33 Weeks

The reason I didn’t post last week was that all was going swimmingly well, both for baby and me.  That was until Wednesday, when I woke up with a very sore right foot,  it wasn’t swollen or bruised but it hurt a lot when I put it on the ground.  Fortunately I was able to get a very quick appointment with my GP after my midwife appointment that afternoon, nothing broken just some soft tissue damage, but it was agony.

Wednesday night I started to feel most unwell with stomach cramps, and eventually a most unhappy bottom.  Thursday was spent recovering from a miserable night, Simon who had had the bug earlier in the week, tenderly took the day off to care for Tom and I.  By Friday evening I was finally feeling better when I discovered I had ever so slightly pink wee.  I immediately ruled out cystitis and remembered that it was the pink wee that finally made me realise that my waters had broken when I was pregnant with Tom.  Not that I thought my waters had gone, but a quick call the to delivery suite was probably in order.

They called me in.  Confident that it was just something that needed to be checked out rather than worried about, I set off to the hospital alone, leaving Simon to do an quick tidy up in case it was more serious and my mother in law had to come over to baby sit Tom.  I arrived at about 9:30ish in the evening, given a bed to rest on in the small recovery ward and a cup of coffee, while the midwives and nurses bustled around with quiet determination.  Even though it was a busy night, I was checked, monitored, sampled, examined, given a reason for the blood (“sensitive” cervix) and sent on my way again within 2 and half hours.

This morning I had my regular U/S scan.  Baby is doing well, good dopplers and she’s got yet bigger.  After having a smaller than average head circumference a few weeks back, she’s now packing away the brain cells. The first reading my consultant did showed a circumference measurement expected on a 37 weeker! So she checked the measurements again,  looking carefully at what brain structure could been seen on the ultrasound.  Happily baby’s brain looks normal, and the redone measurements while still over the 5oth are more reasonable. Baby’s leg and abdominal circumference are big too which also makes the head measurements not look so abnormal.

The AFI however isn’t good, from a nice measurement of 10.5cm last Monday it has dropped down to 6.6cm which now places me firmly in the borderline category.  The baby did have a full bladder and stomach so there’s a bit more amniotic fluid to be had once she’d done a wee.  However the levels keep fluctuating and each time they dip, they dip lower.  Because of this I’ve been “promoted” to the the twice weekly ultrasound club.  My next scan is on Thursday with a sonographer, hopefully the levels will have gone up again, if not they’ll call my consultant in and we’ll take it from there.

I’m not worried, even if the baby has to be delivered this Friday, she’s big, she’s healthy and she’ll be 34 weeks then, so the risk of adverse effects from prematurity are so much lower than they were even a week or so ago. Of course 35 weeks is better than 34, and we are aiming for 37 weeks, but whatever happens now, I’m pretty confident she’s going to be ok.

Edited 26 July for sense and grammar.

2 Year Check

Now that Tom is out of warranty, he gets a final check up before being signed out of the Health Visitors’ books. He had that check up today with one of the nursery nurses. The nursery nurses that work in the team are really good, they know their stuff. She checked Tom’s hand eye co-ordination then gross and fine motor skills. Then it was on to the all important language skills. She put out a few objects on the floor and asked Tom to pass them to her. He did ok on those except for the ball and cup which he was very engrossed in and when he did eventually respond to her request for the cup, he gave her the ball. She tested his language skills asking what things were called, he was ok with most things except the cup again, she asked “what’s this?” silence from Tom, finally she said “cup” he replied “ball”

We’ve been worried about Tom’s speech for a wee while, a few weeks before his birthday he only had about 20 words and then we were interpreting the different intonations he gave to “baa” to mean about 4 of those words. Then about 2 weeks before his second birthday he had a speech explosion, he learnt new words everyday, he now tries to repeat a word after we’ve said it, instead of staying mute as he did before. His pronunciation is becoming clearer with every day. Although he is still mostly talking scribble, there are hints of English in there, he does seem to think that we should be able to talk scribble too, but he’s out of luck there.

He doesn’t form sentences though apart from “bye-bye x” including the lovely “bye-bye wee wee” when the loo is flushed. If he doesn’t have a prop he won’t ask for something. So unless he’s got a book in his hands to show me, he won’t ask me to read to him, same for drink and food, he needs to show me the cup or the bowl.

Sally, the nursery nurse said she was going to refer him to the Speech and Language therapist to look into the delay. She said it would take between 6 to 12 weeks to be seen and we might find that in that time he catches up verbally. She did ask about his hearing, I think that there’s nothing wrong with it apart from tendency towards selective deafness when we ask him to do something he doesn’t want to. She doesn’t think he’s autistic, nor do we.

