was progressing well. I still took my time to announce the pregnancy - waiting until week 17 when this little fella seemed well and truly settled in.

This weekend we ticked over into 30-weeks pregnant and dutifully attended our first full day of antenatal classes at the hospital. I've been excited about the classes - it is another marker in the progress in our miracle pregnancy. Hubby thinks 6 hours of sitting at antenatal classes on our Saturday is a drag, but a necessary and useful one.

Day 1 of antenatal classes is a little about familiarising ourselves with warning signs in this later stages of the pregnancy but mostly about understanding the process of labour, how long each stage takes and what is happening at each stage. As demonstrated using a small doll and female pelvis, it is clearly hard work to squeeze a small person out through the female pelvis. Yay!

We did a tour of the birth suites, so we could see where we most likely be bringing our baby into the world. We were shown the parking for dad's bringing in their partners and the pregnancy observation unit, where we will most likely go first up when arriving in labour.

The day was undeniably informative, even it it was a little slow moving and I had to sit in the most uncomfortable chair. I was pretty uncomfortable on the day. I just couldn't settle into my seat. My back and hips were sore. All the other pregnant ladies looked alright, but I kept shifting in my seat.

Pleased with an early mark we headed off to do a little appliance shopping - as I've now decided given it is only 10-weeks to mini matty's arrival that I really should get the damn kitchen renovated. I'm mad! So after some time standing around looking at kitchen appliances, we are pretty happy we have decided on the items we will need to finalise our cabinetry and head home.

I'm tired and sore so I head for a lie down. We have another day of classes tomorrow and I don't want to be a wreck for it. The second day's class is all about caring for our new little chap when he finally arrives.

An hour and a half later I wake up and feel a lot better, I wander out to the lounge room to chat with hubby and suddenly find myself feeling wet. It was weird - I say maybe I've weed myself, but I don't know. Matt is laughing at me as I whisk myself off to the toilet. I do a wee and look at my pants, where I clearly seem to have wet myself. Confused I pat some toilet paper on the wet spots to find the fluid is pink, not wee coloured. When I wipe myself it is clear that blood it definitely a part of the mix and the other fluid could be wee, or given I've just been at antenatal classes I begin to wonder if possibly my waters have broken.

I call Matt in and he isn't giggling about it anymore. He gets changed back into leaving the house clothes and rings the hospital as I try to find something else to wear and a mega pad to catch what ever is going on down there for the nurses and doctors to consider. The pregnancy observation unit want us to come straight in. First win from the antenatal classes - we know where to go and where to park! Oh, and of course we know that bleeding at 30-weeks is a bad sign - but I think we would have been on to that.

It doesn't take us long to get to the hospital and into the pregnancy observation unit. They immediately want to look at the mega pad, so I'm given a fresh one to swap to. The midwife gets me into the bed. She has called my obstetrician, he will be there in about half an hour, meanwhile they want to run a trace on baby to see how he is going. Two different monitor things are connected to me with big elastic straps. One listens to baby's heartbeat, the other monitors what my uterus is doing and the baby's movement. I'm also given a button to push every time I feel baby moving. Despite being pretty busy during the day, I'm not really feeling him much now, so I'm given some water and ice to crunch to try to get him going.

Soon enough our obstetrician arrives. I bumped into him in the morning during the antenatal classes, so he makes a joke about not expecting to see us back so soon. He pushes my tummy a bit to see what my uterus is doing. He tells me it is soft, which is good. He asks about how I've felt, have I had pain, have I had any tightening or contractions? I tell him the whole thing has been painless, just a shock. He wants to do a speculum examination to see what's happening near my cervix. Here things aren't so good. He can see a fair bit of blood and clots. He takes some swabs to be tested for infection.

Now for the verdict. The obstetrician explains he thinks I've had an edge bleed from the placenta, known as an antepartum haemorrhage (APH). He explains that the amount of blood loss I've had and how the cervix looked suggests it was more than just the cervix bleeding. He explains an edge bleed can be a one off and if it settles down with no fresh bleeds over the next 7-days that is considered pretty stable - this is good! However a few not so great things can happen and the window for this to occur is the 48-72 hours following the initial bleed. Firstly - the bleed I've had can cause irritation and trigger contractions and labour - this is bad. Secondly more edge bleeding can occur, leading to irritation of the uterus, contractions and labour - this is bad. Thirdly a complete placenta abruption can occur, leading to contractions and labour - this is bad.

So I have one chance of good, three chances of bad. Hmmmm. The conversation from this point gets a little harder. My ob is going to admit me to hospital for now and with three chances of bad happening the obstetrician wants to start me on a course of steroid injections just in case mini matty is rushed into the world. The steroids will help mature his lungs and give him the best chance if he does arrive early.

At this point my mind starts to catch up we are now seriously preparing for a worst case scenario early delivery. I tell my ob that I'm starting to get a little stressed out and don't mind if I have a little cry. He remains calm and says he'll just continue on. He explains the benefits of the steroids and if it were his baby he'd definitely be taking them. Also even though mini matty is 30+ weeks there would be a benefit in me taking magnesium if I do go into labour. Magnesium is commonly used in pre-term delivery under 30-weeks and has something to do with brain development of the baby. He explains research is currently being undertaken into the benefit of magnesium in delivery of 30-34 week babies, and it seems there is a decreasing benefit, but given I'm so close to 30-weeks there is probably a real benefit in our circumstances.

