In which I ruminate...

I just turned off the alarm for the maternal heartbeat on my monitor.  It's limits are set at 50 and 120 and I go up into the 120s pretty frequently, typically this is when talking to someone, and so it was a bit annoying.  It's probably a bad sign that I'm more familiar with the machines around here than some of the nurses.  I thought about changing the upper limit, but figured just turning it off would make for a simpler return to standard state, though I believe it does reset anytime it is unplugged as well.

Why I think this fact is worthy of sharing with you, I don't really know, but eh, I never claimed to make sense! And perhaps an even better question is why I think I need to share a picture of the monitor, but I do:

And in the style of live blogging, the whole story changes!  The pulse ox cord apparently had some issues.  I do like that none of us yesterday or last night thought to actually look at the clock and take my puse, we just accepted the 120s to 150s.  My nurse today, who is a favorite and definitely one of the most competent, looked at me and declared that my pulse was not that high, took it by hand and changed out the part. 

See, isn't my life fascinating?
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I have decided that the L&D floor is a time distortion field.  Came in for three hours, stayed for 10 days.  Right now, I'm still here from my two hours of monitoring Monday night.  There had been some talk about letting me go this morning, but while there haven't been any deceleration events (which are apparently measured in minutes), there were more variables and with greater drops than the current on-call OB (who is the doctor I had for four weeks while mine was on maternity leave last time) is comfortable with.  She sounded like she wasn't concerned per se, but isn't feeling sufficiently comfortable with Lefty's strips yet.  It's now a different on-call doctor, my OB doesn't work Tuesday or Wednesday as she has three small children of her own, but today's doctor said that the next one may discharge me after 6am tomorrow
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I know I'd mentioned that I found the changes in the NICU in the last 17 months kind of fascinating when the neonatologist came down to talk, but I've also discovered another interesting change in the obstetrics side of things.  Last time, they didn't repeat steroids.  In the last few months, they've aparently had their thinking come around to be more like a decade ago and they do repeat if it's been around four weeks or so and they think there's a reasonable chance of delivery in the next week or so (this time they were thinking possible c-section for distress instead of PTL.  read as NOT MY FAULT for once).  So, I had two more doses of Betamethasone Sodium Phosphate with Betamethasone Acetate Monday night and last night.  It's possible they will do one more round if I were to go into labor or we were removing the babies for distreen reasons between about 32 and 34 weeks.

By the way, random note, but these shots are much more pleasant in the bum than in the thigh.  Four of my six doses ever have been thigh and I highly recommend taking this route.
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I am on continuous monitoring until we are assured about Lefty's strips and I'm oddly proud of my ability to come and manage.  Many people have a lot of trouble because you can't really get much continuous sleep as anytime a baby comes off the monitor, the nurses have to come in and put them back on.  I am apparently very good at noticing them come in, confirming that they don't need me to reposition and then go back to sleep while they are moving straps and monitors and all of that.  Having a real bed instead of the transformer delivery bed also makes a huge difference.  When they were talking about running continuous monitoring, I in my own mind thought that I could probably only make it about 100 hours before I started to lose it, but I really don't think this is the case.  I think I can stay on as long as necessary without too many issues.

Cool rag doll look!

Biggest problem is needing to keep the pulse ox on 24 hours a day as it makes it much harder to work on things for work or even play around on the computer/phone.  However, one of the nurses said I could move it to my thumb and this makes the typing MUCH easier as I just use my right thumb exclusively fore the space bar and all is good.
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In my last thought, girls are 29 weeks now. Officially non-micros no matter what happens now!  Still voting for them to stay put, but we are really coming along in terms of intraventricular (IVH) and NEC risks now.  AND, they are big enough to serve as a tray when I have to eat lying down to keep them on the monitor:

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So, I think the summary version is that we are still here in the hospital, but all three of us seem to be doing pretty well.  And no reason at this time to expect anything drastic to change.

Oh, and their last possible date is set, July 19.  And since they did finally change from shoulder presentation presenting/transverse upper, to breech/transverse, looks like definitely going to be the c-section route.

Overachieving Fetuses

I'm not sure my brain is qualified to keep track of what I've updated here versus Facebook versus what I've told people.  But it does look like we are due for an update here.

