The Amniocentesis

We arrived early for the 9AM appointment. Sitting in the waiting room, I was excited and nervous, giddy even. My stomach was tying itself in knots. Our car was loaded up with our hospital bags and the car seat just in case.

Earlier in the week, when I explained the plan to colleagues and friends, they were alarmed. “You’re having an amnio? Isn’t that risky?”

I repeatedly explained what the doctor told me. Yes, an amniocentesis carries a small risk of miscarriage. That’s why they use them sparingly in the first trimester to detect genetic and chromosomal disorders. But at 37 weeks, technically full term, “miscarriage” is really nothing more than an early delivery, so the risk of fetal death is just about nill. Even if I were to go into labor and deliver the baby as a result of the amnio, the chances that he would not survive were next to nothing.

In the exam room, the ultrasound technician lubed up my belly and started running the wand over it. We looked at Baby NoName’s limbs and kidneys. She measured his leg bone, his belly, his head. She estimated his weight at six pounds, four ounces, right where he should be for 37 weeks. She looked for big “pockets” of amniotic fluid and estimated the amount of fluid surrounding the baby. She tried in vain to get us a picture of his face, but he had “dropped” so far into my pelvis, that she could not get his whole face, just a profile. “Oh well, we’ll see his face in person soon enough,” I said with an anxious laugh.

The doctor came in and asked if we had questions. Not really. The procedure is pretty straight-forward. They use a needle to extract amniotic fluid from the uterus so that they can determine whether or not the baby’s lungs are fully developed. I asked how long it would be until we had the results. “We’ll call you with the results by 4PM tonight. But I can usually tell just by looking at the fluid. It should be cloudy.” He warned me that the needle is really long. They’re kind of one-size-fits-all, so they need to be pretty long to accommodate moms with a bigger layer of fat. I looked away because I didn’t want to see the needle. I don’t have a problem sticking myself with a needle, but I’m not so comfortable when someone else is wielding the syringe.

He turned out the lights so that he could focus on the image on the ultrasound screen. He joked, “I have to turn out the lights so that I can see better.” I focused on the screen, too. That long needle was kind of freaking me out.

He inserted the needle and I prepared for the sting. But it didn’t hurt at all. Actually, the insertion felt a lot like an insulin shot. After that, I could feel the needle in my belly, but there was no pain. It just felt kind of weird. The whole thing was over in just a couple of minutes. The nurse turned on the lights. “Looks good and cloudy,” he said.

Next he did an internal exam to check my cervix. I was not dilated at all. So assuming that the test results confirmed his “cloudy” diagnosis, Cervidil would be our next step.

In the meantime, we headed over to the fetal evaluation department at the hospital for an hour-long non-stress test. They wanted to monitor the baby and my uterus for normal activity, heart rate, and contractions just to make sure that the procedure did not cause me to go into labor. Baby NoName performed his characteristic turns, kicks, and flips, and, an hour later, the nurse declared the test a success. We were free to go.

The next four or five hours were the hardest part. Waiting for that phone call was excruciating. Right on cue, though, at 4PM, the office manager called from the OB’s office. The results were in and Baby NoName was ready. “Come to Labor and Delivery tomorrow at 5PM. Eat before you come. In fact, eat something good, because they won’t let you eat once you’re admitted,” she advised.

Wow. This is it.

Finally, an Update

First, let me thank the couple of readers I have who have hung on with me through my most recent hiatus. Things are getting kind of crazy in my little world now and blogging has definitely taken a back seat. Without further adieu, here is an update on what’s going on and how things are going.

I am officially 36 weeks pregnant today. Baby NoName is still passing his non stress tests with flying colors. I was scheduled for one yesterday, Memorial Day, and the Fetal Eval Department was closed, so I had to go to Labor and Delivery for the appointment. It was kind of nice to get a sort of dry run for finding L&D and where to park again. The maternity ward was pretty quiet. I’m hoping for the same environment on the big day.

Luckily, when we arrived at the reception desk, I recognized the L&D nurse from the Fetal Eval Department. She fills in there from time to time. Along with Baby NoName’s regular kicks and heart beats, she also recorded two contractions. She says this is normal at 36 weeks. They are just “practice” contractions. They were so weak that I didn’t even realize that they were contractions. They felt kind of like Baby NoName was stretching inside my uterus and just pushing his little walls to their limits. If I have more than six in an hour, I should call my high risk OB.

We officially have a plan for the birth now. Seeing as both baby and I are healthy, we have planned a tentative induction for 37 weeks. That’s next week! I think that if I had resisted and tried to wait this out until closer to 40 weeks, my doctor would have agreed, but the truth is I am tired and grumpy. The testing and prodding and doctor appointments are really starting to get to me. I’m not sure how much longer I can take this routine. Couple that with an increased risk of fetal death in the last month for type 1 diabetic moms, and I am more than ready to get this show on the road.

