It's a little bit ironic... don't you think?

The week of Emerson Claire’s birthday haunts me every year as I can’t help but walk through the days that of my panic as my body failed to stay pregnant and our little miracle entered the world as my soul was paralyzed with fear yet enlightened with the only thing I could do…hope. As many NICU moms can relate, every year while planning to celebrate, a shadow casts over me as I recall the blood, uncertainty and helplessness we felt as I lost my fight to stay pregnant. The smokey California skies this weekend didn’t help me escape again this year...

Every year I walk through November 2015 day-by-day, with the PTSD temporarily creeping back into the aches of my heart that have healed with Emerson’s smile and progress but still hurt

  • November 11- finally 28 weeks, home from weeks of hospitalized bed rest, finally reunited with my Grace but living temporarily at my parents while the house we had just purchased is remodeled.

  • November 12th- picking out stains for our new hardwood floors when sudden excruciating pains overtake my abdomen. I call the doctor and they say I am probably fine but see me. They think it’s my body adjusting to being upright again. Tiny bones break in my feet having used them for the first time in months.

  • November 13th- I start bleeding and can’t get out of bed but too sheepish to go back to the doctor as they said I was fine yesterday…right?

  • November 14th evening- Blood and tissue is passing and I send a text to my MFM who tells me to rush to the ER. I am admitted and I get hooked up to dreadfully painful magnesium drip to prevent brain bleeds in Emery, meds to slow contractions while we try to get two rounds of steroids in for her lungs. Panic overwhelms the physical space as everyone rushes by with uncertain looks. I’m facing a placental abruption and my waters are leaking. I just remember so much tissue and blood, so much pain, and panic.

  • November 15th-  The neonatologist comes in and what may be one of the scariest moments of my life (and Grant’s, my parent’s and Grants’ mom who are gathered in the tiny delivery room.) She unemotionally rattles off all of our odds- for survival, for serious handicaps, and forewarns of the arduous NICU journey. We nod and try not to look at each other and hold it together. Tears well on the inside. Seconds later I can’t help it, I scream and the NICU team assembles in mere second, its truly marvelous Grant and I recall, a fluid team working together. They tell me to hold her in for 2 more minutes, and literally mean to stay pregnant for another 120 seconds. At 90 seconds I tell them I can’t anymore, holding my breath with my heart racing as I battle being unable to keep her in and protected anymore.

    The next 10 minutes are a blur as Grant and everyone hovers over her teeny limp, purple body- but I couldn’t see her then. Grant and the neonatologists whisk her to the NICU and I’m left alone in a bed of blood realizing that the nightmare I tried so hard to avoid all those weeks on hospitalized bed rest was happening- I was living the nightmare. And oddly - all alone.

    Grant was with the NICU team with my phone in his pocket, so no one came by to tell me if my 29 weeker was alive. May not sound like terribly long, but those 4 hours not knowing are etched in every ounce of my body with fear and guilt running through my blood of bringing a little girl into the world 11 weeks too early. It would be days before I could hold her, and when I finally saw her, my first thought was she looked like an uncooked purple pork tenderloin. Who thinks that the first time they see their child?

    With Emery overcoming her 6th battle of pneumonia of 2018 this week, its a reminder how a few extra weeks in the womb would have protected her and let those lungs and immune system grow.

    With so many beautiful congratulations as we announced the pregnancy of our little boy last week, many inquisitive friends also asked how this pregnancy would go with my history and if I’d be blogging. Between working on my doctorate and the two little girls at home, I wasn’t planning on it, but felt compelled to share at least the milestones of this journey.

    So here is the irony: this week, the week that washes over me like a cloud of inescapable soot, I have to have a fairly invasive surgery to stay pregnant... ironic that it’s the same week 3 years ago my body failed to do so. It could very well be the same day.

    We go in for pre-op tomorrow, Tuesday, November 13th up in San Francisco with Dr. Michael Katz- a lauded MFM who has some of the highest success rates in the world and will schedule the surgery for sometime the following 72 hours... which encompasses Emerson’s birthday. With this preventative TVCIV cerclage, timing is of the essence as they have to move my bladder and other internal organs to stitch up while keeping the growing baby’s sac small and safe from incision. 

    I remind my self we have a happy ending with Emerson and live life to the fullest each and every day. This week, while we celebrate our sweet miracle baby’s third birthday and try to forget how we lost our battle to stay pregnant longer, we are taking literally the biggest steps we can to stay pregnant this time around with our little boy to complete our family. Wish us luck!

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Today is World Preemie Day- and it has a whole new meaning for our family

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Today is world preemie day, raising awareness about the battle NICU nurses, doctors and parents of preemies fight for the littlest ones born too soon. I have so much to say, but words will fail to express my heart right now as I am still grappling with the turn of events- grateful our beautiful girl is here and thriving, but terrified. The vulnerability I feel is unlike anything I have ever experienced, with emotions ranging from joy to guilt and so many looming questions. I know they say not to ask those questions: the "what ifs" but I can't seem to quiet my head. What if she had been born at 24 weeks? Thank goodness I did the 5 weeks of bed rest. But what if we had gone for a cerclage instead of a pessary? What if I hadn't been released from the hospital? What if I wasn't allergic to the indomethacin and could have used it to halt labor just another day or two? An allergic reaction for me that would have allowed my baby to cook surely would have been better, right? It seems to be a dark tunnel of confusion, but we are doing our best to stay positive in that we had a good delivery, we were in the right place to get her phenomenal care from the start, and we need to be grateful that maybe bedrest did buy her another 5 weeks of cooking. 