So he wants me to stay in, do the steroid injections and have twice daily traces run on baby to make sure everything is going okay for him. As if I'm going to say no thanks, I'll go home and take my chances.

My ob leaves and says he'll be back in to see me in the morning. The midwife - who happens to also be 30-weeks pregnant - comes in with the steroid injection and jabs me in the leg. She tells me they are just preparing a room for me upstairs and kindly gets us some shabby hospital sandwiches to chow down, given we've missed dinner and are now staying overnight at least.

Soon enough we are transferred to the antenatal ward and I get settled into my room. The midwives here are very busy and we have a decent wait before I get greeted and checked in properly. We have arrived at hospital with nothing - so I have no pjs, no toiletries, no snacks. Just Matt and I in the room in a kind of shock, both of us willing this to be the one off scenario not any of the other three options.

Once the midwife comes in she tells me about the room. She is very specific about my call button and tells me if I have a problem hit it once, if I have a big problem, ie a big bleed, hit the button three times and they will be there ASAP. This is the first time I've been told about this type of button function and reiterates in my mind they are genuinely concerned about this bleed progressing into something more serious.

We decide Matt should go home and try to get a good night's sleep. I can always call him if anything happens, and he can be back in 15-20 minutes. I've prepared a list of things for him to pack and bring in for me in the morning.

I slip into a hospital issue gown and settle in for the night.

Friday, August 2, 2013

The last trimester begins

This week I've ticked over to 28-weeks pregnant and officially into the last trimester. Entering the last trimester I've found things getting a little more about the business end having a baby - which makes a lot of sense I guess.

This week I've had a pre-admission interview with the private hospital we are having the baby at and I'm sorry to report it was a dead set downer.

Making it to this pregnant is still amazing to me.  And for the past few weeks I've really enjoyed being pregnant and started believing I will have a baby soon. I do still sometimes catch myself, and think 'don't count your baby before it's born' - but then I feel the little munchkin kicking away and I'm back to thinking about the much more likely scenario of having a real small person of our own soon.

The telephone pre-admission call didn't start well. I'd missed my initial appointment, so this time I was on the ball waiting for the call, that didn't come. I followed up after half an hour and soon enough I got a call from a midwife. After going through the basics I hit the wonderful question regarding what number pregnancy this is, whether I'd had any miscarriages and terminations. The joy of explaining this is my sixth pregnancy and we've had no children. Then having to remember every lost pregnancy and every hospital the procedures were done in. Trying to explain the heterotopic pregnancy. It was bloody hard - and confusing. She was rushing ahead, getting the details wrong. In the end I was so flustered I couldn't even remember when one of the miscarriages happened. After we went through this history she then asked whether this pregnancy was naturally conceived. Uhmmm, no, it was IVF - did you not just take down my left fallopian tube and then my right fallopian tube were removed due to ectopic pregnancies?

For the past weeks I'd put thoughts about the losses behind and was just enjoying this pregnancy, so all that was a bummer. The midwife then asked about gestational diabetes. I'd just done the test on the weekend and my obstetrician had confirmed that I wasn't diagnosed with gestational diabetes. Yay. He did mention that my numbers were on the high side of normal, so he would keep track of the measurements  of baby just to make sure everything was okay on that front. So I tell the midwife I'd been tested and it came back negative. She looked up my results and then proceeded to lecture me on my numbers being high and that I didn't want to get gestational diabetes. I told her my ob said he'd keep an eye on the baby's measurements. She continued telling me I should be watching what I eat and only eating low GI. If I get gestational diabetes the likelihood of me getting diabetes later in life is increased. Oh and did I know I was already overweight, which puts more pressure on the body and the insulin resistance that can develop...

Yes, I did know I was overweight. Yes I know the risks of gestational diabetes. Yes I got your brochures on breast feeding but figured until I had a baby to try it out with it probably wasn't worth reading. Can we move on now and focus on the miracle that I'm actually 28-weeks pregnant. No, let's talk about my mental health. How am I feeling? Well, now that I'm thinking about the fact that I'm overweight, and that even though I don't have gestational diabetes you've made me panic about my chance of still developing it and remembering the 6 babies I've lost over the past four years, I'm feeling a little sad actually. But 30 minutes ago, I felt great and yes I can cope with the house work, or cope if the house work doesn't get done. Believe me, I've got that down pat.

My first midwife experience and I didn't love it. Yay. So glad I have an awesome, non-panic instilling obstetrician that I get to see instead of seeing scary, kind-of-heartless midwife.

Our next obstetrician's appointment is just over a week away. At our last appointment our ob did the scan to check baby's measurements and mini matty is shaping up to be a big boy. His head measured on the 75th percentile, his femur measured 5cm, which was smack bang in the middle on the 50th percentile, but his abdomen measured on the 97th percentile! He averaged out as being on the 80th percentile and weighing an estimated 965 grams. Apparently all that is fine, if he is just growing to his genetic potential. The key is the measurements that will be taken at our next appointment and whether mini matty is still growing at the same rate. Growing too quickly, getting too big is the problem, and the key problem for gestational diabetes - that I don't have, but apparently I don't get to relax about that until these next measurements are done and (fingers crossed) mini matty measures on around the 80th percentile still.

The pre-admission phone call is a blip and I've been back to loving it again. Last night I did some research and decided what type of bouncer I'd like to get... imagine our own little person bouncing away...