With the exception of one 12-hour stint in L&D Sunday night/Monday morning, I've been successfully serving my bedrest at home.  That was the product of a flareup of the uterus of bitching.  I started contracting Sunday afternoon every 6-7 minutes which increased to every 5-6 minutes after a couple hours.  They were only about 40-45 seconds in duration, so it seemed very unlikely that they were causing cervical change, but since we are still pretty early gestationally and they were regular, they had me come in to get checked and run additional IV fluids on top of my water chugging.

Thought 1 from that 12-hour visit: I was dubbed level-headed and rational for the fact that I took myself.  My logic was that I was pretty sure that I was not having cervix changing contractions, it was bed time and it's much easier to deal with one of your parents leaving at bed time than both and barring an immediate emergency c-section, even in the worst case scenario we should have at least 2.5 hours of warning, so Paul could get up to the hospital.  The nurse said that most moms are too flipped out to think about what will be best for their existing children, so apparently I'm calm as a cucumber.

Thought 2 from that 12-hour visit: if you let them give you 5 of Ambien, you can actually get some sleep on the L&D side!

Thought 3 from that 12-hour visit: I think I've come to an understanding of my uterus of bitching.  It basically responds to anything being off or stressful on my body as a system by contracting.  The actual cervix changing ones from a couple weeks ago I really think were just because of the cold I had.  It does seem like a rational response from the body: body under stress, want to reduce stress, evict occupants.  The destabilizing factor this time is a bit more embarrassing.  I think I had a little constipation going on and that was enough to make my uterus declare that this wasn't what it signed up for and it was going to make things simpler!  So, I think the grand conclusion is that I just need to keep things easy on my body and the uterus of bitching will keep its trap shut aka not contracting.

Got discharged at 5:30 am, so was able to hit my normal Monday morning perinatology appointment.  The preterm nurse was out of town, so I didn't have to see her and went straight to the perinatologist which was very nice!  This was our first week of doing biophysical profiles.  The peri was willing to accept my statement that both achieved 15 by 15 accels during monitoring the night before, so we skipped the NST and just did the ultrasound part of it.  Both got 8 out of 8, but it took quite a while to get Lefty to show her breathing practice.

My favorite ultrasound picture of this appointment was Righty's hand and Lefty's feet together:

Also got a shot of someone's tongue:

 And someone yawning:

Because of the time waiting to get Lefty to show off her breathing, we also get profiles and face-on views of both babies.  And confirmed they are both still girls!

Also confirmed that I don't have the gestational diabetes!  But my vitamin D and calcium levels are low despite the supplementation, so we are stepping them up even more by tripling my vitamin D.  No changes are necessary to my calcium amounts because the theory is that getting the vitamin D levels up will increase my uptake of what I am taking.  And I need to take a belly shot as requested, but here's one from last weekend for now:

And this picture of Chiron sitting on Trajan amuses me and so I am passing it on:

Oh yeah, why did I call them overachieving fetuses?  Well, biophysical profiles don't normally start until 32 weeks and they both got perfect scores at this 28 week appointment and also achieved accelerations of 15 by 15 (meaning 15 beats for 15 seconds) which also isn't normally looked for until 32 weeks.  So, they are overachieving fetuses.  Good girls!

And in one last celebration, hitting 28 weeks will mean that they while they may still end up being preemies, they will not be micropreemies!  And even if they were born in the next few days (not the plan), they should be able to skip the Giraffe incubator phase in the NICU.  So again, go girls!

24 hours

If I can be good for 24 hours, discharge shall be mine, wahahahaha.  By good, I mean that I have to stop bleeding and have no new bleeding, contract minimally on the monitor and I guess feel like I'm good and stable?  We are theorizing that the bleeding was only due to a cervical ultrasound yesterday and so we went ahead and did a cervical exam today so I can have a calm cervix and get discharged.

I'm supposed to be good because my OB is leaving town and won't be back until Monday night and we established that I have a history of misbehaving when she is out (read maternity leave for her in version 2010).  However, I argued that one event doesn't make a history!  And so I can define a new trend.

I really think I am comfortable with the discharge.  I don't feel like I'm in preterm labor.  I feel like I have a pissy uterus that likes to express its displeasure with the world when anything doesn't quite go its way.  But I think it's bark is likely much worse than it's bite.  So maybe it's not a uterus of doom?  Maybe it's just a uterus of bitching?