So the plan is that we have an amniocentesis scheduled for next Monday. The amnio is used to check the maturity of Baby NoName’s lungs. Apparently, the only real risk with an amnio is contractions. When you get an elective amnio in the earlier stages of pregnancy this is more of a risk because it can lead to miscarriage, but at this late stage, the risk is much less because the baby is much more likely to survive if you go into early labor. Basically, contractions at this stage are OK because we are more or less ready to deliver the baby anyway.

If the amnio shows healthy, fully-mature lungs, then we are ready for the induction. If my cervix is not yet dilated, I will be admitted to Labor and Delivery the same evening for Cervidil. This is a prostaglandin gel that they apply to the cervix to soften and thin it. Then they will start the Pitocin through an IV in the morning. Pitocin is an artificial version of oxytocin, the hormone that my body would make naturally during labor to cause contractions.

If I am already starting to dilate on my own, then we will just wait until the next morning, skip the Cervidil, and start with the Pitocin.

I am a little freaked out about the whole induction process. I’m reading that Cervidil can cause painful but non-progressive contractions. And Pitocin can cause contractions to be more painful, but ultimately not work well enough to progress the labor. I have heard horror stories of inductions that last three agonizing and exhausting days and then result in c-sections anyway. It seems that sometimes induction works and sometimes it doesn’t. I expressed my concerns to my doctor who told me that these scenarios are all possible, but that there is no way to know if induction will work until we try it.

He is strongly in favor of induction over a straight c-section given that Baby NoName and I don’t have any of the standard diabetic complications. It is hard for me to believe, but my eyes, my kidneys, my blood pressure, baby’s heart, baby’s weight, and baby’s spine are all perfect. I guess all of those late-night BG checks and the never-ending appointments are finally paying off.

So I made a deal with him. We will try induction for one day (24 hours if we have to use the Cervidil the night before.) If I am not progressing and am not at least semi-comfortable, we will move forward with the c-section rather than waiting another day or two as is his standard procedure.

In the end, I think it just comes down to me freaking out about the whole labor and delivery thing. No matter what route he takes to get out here, it is not going to be a walk in the park,. So ultimately, it doesn’t really matter which avenue he chooses as long as he is healthy.

A Day in the Life of a Diabetic Mom-to-Be

In response to Karen’s great Diabetes Blog Week idea, and also in response to Saffy’s question about how I fit in all of the pregnancy-stuff around work, here is my contribution. The topic is “A Day in the life . . . with diabetes.”

5:45 AM: Can’t wait any longer. Have to pee. I’m dancing in front of the toilet while I fight with the vial of ketone strips. Finally.

6:00 AM: My husband stumbles into the bedroom headed for the shower. Seeing as I have been up at all hours of the night for months now, he usually sleeps on the couch. One of us might as well get a little sleep, right? “Are you done in bathroom?” he asks. I mumble “yes” from under my pile of pillows. I can’t believe it’s time to get up already.

6:30 AM: My husband leaves for work. I do a test: 97. I crank up the laptop and upload my BG readings out of my pump, then print them for my doctor.

7:00 AM: Into the shower. A frantic hour of readying myself for the day ensues: shower, hair, teeth, breakfast, packed lunch.

8:15 AM: Another test: 98. I’m late. I throw everything into my laptop bag and rush out the door. Along the way, I discuss this BG reading with my inner self: “It’s only been an hour since breakfast. Will I be low at the two-hour mark? Maybe not … I did have peanut butter with breakfast. I stuff my meter in my coat pocket and pull out of the garage.

9:05 AM: I’m late for my non-stress test. I roll into the parking garage and make a mad dash for the fetal evaluation center. They hook me up to the monitors, and Baby NoName sleeps. We give him a little jiggle, I drink a glass of ice water, and we use the “alarm clock” to try to wake him up. Finally he startles and starts dancing in there. The peaks and valleys are recorded on the red and white graph paper. A half hour later, the nurse is satisfied. She permits me to move on to the next appointment of the day.

9:45 AM: I arrive on the other side of the hospital at my High-risk OB’s office. I am making good time. Sometimes the non-stress test takes an hour. The office manager smiles and calls me by name from behind the sign-in desk.  I sign in, pee in a cup, and weigh myself. It turns out that the Ultrasound Tech is ready for me already. I do a quick test while I’m sitting on the exam table. The Ultrasound Tech has to wait for me and I feel guilty. 156. Damn peanut butter. I ignore the “insulin on board” recommendation of my pump and dial in a .7 unit correction. Let the ultrasound begin.

