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.

Rest And Observation

I was supposed to go home Monday after a weekend of resting and being observed, however I ruined my chances of that when I had the chest pain again every early on Monday morning.  Having been told off for ignoring it, I was a good girl and reported it to the midwife on duty.  One ECG later a tired looking doctor came into my room and told me that it was, judging by the description skeletal-muscular in origin rather than a heart attack, palpitations or a pulmonary embolism.  However if I had any more I was to press the buzzer by my bed to report it (I walked down to the nurses’ station with the first one)  Monday morning while waiting to see when I was going to have an Ultrasound scan so that I could go home, I got the pains again.  Cue another ECG and tired looking doctor  in scrubs talking me through the results and the next steps, though as his speciality was gyne he would have to get one of his “medical” colleagues to confirm this with me.

The next steps were a chest x-ray and ultrasound of my legs to check for blood clots, if there were none there it was highly unlikely that I had a “PE” to rule out a heart attack they would have to wait about 12 hours to take a blood sample which would show if I had one.  That 12 hour wait put the kibosh on me going home on Monday.

Having one’s legs ultrasounded is icky, warm gel squirted over the length from ankle to groin, it felt spectacularly wrong and no doubt looked it.

The bloods were taken by an incredible efficient Russian doctor who had the needle in my left arm almost before I had the chance to point out I was left handed and could the blood be taken from the right arm please.

The results of the tests trickled back over the next few hours – no sign of clots so the risk of it being an embolish are very small and the blood test was negative.

This morning I was packed ready to go at 8:15, I didn’t get discharged until 18:45,  We complicated cases have our individual consultants who are the primary contacts for our care.  Our consultants are busy being on call/in theatre/clinics/consulting with colleagues/having cups of coffee and a bit of a breather before the next thing so despite chasing and nagging by the lead midwife on the ward, we poor inpatients are not necessarily the highest priority especially if its just a case of OKing our discharge.  It’s not an idea situation at all, but to put a spin on it, even though I was bored out of my tiny skull I did manage to get more rest.

But it’s so nice to be home, put Tom to bed, a happy smiley, tired and kissy Tom too.  And to be able to sit on the sofa and give my husband a proper cuddle.

29 weeks, a slip and a slide

We’ve made it to 29 weeks which means if the baby was born today she’d have a 9x% chance with expert care. But we don’t have to worry about that, because at my weekly scan today things looked very good in womb-land. Baby had grown and has the head size of a 29 week plus a few days foetus, same for her abdominal circumference. The amount of amniotic fluid around her has increased as well so that’s no longer a worry and the dopplers were really good.

It’s me whose a bit of a mess. I confessed to having a bit of chest pain the other night which I ignored because my fingernails didn’t loose their healthy pink colour. And that The other night I felt really wrong in myself but nothing I could put a name to. That I’ve been in pain almost constantly for a while now, side pain, one or two really painfully braxton hicks contractions, sciatic and higher back pain come and go. pains at the top of the uterus.

And I had a bit of a “fall” this morning. I heard a crash in the house while I was hanging out the washing this morning. I strode purposely into the living to see what was wrong and I stood on one of Tom’s books, the sort of book that has a shiny cover. My left foot went sliding forward, my right one stayed where it was so I did the splits. Except I can’t do the splits, not even when I was young and lithe. At first I thought I had pulled a major leg muscle but fortunately not but my groin muscles are protesting mightily. When I told my consultant all this, after shuffling in like an old lady she told me off for ignoring the chest pain and decided to admit me over the weekend for monitoring and rest. So I’m in a side room on the gyne/new baby ward resting listening to the occasional cry of very new babies.

Holiday

We’ve just had a weeks holiday in Wales, near Tenby.  The weather was variable but we were not down hearted.  It was an excellent holiday possibly because it exceeded our expectations.  The holiday cottage was comfy, there was a free swimming pool in the holiday cottage “village” which was cleaner, nicer and bigger than we were expecting.  The views from the cottage, when it wasn’t raining, were great – we could see the sea, the local pub did really nice food, you get the picture.

We even had one really nice day which we spent on the beach.