I'm supposed to be very limited in what I do at home.  No lifting the boys in any time or condition.  No stairs just for giggles.  No housework.  The oddest explicitly stated limited that she gave me was "no shopping".  I'm taking this as meaning physically shopping, so don't worry dear friend Amazon! I can shower, bathe, go to the bathroom and go to doctor's appointments though and continue working from home similar to how I do in the hospital (and since the house is a mile from the office, this is MUCH easier if I need files or anything to be brought to me).  

I think I forgot to mention here that in celebration of finishing mag I bought a stroller the other day!  We have settled on a two-stroller solution to our stroller logistics and I purchased stroller number one.  This is a Baby Jogger City Select with the second seat.  I was feeling enthusiastic enough that I ordered the glider board thing as well.  This stroller will take both of the Chicco Keyfit 30s, but I haven't ordered the adaptor bars yet.  My theory for ordering this stroller now is multifaceted.  One, it allows us to sell the Bugaboo and it's accoutrements on Craigslist while still allowing Poppins and Chiron to get out.  Two, the weight limit on this stroller actually still includes Trajan, so he who has never really used a stroller much can get to play with it this summer and get that out of his system some before it gets into real use.  Three, the 2012s are out and have been out for a while and the 2011s haven't dropped in price and since there were so few changes to the 2012 model, they probably won't anyway, so it made sense to be the stroller to buy.

If you're curious, the second part of our stroller logistics solution that we have settled on is a Valco Trimode Twin with a Joey Seat for Chiron.  The BJCS will be more for Paul and I (who can sling or Ergo a third if necessary) and in the car while the Valco is mainly for leaving at the house and for Poppins to utilize.  The model years on the Valco don't seem to be updated and I want to get more on top of it's product line development and history before I buy one.  Also, the colors are giving me pause.  I think we'd probably do best with just the Raven, but it doesn't seem to exist, so maybe the Arctic?

Have we noticed the leaps of faith I've taken?  We are employing an entire person, I bought a stroller and we have girl clothing in our garage up to 3T.  We also now have three crib mattresses and are moving towards figuring out bunk beds for Trajan so we can turn his full-size bed back into a crib.

And in other news, my subtle pity party has ended as scheduled this morning and I'm back on board conquering the world and generally being competent and in charge.  It was a subtle pity party, but it still feels good to be over.

And for some random pictures because I think they are fun:

Chiron on the way to storytime with nanny yesterday in a picture she texted me:

 

The awesome alligator that one of my friend's fiance's crocheted and she brought to me.  He does amazing work!

My bed stuck up high by the exuberant Trajan.  He really does enjoy the hospital bed.

And my view, because well, ain't it awesome?

So, the conclusion is that my uterus and my cervix are both whiners and like to vent their agitation frequently, but they keep doing what they are supposed to do despite being big pansies.  Keep it up guys.

No news news

No news is the best kind of news, right?  Still hanging out at the Seton Spa and Resort, but am now ensconced in stable antepartum care.  I saw my OB this morning and the plan is to evaluate Thursday.  I was supposed to have my weekly growth/modified BPP scan today, but the perinatologist shifted it to tomorrow.  If that is good, plus I look good on a cervical exam which my OB does on Thursday and I can commit that I can adhere to real bedrest at home, then I will be discharged Thursday.  If any of these three conditions are not true, then I stay here.

Right now I'm trying to keep an open mind to either outcome.  Being honest, I'd rather be at home.  I really think between having Paul and Poppins, I should be able to be a good bedrester (and my mom is here for right now, but she has responsibilities out of town, so trying to plan without relying on her) and this would let me see the boys.  And bedrest is much better with dogs than without!

There are nice features of hospital bedrest as well though.  In particular, visitors!  I think people are more comfortable dropping by the hospital than a house, so I get to see more folks which definitely helps the mood.

I luckily am able to work full-time from either the hospital or the house which I think is crucial to my good spirits.  The house is a mile from the office while the hospital is 15 minutes or so, so the house would be a little more convenient to the poor soul whose job includes running me files, but she is a very good sport, so I'm sure she's happy to do either way.  I am not having Paul bring my hospital printer up here to get setup in advance of Thursday.  If they keep me Thursday, then I'll have him set it up.