Baby NoName is doing great, although the tech discovers for the first time that the umbilical cord is a two-vessel cord, not a three-vessel cord as we originally thought. The doctor assures me that it is nothing to be concerned about, but I make a mental note to google the difference later.

I realize that I left my BG readings on the kitchen counter … or somewhere. Pregnancy brain again. I will have to fax them in tomorrow.

10:45 AM: I finally arrive at work. Another test: 93. Much better. On to e-mails and meeting preparations. I sneak in a quick glance at a couple of DOC blogs between projects. I’m starving, so I eat my mid-morning snack.

12:30 PM: Lunch break. BG is 115. I head out to my car for a thirty-minute cat-nap. I am absolutely exhausted.

1:00 PM: Back in the office, I get back to work, and nosh on my packed lunch. Sometimes it’s one of those “healthy” frozen dinners. Today it’s a ham and swiss sandwich and an apple. Due to digestive woes, low blood sugars, and cravings, my pregnancy diet contains a lot more carbs than my non-pregnancy diet. BG is 62, a little low, so I take a little less insulin than the pump suggests.

4:30 PM: The office is starting to clear out. BG is 55. I peel an orange and start to munch on it while I work on one of many never-ending projects. For whatever reason, my BGs have been plummeting in the evenings, so the 4:30 snack has become a normal part of my pregnancy routine.

6:30 PM: One final test before I hit the road: 83. Afraid that my sugar might be dropping, I grab a handful of M&Ms from the office candy dish. I pack up and leave because the “late shift” support rep is locking up, even though I don’t have all of my hours in for the day. This means tomorrow will be an extra long day.

7:30 PM: I am at home, collapsed on the couch. My husband and I are trying to think of something to eat for dinner. All I want to do is sleep, but my BG is low AGAIN. We settle on grilled cheese sandwiches. I am delighted because he is doing the cooking AND the cleaning up. We watch a little TV while we eat and catch up.

9:00 PM: I can hardly hold my eyes open. I get ready for bed, do a test, take my pills, and double-check my stash of juice boxes and gum drops on the nightstand. Satisfied that I have enough sugar to make it through the night, I fall into bed. Because I under-bolused for dinner in fear of another low, I am at 180 now. I take a small correction bolus and settle in under my pile of pillows.

11:00 PM: My husband is on his way to bed. He wakes me up to test. 105. The number barely registers before I roll over and fall back asleep.

2:00 AM: I have to pee. Again. And my hip is killing me. While I’m up, I test. 65. Eyes closed, I slurp down a juice box and then drop it on the floor in the general vicinity of the trash can. Close enough.

4:00 AM: Again with the peeing and the testing. Luckily, my BG is in the “safe range.”

6:00 AM: My husband stumbles into the bedroom … another day begins!

There are a bunch of other D-bloggers participating in Diabetes Blog Week, too. Check out the list on Karen’s blog here.

Another day, another appointment

I had another non-stress test today. They were busy this morning – all of the reclining chairs were full of moms-to-be, bellies bared, and the wub-wub-wub sound of baby heartbeats was bouncing off of the walls.

While the nurse was hooking me up to the monitor, a lady who is 33 weeks pregnant with twins was sent over to the hospital because she was having pre-term contractions.

This made me a little nervous, so I kept peeking at my print out to see if the contraction monitor was catching anything. The line was flatter than flat. Then I started to worry that there were not any contractions at all, not even the little “practice” ones … sometimes my mind gets the best of me.

Baby NoName is still hanging out in the top of my uterus – way up above my belly button and just below my chest (That explains the constant assault on my ribs.) He really likes my right side, for some reason, too. Even when I lay on my left side, he manages to stay up there, as if he’s hanging from a tree or something.

The nurse keeps saying things like, “this baby is only 31 weeks” and I keep thinking ONLY 31 weeks?! This has been the longest 31 weeks of my life! What she means, of course, is that Baby NoName’s heart rate does not fluctuate as widely as some of the other babies. This is OK, though, because he is so young.

Luckily for us, Baby NoName continues to pass his “tests” with flying colors. Sometimes he is a little sluggish, but who can blame him? This schedule is grueling, and seeing as his mom is barely able to hold her eyes open lately, he is probably feeling some sort of overflow fatigue from me. In the end, he always manages to come through with at least a couple of good kicks and then we are on our way.

After my physical therapy appointment tonight, I am appointment-free for a whole three days before the routine starts up all over again next week.

Onward and upward!

30 weeks: Childbirth Classes and More Non-Stress Tests

We spent the weekend in Childbirth classes. Two loooong days of PowerPoint slides and breathing exercises. I am officially scared out of my mind about labor. The pain, the uncertainty, the exhaustion, and then when it’s all said and done, you have to be healthy enough to care for a newborn. And I’m not too impressed with the hospital where I will be delivering, either. I didn’t exactly expect a Ritz Carlton or anything, but a postpartum room with an attached shower would be nice. Maybe I am just spoiled, but I thought my days of shared showers went away when I graduated from college. Heck, even most dorm rooms have fully equipped en suite bathrooms these days!