She gave me some hints to help him along with his language, be very verbal when playing with him, keep the language simple, over emphasis can help. Songs and nursery rhymes are good – which I knew but I’ve forgotten so many of the tunes.

She said that he was a “bright, energetic boy” and seemed pleased with him, even with the speech delay. I think the big sloppy kiss he gave her may have helped.

31 weeks

I had my latest scan today but not done by my consultant as she’s on holiday.  One of the hospital’s sonographers whisked me away to the blessedly air conditioned examination rooms.  Healthy baby is healthy, she’s turned during the week so is now head down, I think she must have done so yesterday as I could feel her moving about, in an alien about to burst out of my belly sort of way.  The doppers were good, nice shape and boringly average for this stage of gestation.  As the sonographer said, we like boringly average.  The AFI* though was down, last week it was about 11cm today it was approximately 8cm.  Still within limits, just, for 31 weeks gestation but the sonographer was not unduly worried as the baby has enough fluid to kick her heels in and had a full bladder, once she has done a wee the levels should perk up a bit.  Yep amniotic fluid is basically baby wee with added skin cells and discarded hair and the baby drinks it – no wonder Tom prefers the taste of water once he’s had a chance to “bathe” in it.

The sonographer wasn’t worried, so I shouldn’t be, even if the levels drop down lower next week, they may not take action as I don’t seem to be leaking fluid, therefore no tear in the membranes so we’re at a low risk of infection, and the baby isn’t showing distress.  However I’m glad that I had decided to pack up a bag of baby stuff.  No preemie nappies or clothes as I’m reluctant to spend money on stuff we hopefully won’t need, but I’ve collected up a bright toy for her to look at, a crocheted cotton blanket, baby bath towel and the smallest newborn clothes I could find, some stuff Tom never wore as he never fitted into them.

So how has the last week gone? As I’m getting bigger, the more I’m feeling this pregnancy.  Heartburn is my almost constant companion, Gaviscon is my closest bosom pal.  I’ve got a mild touch of SPD which makes walking and turning over in bed painful.  I seem to be affected by the humidity more than I am by the heat.  Last night according to the Weather Pro app the humidity levels were up in the 90s yet it wasn’t that hot, only 15C, Simon was happily comfortable but I felt like I was in a Turkish Bathing House.  Today it’s pleasantly warm, 21C feeling like 23C but as the humidity level is a more civilised 55% I’m far more comfortable.  The swelling of feet and ankles is getting more pronounced, but that’s just part of pregnancy for me.  My boobs haven’t really changed this time, well as far as I can tell, they didn’t suddenly get bigger when I got pregnant and they quickly conceded the fight to be the first thing in the room to my belly.  I have a feeling that they’ll turn into comedy balloons after the baby is born, might be worth holding off getting nursing bras until the last minute I think.

The hormones seemed to have found the tear ducts.  Until a few days ago, I was quietly pleased that I could read sad news items and watch cynically manipulative TV ads without howling my eyes out, not any longer, the other day the flood gates opened.  Since then I’ve stayed away from items about kittens, babies or brave doggies trekking across Africa to find their masters.

I find it very hard not to worry about the pregnancy.  From Thursday to Saturday evening the baby was very quiet, even though I could count 10 kicks within one hour, I worried.  They were feeble kicks, why was that Braxton Hicks really painful, what if it wasn’t a BH but a real contraction.  Even when everything seems to be going well there is a low grade constant worry, grumbling away.

I haven’t enjoyed this pregnancy, I’m not excited by it either, the worry has been too great.  I’m torn between wanting the baby here now, even as a preemie.  Because at least that way she’ll be in the caring hands of the NICU with dependable machines to help take care of her rather than relying on a placenta that may start failing at any moment.  The more rational part of me thinks no, right now she’s best off where she is, the placenta isn’t failing at the moment, she’s growing well, the longer she stays in the womb the better her long term chances are.  The faff of trying to be with a preemie in NICU, caring for toddler at home, recovering from a C-section, while in the throws of moving house in late August would be horrific.  Far better to be still pregnant and able to do more stuff, even if it’s limited to packing the occasional box and entertaining Tom with books.

The end of this nightmare feels in sight.  We’ve got a roughly 5 more weeks of this at the most.  If all is well at the 33 week scan, we will ask about setting a date for the c-section around the start of week 37, roughly 19th August.