It's odd being back in antepartum because I know the nurses and staff so well, but it is a nice familiarity and there is real sanity benefit in getting an NST every day and fetal heart tones every night.

It should be obvious from these last few paragraphs that I have no clear preference between being kept for the duration and being discharged.  I think the real truth is I'm on board with whatever the OB and the perinatologist believe is best for the girls.  If I could keep them out of the NICU for one week by being in a bed with my head slanted towards for the floor for a month, that would be more than a fair trade.  Seriously, it is so much easier to be the patient than to watch your child as the tiny patient.  Any hour we can decrease their stay in the NICU by is honestly an hour that's not just better for them, but for our entire family.  So, stay put girls.

The boys basically come here to eat and read books.  And Trajan likes to adjust all the bed buttons.  And there's unlimited pudding.  What's not to like?

All is good...

I really thought I posted something two days ago, but it turns out that perhaps I'm not the best phone blogger while on mag and I didn't put anything.  So, the short version of it is that we are all doing well.  Chiron has less fluid draining from his ears, Trajan apparently is the toughest, most resilient fella on the planet and was completely unfazed by the anaesthesia, the surgery, the pain, the hospital or anything.  And the girls are both kicking butt and I'm getting the word "stable" applied to me.

Longer version:

Bless the commenter who pointed out that I should get a book about getting the tonsils/adenoids out and talk about it with Trajan.  I did and the book said to think about your kid and the degree to tell him or her and I made the decision that he was the type who wanted to know everything that we knew included how he was be gassed, the kinds of tools that they would use to cut, that it would hurt, etc.  He took one of his stuffed animals with him to the surgery, baby jaguar, and this friend also got to go back with him to surgery (since he needed his tonsils/adenoids out) and I'm told that Trajan did a fantastic job talking baby jaguar through what was going to happen.

This is his surly, presurgery pictury and I don't actually know the story on what the face is for.  He LOVES the hospital socks.  That's baby jaguar beside him.  They happily went back through the doors to surgery by themselves, so we were two for two this week for our kids happily heading back with nurses they didn't know for surger :-).

This is his first post-surgery shot.  He came up from the anaesthesia like a trooper (unlike little brother who fought the world like a tiger and was completely disoriented).  He was in love with these rainbow popsicles.  This is immediately after surgery, so he's still pretty high on the meds, but looking great and already explaining that it just feels like he's got a booboo in his throat and that getting your tonsils out is a good thing.

Pretty much immediately after that my mom (who went with Paul for part of the day, Paul stayed the whole day and night) asked Trajan if he wanted some quiet time.  Trajan agreed and even put the nap mask on and was back asleep in less than a minute.  When he woke up from this nap, he apparently seemed pretty much completely recovered.  So, apparently my apprehension was all for nothing and I should have stuck with the half of me that knows my kid and is frankly time and again amazed by him.  Trajan really is a superhero to me.

Just another example of him explaining things to baby jaguar.  The IV is how you let your blood drink, pretty cool, huh, baby jaguar?  Kid thought that getting to sleep at the surgery center was an awesome treat/trip reward.  And then was discharged the next morning with no events!

Little brother has so far been to see me both days and I dub him my cutest visitor to date:

They both came yesterday and I'm going to need to get things set up with books and toys and all again to make this place a fun visiting spot.  I'm highly confident I know what to do to make Trajan have a positive experience with my being here, but I'm much less confident with Chiron.  Any tips to make a very attachd toddler understand visiting his mom in bed would be appreciated.  So far, he's been very happy to just lay in bed with me, snuggle, read, talk and be.  But I also think that he has a little stomach bug that may be slowing him down.

Trajan is still wearing his surgery socks and his arm band and really enjoyed realizing that I had a hospital band too!

I think my dad probably has some pictures of the boys visiting yesterday when they came with Poppins and my parents, but I was much more focused on enjoying them and the like, so all I've got is that shot that shows he has a band too :-).

I'll have an update on me and the girls sometime in the next few days, but I think I may wait until Tuesday when it sounds like we are going to have more of a conversation about "the plan".  I was just moved from L&D to stable antepartum and am set up there.  This gets me a real bed instead of a delivery bed, the right to short showers and the ability to wear clothes instead of a gown.  It also shifts the girls to getting monitored once a day with an NST rather than the continuous or hourly monitoring that we've been doing.