I’m starting to spend more time at the hospital in the big city than I am in my own home. Between the classes, the non-stress tests, and the doctor appointments, I am there several hours every week. The parking attendant in my go-to garage recognizes me now. As I wander the halls from appointment to appointment, I’m starting to recognize the staff. I’m even starting to get the hang of navigating the crazy hallways and the four different sets of elevators.

This morning I had physical therapy, which helped a ton. My husband had to help me up at one point last night. I was in tears over the whole pain-in-the-rear/pelvis thing. In physical therapy this morning when the therapist snapped those two bones back into place, I immediately started to feel some relief. I hope I can make it until my next appointment on Saturday. I asked about coming in more often, but my insurance only covers 20 visits. So I’ll try to stick it out until Saturday. The therapist did give me some good exercises and seating positions to try to keep everything aligned and strong. We’ll see what happens.

After physical therapy, I drove across town to the hospital where I had a non-stress test and a visit with my high-risk OB. My doctor mentioned that I looked tired. I thought to myself that I am doing pretty well if tired is the best adjective to explain my appearance. I am utterly exhausted. I’m swollen. I’m sore. I’m on an emotional roller coaster. He’s lucky I didn’t burst into tears of frustration and fatigue right then and there.

He says everything looks great … except after he measured my belly, he said with a grin that I am measuring a bit big. Great. I was too distressed to even ask if I should be concerned. I have another ultrasound in two weeks, so I guess we’ll get the scoop then.

In between the physical therapy and the non-stress test, I made a mad dash into a grocery store to to pick up a BG meter. I managed to leave mine on my nightstand this morning. Luckily, they were offering Freestyle Lite starter packs for FREE. It included ten strips and a handful of lancets. It was the highlight of my day.

Tonight it is back to the hospital in the big city for Childcare classes.  We’ll learn how to change diapers, how to feed, and how to bathe Baby NoName, but we’ll also learn tips like when to call the doctor, and what to expect month-by-month. Seeing as neither of us has much experience actually caring for a baby full-time, we’re pretty nervous about it all. Everyone tells you that you just have to figure it out as you go, and we’re trying to keep that in mind, but hopefully the class will give us a little confidence until we sort it all out.

The Non-Stress Test

This morning I headed to the hospital for the first of many Fetal Non-Stress Tests. The test monitors the baby’s heart rate and measures the baby’s movements to measure how the heart rate changes in relation to the movements. The nurse explained to me that, basically, the heart rate should increase by at least ten beats per minute when the baby moves.

First they sat me down in a recliner and strapped the monitor to my belly. Then they handed me a “clicker,” kind of like the kind you might use in a game show. I was supposed to click the button when I felt the baby move.

It turns out that I did not click the button much today. I guess Baby NoName was feeling sleepy or maybe just lazy, because, aside from a bout of the hiccups, he was not moving much. We tried a drink of cold water, which elicited a couple of weak movements, and a “buzzer” pressed against my belly, that Baby pretty much ignored. Oddly enough, I think he is turning summersaults in there right now. After an hour of trying to coax some movement out of the little guy, the nurses agreed that they probably had enough data and that the data looked good. So we wrapped it up and I headed over to the doctor’s office for a routine check-in.

The doctor confirmed that the results of the test were good, and we talked a bit about my blood sugars, which have been all over the place lately. Despite my best efforts to test and track, I cannot discern a trend of any kind. Sometimes I will run low after a meal, other times high. Sometimes my basals will be right on and others I will run high or low. The doctor acknowledged that this is all par for the course. He says that some diabetics find that their numbers shoot straight up in the third trimester, others find that they increase steadily, and still others find that their numbers rise slightly and then tail off. We’re not sure which of these is happening to me yet, so I will just keep testing and treating, testing and treating. Lather, rinse, repeat.

In other, more stressful news, I found out last Friday that my interpretation of the company’s maternity leave options was grossly incorrect. So my anticipated leave time has been drastically reduced. It’s probably best if I don’t go into the details, but let’s just say that my mom had better benefits when she had me in 1978. I am extremely disappointed, but am trying to adapt to this new normal. It means my husband and I need to re-evaluate our plans for caring for our son for the first six months, and that we may need to find daycare sooner than we expected I really do not need this additional stress right now.

On the bright side, some of the girls at work planned a shower for me for this Friday. I am super excited about it, and am trying to keep focused on the upcoming shindig, instead of the bad maternity leave news.