*AFI – Amniotic Fluid Index – the amount of amniotic fluid around a foetus.  Not a precise measurement but calculated by measuring the depth of 4 pools of fluid around the baby.  The pools have to be clear of arms, toes, umbilical cord.  The result is given as a depth in cm rather than as a volume (cm cubed), calculating the volume could well be an assumption too far.  The absolute limits are between 5cm and 25cm but  there are relative limits which relate to the gestational age.

30 Weeks

Another good scan, the baby is doing well, she’s growing apace, the dopplers are good and so is the amount of amniotic fluid. If we carry on like this we are good for 36 weeks, possibly to 37 weeks. I’m in a lot better state too, I’m tired and achy but no longer shattered.

However there are two main things that could stop us getting to 36/37 weeks.

I’ve had a procedure that involves puncturing the amniotic sac I’m at a higher risk of my waters breaking early than for a normal singleton pregnancy.

Of course this isn’t a normal singleton pregnancy – it started out as being a twin pregnancy with one placenta, a placenta that was wired up wrong causing the malformation of the acardiac twin. The placenta has already had a “wobble” four weeks back, we are very fortunate that the baby hasn’t suffered, she isn’t small for dates or show any other stresses from placental insufficiency. We are also very fortunate that the placenta started performing its part again. But because it wobbled once, the chances of it doing it again are far higher than in a normal pregnancy even for a woman of my age.

The frustrating thing is we can’t put a figure to those increased risks, the consultant is very loathe to even try, partly because she doesn’t want us going away with a false sense of security and partly because the factors and events of my pregnancy are if not unique, pretty darn rare. That rareness means the medical literature almost stops being scientific data and starts to be scientific stories. I read in one abstract about TRAP Sequence that since it had been first described in the 17th century there had only been about 400 recorded cases, that not a lot to be going on with.

Even though the risks are higher than for a normal pregnancy it is not a racing certainty that the baby will be born preterm, it’s probably not even likely that she will be, but being prepared for it makes sense.  I have my hospital bag packed, it’s sat waiting by my side of the bed.  I’ve tried to research what might happen if the baby was born prematurely, but as it is so common the information Dr Google gives is somewhat garbled, repetitive, and loaded with anecdotes from mothers who have had preemie babies in the past and are now trying to reassure those who are going through the same thing.  Worthy and comforting but not really useful.

I asked my consultant to run through what would happen if the baby was born today, at 32 weeks, at 34 weeks and at 36 weeks, she and the midwife on the unit did one better they got me a visit to the NICU.

The babies were tiny, the atmosphere was calmer and more cheerful than I had imagined based on what I’ve seen on TV, and far more hopeful too. If the baby is born tomorrow, if she is pink, wriggly and making all the right noises, I would get a chance to hold her almost straight after birth before she’s transferred to the NICU.  Assuming that she didn’t need surgery, she would stay in the QEH NICU until term, getting out early would be a bonus. Surgery would mean transferring to a different hospital.  At first she would be in an incubator with various tubes going in and out as she would have difficulties with breathing, eating and maintaining her body temperature.  Survival rates are roughly 95%.

If she was born at 32 weeks exactly the same things would happen except they would expect her issues to be reduced and survival rates are even better.

At 34 weeks her weight comes into play, if she weighs more than 1.8 kilos at birth, she may not spend that much time if any in an incubator, she may go straight into a cot in the NICU – it does depend on her health of course.  If she’s a heavy 34 weeker she is far more likely to come home early, probably not with me but hopefully before her due date.  Survival rates are pretty much the same as for term babies.

At 35 weeks she’s very likely to be over 1.8 kilos, if she’s healthy at birth, there’s a very good chance that she would join me on the delivery ward after birth, only going over to the NICU for checks and tests.  Theres also a very good chance that she would come home with me.  At 36 weeks those odds are even greater and at 37 weeks she would have to be poorly for the NICU to see her.

Warning – these are typical timescales – our baby may not be typical, and for anyone landing on this page researching what happens with preterm babies these timescales are only good for the Queen Elizabeth Hospital, King’s Lynn and in this year.  Check with your hospital to see find out how they manage preemies it may well be different.

It doesn’t work for everyone, but I feel a lot more in control, (no matter how illusory it may be), now I know what the typical scenarios are for a preemie baby.  I don’t feel as scared of the NICU as I did before I went in, I was worried I would see the tiny tiny babies and burst into tears – I didn’t, I did have a wee cry but that was over something different.  And finally having seen the staff and the parents tending to the parents I have a good feeling we’d be in good hands.