I did have a conversation with a neonatologist the other day and it went pretty well.  There actually have been some substantial improvements in just the 16 months since Chiron was born.  Still hoping to go much longer, but it's a much rosier picture than the conversation I had at 24 weeks with a neonatologist last time.

Anything you want to know about the uterus of doom?  About the girls?  They've been doing great on monitoring, actually achieving 10 by 10 accels pretty often which is fantastic for 25 weekers and are doing everything we could ask of them. 

That's my ramble, what should I update?

New Territory

So, I wrote the title for this about a week and a half ago, but haven't updated anything. Not because anything is wrong, but just been too frantic with work getting things done to have any time between work and the boys and life.

All is good.

On the girls' front, I actually ended up calling my OB's nurse the next morning and talking to her about the preterm clinic.  And totally lost the capacity to speak without crying which is something that happens to me about once every half-dozen years.  Luckily, she's a very patient and kind soul and waited me out and helped me get the whole story out.  The end result was that she talked with the OB and they declared that I didn't have to go to preterm clinic anymore.  However, by that point I'd come to the conclusion that anyone could say something stupid and perhaps I should give her another chance.  So I went ahead and went the next Monday morning and it was fine.  I figure that it makes more sense to follow the recommended protocol as long as it isn't causing me to stress out unnecessarily.  Went again today and I would actually go so far as to say that it was a positive experience with the preterm nurse, so hopefully things will stay that way.

With my flipout I actually ended up seeing my OB last Thursday where she patiently dealt with me 25 item long list of questions that I'd developed as part of my flipout.  This was not the first time I'd done this to her, but the first time she saw it printed out instead of just on my phone or laptop screen.  I kind of thought maybe we'd just get through a few of them and save the rest for next time, but she actually did the whole dang list!

She also talked with the perinatologist and got me set up for weekly ultrasounds with the perinatologist who strikes me as the best.  Until 28 weeks, he is just going to assess their amniotic fluid, look at their heartbeat patterns and generally assess their movement.  Then, starting at 28 weeks he will do a BPP each week.  And at some point NSTs get added in. 

While there is definitely a risk of recurrence in stillbirth due to cord accidents, I'm pretty sure they are doing most of this extra monitoring to keep me sane more than because they think it will make a difference in the girls' outcome.  Honestly, I'm ok with that. 

Here's their heads this morning.  We are definitely in new territory as we are past the point of the demise in the last pregnancy.  ALso, these girls move around a LOT.  At 20 weeks, they were stacked both transverse with the right one lower.  Then at 24 weeks, they had switched and the left one was presenting and she was vertex along the left side of my uterus with the right one stretched across the top transverse with her head to the right.  And then a week later, the right one was back to being presenting and she is breech on the right side of the uterus with the left one transverse across the top of the uterus!  It's anybody's guess where they are going to end up!

We dropped our boys' 0-12 month clothing off with friends yesterday, it was impressive.  Still pretty amazed by that purchase.

On the boys' front, it's surgery week.  Chiron is getting tubes tomorrow and then Trajan is getting his tonsillectomy/adenoidectomy on Thursday.  

Chiron is still adorable:

Trajan was an adorable ringbearer:

Poppins is still going great.  I had a great time chaperoning Trajan's field trip a few weeks ago and CHiron went to his first birthday party for one of his friends.

Life is good, and perhaps now that I've acknowledged I've failed to write about all kinds of things, I'll get back on an updating schedule.  I think it was largely trying to get work ready for me to be out for both surgeries that was kicking me backside, but I do still have a lot of work for the next few weeks, so it's entirely possible that I'll fail as an updater. 

Random note: we have now had 19 or 20 ultrasounds this pregnancy and I'm not even remembering to take pictures of all the shots we get, much less upload them.  How's that for crazy?

In conclusion, I'm sticking with the idea I opened with, all is good.

And I lost it...

So, I've held it together very well.  Hell, I'm not even sure I'd say I've been holding it together, because it's been pretty easy.  I'm rational.  I understand things happen.  And that doesn't mean it will happen again.  So, I've been very fine.  I've taken to thinking of these two as going to be here at some point.  I've entertained the idea that it will be via the NICU possibly, but really expecting them by 37-40 weeks as a part of our day-to-day life.



Then I lost it.