We returned on Saturday, setting off early as we had to make an appointment at the hospital for my weekly scan.  My consultant very kindly offered to come in on her day off to scan me, rather than us come back a day early.  The holiday obviously did some good with the pregnancy as well.  The amount of amniotic fluid has increase and the dopplers (measuring how well blood is flowing in the baby’s brain and the umbilical cord) had improved too.  The consultant was very pleased she started to talk about being able to make it to 36 weeks which is a great improvement on what she feared only 2 weeks ago.

Of course we’ve got to remember that 36 weeks was her current best case senario, the next scan could be not so good, or I could go into spontaneous early labour, but right now it’s looking fairly good.  I’m 28 weeks pregnant now, staying pregnant for another 8 weeks is very doable if I get plenty of rest, and don’t take up mountain climbing, absailing or one woman yachting in the meantime.

26 weeks and counting

Yesterday I had a “routine” scan, the results were not fantastic, the baby was not very active & the amount of amniotic fluid had dropped since I was last scanned 10 days ago. This worried my consultant enough for her to send me back down to NNUH for a second opinion. She also said that she doubted we would get to term with this pregnancy and that we are at a high risk of a premature birth. Perhaps within the next 4 weeks.

I had the second opinion scan today. First the good news. Baby is still developing normally, her brain looks normal – inactivity is a possible sign of brain injury. The placenta is working, her heart is ok. There appears to be nothing wrong with her kidneys. She’s fine at the moment. She was also showing nice activity today.

I do not appear to be leaking amniotic fluid, so very unlikely to have ruptured membranes. Also good news

All in all there was no reason to consider delivering the baby now, or admitting me for monitoring.

The more unsettling news is that the levels of amniotic fluid have fallen and there is no obvious reason why. They are not so low that they are a threat to the baby’s well being but a definite cause for concern.
The consultant recommends that I am scanned once a week. I asked him about bed rest & upping my fluid intake to try to up the levels (both recommended by Dr Google) he said not to bother. Drinking more will only give a temporary boost and he had never heard of bed rest helping to increase the amount of amniotic fluid.

We are still at risk of premature birth but probably not this week. And hopefully not the next few weeks after either, but with this pregnancy we’re learning that it’s best not to forecast too far ahead. So I’m not going to say any more than that.

Two today

When he was born it was hard to imagine that this.

Tom - 5 hours oldLittle, squished faced person, who slept and cried and could barely keep his eyes open for more than 5 minutes at a stretch would be this person a year later.

First BirthdayA very little boy who took his first steps with a trolly on his birthday, couldn’t really speak except the occasional mama and dada.  Over the past year he has turned into this sturdy young lad.Tom at Two  He’s had his first haircut and a few others over the year, he’s walking and slowly learning to talk, just yesterday he started pointing at himself saying “me”.  He’s started to show his likes and dislikes.  Tantrums are an occasional feature in our lives.  He’s down to one nap a day though when I’m lucky it’s a long nap.  He’s still not shown a strong preference for either his left or right hand but today he’s been mostly left handed as you can see.  He’s an affectionate, sweet little boy who loves to run around being shouty or snuggle up quietly for either a cuddle or a marathon reading session.  He says “bye bye” to the airplanes that fly overhead, he still adores washing machines and gets upset if I don’t let him help me load or unload ours (oh I hope that trait lasts until he leaves home).  Bananas are the best thing ever and he loves having a bath.  The first time we took him to the beach he fell in love with the sea and cried when it was time to go home, I think if the Royal Navy were allowed to sign up the under twos he’d have joined for life.

He loves climbing up slides and trying to slide down steps, he’s not very interested in soft toys but loves his Happyland and Duplo plastic figures.  At playgroup, he plays with the dolls house (like so many of the little boys do – I think it’s to do with the doors and windows) and then with the toy cars and garages.  He’s getting interested in the other children but hasn’t worked out how to play with them yet.  He loves his grandparents, he loves his Nana’s cat.  But his favourite toy in the whole world at the moment is our iPad2!.  He’s a 21st century boy who gets frustrated because the telly isn’t touch sensitive.  He’s started to try to sound out words, letters and numbers – so far they are all “Eeeeee” but it’s a start!

He’s an amazing boy, and I’m so glad he’s in my life.