I don't know if it's being at the same gestational age or realizing that I'm going to have to go for the longest stretch in the history of this entire pregnancy without an ultrasound or the preterm labor nurse upsetting me, but I've lost it.  It was definitely the preterm labor nurse as the trigger, but I don't want to put it all on her.



How do I know I lost it?  I called my OB's nurse this morning to confirm that something the preterm labor nurse said I didn't need to worry about and I ended up where I could barely (if that) talk because I was crying and just had lost control.  I'm sitting here typing with tears running down my face.  Thus, I say I've lost it.



To backtrack: yesterday I had an appointment with the preterm labor nurse and then an OB appointment.  The preterm labor appointment was in the morning and went great in terms of the babies and my status as a pregnant person.  Both had good heartbeats.  Blood pressure was good.  Cervix is long and closed, yeah!  OB appointment also went well with both looking good on the quickie ultrasound and she also checked out my cervix and agreed it looked great.  Four cervical checks in 88 hours, I declare my cervix to be pageant queen popular.  Everything medical and related to this pregnancy at both appointments could not have been improved upon.



So, why the crazy?  Well, the preterm nurse took me back to last time.  I had an appointment with the perinatologist and her scheduled for a Thursday, but after feeling jumangi drums and just so much absurd amounts of motion that it distressed me, they had me come in Wednesday to check them out.  They did the 24 week anatomy growth scan (24 weeks would be Friday) and everything looked great.  Viable and perfect were words used.  Yeah, ain't that almost funny?



She brought up this appointment and what I had felt and brought up that this was likely Aurelia doing her best to try to get oxygen.  The nurse even said to communicate "hey mom, I'm not getting air."  Yup, said that to me. 



Yeah, that's a kick in the ass.  But you know what, there's nothing we could have done differently.  There's nothing we could have done to help her.  And if I'm being completely honest, the outcome of two 24&0 weekers one of whom has been experiencing oxygen deprivation likely would not have been a better outcome than where we have ended up.  But still, having someone say that yes, that meant something was wrong and I was the only one capable of getting the message makes me sick.  And now I'm supposed to be watching for fetal thrashing?



I meant to ask the OB about it yesterday and we got to the point of saying that the preterm labor nurse had upset me (though I kept it completely together with her oddly), but got distracted and never got into why.  Go attention deficit.



Also, the OB had convinced me early on this pregnancy that we weren't certain this was a cord accident.  And this I think helped with my piece, because cord accidents are one of the causes of stillbirth that has recurrence where many stillbirth causes are flukes.  So, now I'm back to that worry about the recurrence rate. 



Oddly, I just realized that I never changed the little summary box of "our world" that's in the border of the blog page to not say cord accident when the OB convinced me that the neonatal nurse practitioner told me it as a certain cause to make me feel better, but they couldn't be certain.  I will say that cord compressions definitely fit well with the symptoms and the experience of her motion.



And I'm feeling much better post this rant/ramble and a conversation with my OB's nurse, who is an amazingly patient and kind soul, this morning. 



I have the 24 week anatomy/growth scan with these two on Monday and then I will see the preterm lady again.  And then I enter my new distress as the OB set my next appointment for four weeks and the perinatologist will set my next appointment for four weeks, so I will have to go almost four weeks without seeing them on an ultrasound when I haven't gone even two weeks so far this pregnancy.  The preterm labor clinic will do the Doppler, but even she has said that she's not 100% certain she's identifying them separately.  It may seem odd, but the idea of possibly not knowing one is dead for weeks is almost more upsetting than the idea of one being dead.  So, I anticipate some basketcaseness for the next four weeks.



I'm not ok, but I'll make it.

Afterthought: I am very lucky that I'm signed up to work pizza Friday at Trajan's school today. Two hours of serving up pizza and fruit and talking and playing with three lunches of kids and the world is always a better place. I'm still convinced I'm pretty blessed and lucky, even if I'm a bit crazy today.

Preterm Labor Clinic Begins...

My OB's practice sends their twin pregnancies to the preterm labor clinic at the perinatologist starting at 22 weeks.  I did it last time, but only made it to three visits before "it all changed."  Had the first appointment for this go round today and it went well.  Was greeted with a deja vu comment.

I'm up 15 pounds now, which is less than they'd ideally want, but is enough that she isn't worried and says to just to keep up working on it!  I'm 22 weeks and I'm measuring 31 weeks based on fundal height which interestingly is the exact same measurement that I got last time at 22 weeks with her!

We talked through all the activity guidelines and reviewed preterm labor symptoms.  She wants me to work towards working part of each day from the house sooner rather than later, so I need to get my technological ducks in a row.  She also wants me to really minimize my carrying of Chiron as much as possible.  Don't need to eliminate entirely, but cut back as much as I can.

After the discussion, she had me leave a urine sample and then she measured the fundal height, listened to the heartbeats with a Doppler and then did an internal exam.  My urine was excellent, an odd phrase to hear, but I'll definitely take it.  And that coupled with a 120/60 blood pressure (which I think is great for me in a OB/perinatologist setting at this point) indicates all is well on the preeclampsia type front.  Righty had a heartbeat at about 150 while Lefty was around 160.  And my cervix is still very long, she said she would believe it's still around the 5 cm that it was the last time we measured, and the inner part is completely closed.  The outer is open, but that's just because I've had a kid before.

The only thing she absolutely ruled out is that she says I am NOT to be the one to stay with Trajan for getting the tonsils out.  She says that that would be a perfect storm nightmare to cause preterm labor.  She actually had her son's out at the exact same place with the same surgeon a few months before and she adamantly said no.  I can be there during the day for the procedure and all that, but I need to leave for the evening hours.  I'll need to talk with Paul (he has a webcast at work this morning), but I imagine this isn't really an issue and he can just stay with him.  She also recommended that we do get the alcohol-free version of the pain meds for a reason I hadn't thought of.  It burns less when they swallow it, so kids are more willing to take it, so it's less likely that we will fall behind his pain and have issues with that.

Everyone I talk to is making me more and more nervous (not sure that's the exact right word) about getting the tonsils/adenoids out and the degree of discomfort, pain and just plain suffering Trajan will experience with it.  I'm cautiously optimistic that at 4.5 he is much more capable of reasoning and discussing than most of the kids who are at 3 and so perhaps that will help.

Look for another ENT update this afternoon or tomorrow on the Chiron front! (and no, that isn't really an exclamation point of excitement, but it's kind of like the theory of you either have to laugh or cry.  I am going with laughing and living.  And glad that Poppins is in place so both of us have been able to work this time).

And to finish up the preterm labor thoughts, I will see her weekly until 37 weeks or things hit the fan.  She is looking for continued weight gain, clean urine, good heartbeats, cervix staying long and closed and me reporting that I'm cutting back more and more on activities. 

She gave me a sheet just like last time that outlines the key dates (I'd already converted my old one, but just for fun, here they are:)

• April 4 - 22 weeks : Need to be resting a minimum of 1 hour midday and 2 hours early evening and begin decreasing all activities at home and work.
• May 16 - 28 weeks: Uterus will be full-term size and contractions more common.  Need to work a maximum of 4 hours a day in office (if no appreciable work at home).  Can work more hours from a reclined position.  Minimum rest intervals of 2 hours midday and 2 hours early evening.  Curtail activities much further
• June 13 - 32 weeks: "Big Goal to Pass" aka it's all bonus from here.  Moms can tolerate very little activity and no activities of any type should be undertaken lasting over 2 hours.  Work should solely be from home and a reclined position.  (She said I could run up and get stuff, putter around the office for possible an hour a day depending how I'm tolerating)
• June 27: 34 weeks: Will not need steroids to mature babies' lungs, will not give medications to stop labor and babies likely in NICU about 2 weeks
• July 11: 36 weeks: Typically no NICU time
• July 18: 37 weeks: Ideal delivery timing

This whole long list is a little funny as last time I didn't make it past the very first entry before I was no longer free and loose in the world.  But I'm thinking positive!  And always laughing.  No matter what, laughing.


And one last thought.  I was wrong about something.  I'd written before I got pregnant that the reason that I wouldn't ride this ride of pregnancy again for a round three is that my sanity couldn't handle it if something went wrong and in particular if we last another baby.  It turns out that I'm pretty sure that that is not true.  I obviously am not rooting for it, but I have had time to really think about what that would be like and I think I can say with pretty high confidence that I would make it.  That I would process it, work through it and come through it still me, just a little bit different.  I am strong enough.  This may seem a warped thought, but knowing it helps me.