They tell us we can bring her home likely end of January. Grace won't meet her until then. The holidays are going to be extremely tough (but fortunately Grandbarb already ordered her personalized stocking to hang on our fireplace with the rest of the family). Already it is exhausting pumping every 2.5 hours and getting the milk to the NICU, and balancing recovery (I was discharged from the hospital 20 hours after giving birth- I can't believe it hasn't even been 48 hours since this began to unfold) taking care of Grace (fortunately we are still staying at my parents and have their help while our house is being finished), and being at the hospital so we can understand what they are doing to our sweet one. 

Yesterday super-dad Grant and I had a chance to hold her for the first time -- and with the cpap machine removed we could finally see just how tiny her features were. Having only seen her through the Isolette, she seemed small but perfect- just a miniature baby. But holding her crushed both of us, she is so tiny and frail and hooked up to many lines and wires. I couldn't help but feel frustrated that I was robbed of the birth experience of holding my baby right when she was born, and leaving her at night to go home is the toughest thing Grant and I have ever done, but we know she is in good hands. 

This piece was sent to me by a friend, and if there are any other preemie parents out there reading, I thought you'd appreciate. I did.

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Update: Baby Girl coming!

Quick update. I've been admitted now to Labor & Delivery. The pessary has been removed and I am about 4.5cms dilated, 80% effaced and having pretty hefty contractions every 90 seconds. I am on the magnesium drip which fortunately isn't so bad. I am 29 weeks.

We've met with the neonatologists which was terrifying but had all of the grandparents here for the meeting actually which was nice to have everyone in the same page re:extended care. Grant is setting up cord blood banking as I type this, we banked Grace's with CBR and as a last minute decision giving birth at 29 weeks, decided to go ahead with this little girl's cord blood and tissue as well through CBR.

My water hasn't broken and since baby is doing well on the monitors, we are just waiting it out. Likely she is coming today, maybe tomorrow if we can get an extra day of incubation in. 

Really grateful to have our family here. Mom made my favorite cookies this morning for when I'll finally be able to eat after delivery and is sitting with a coloring book in the waiting room- unwilling to leave even though it may be a few hours, and dad is getting me my favorite sandwich (after delivering Grace all I wanted was a sandwich!) Pat and Simone are watching Grace and my mother-in-law is helping Grant by managing things at the new house.  

I am a bag of emotions, excited to meet her but also terrified. Because she is being born so early, I won't get a chance to hold her for probably 24 hours and it looks like she won't come home with us until end of January. The holidays are bound to be tough. (Though I already told my dad that his new granddaughter is his 60th birthday gift- his birthday coming up Friday!)  

love you all, thanks for walking alongside our growing family on this difficult journey. 

 

Baby girls home for the next few months... 

Baby girls home for the next few months... 

29 weeks today!

Hit the 29 week mark this morning, awoken by strong contractions 2 minutes apart and bleeding. I am literally screaming in between typing sentences. Glad to have made it to this milestone, really hoping we can slow down these contractions... Was a tough night but in great hands being monitored closely. 

Last night around 11pm I received the second dose of our second round of betamethasone steroids for baby's lungs. That set off a sea of  uncontrollable contractions for about two hours. We tried to control with Procardia (which I am finding has some not-so-fun side effects of its own) and eventually they settled so I could get a few hours of sleep. The place of placental abruption is now tender to the touch on my lower left abdomen, and the bleeding likely causing the ongoing uterine irritability. 

This morning we are likely moving to L and D. Still awaiting the doctors who are conferring about plan of attack. Baby has been great all week though last night began to show some very mild discrepancies in her charting where we're monitoring closely. IV fluids have been helping a ton with the contractions. Really hoping we can do this circus for at least another week and make it to 30, but if we deliver today, I know God is watching over us and whatever his plan, is meant to be.

Love you all, thanks for the continued support- we really need those extra thoughts and prayers today. Get on out there and have an extra great Sunday for me!  

 

Obligatory ugly hospital selfie. I mean, I am a millennial mom after all :)  

Obligatory ugly hospital selfie. I mean, I am a millennial mom after all :)  

Camp Bedrest Day 21: A look at the Physical Aspects of Deconditioning by Bedrest

Here we are on Camp Bedrest Day 21, doing really well and excited about the possibility of assuming my reclined position back at home next weekend. The past few days I've been blessed with a bevy of visitors- friends, family -- and Grant even snuck Kellydog in for a visit to my surprise! Time still ticks by slowly here in the hospital, especially after dinner until around lunch time, but I took up a few new hobbies learning to "Arm Knit" scarves and blankets on YouTube  and starting a "Bedrest Book Club" with some other bedbound mamas I've met on the forums. I also have been absolutely spoiled by old friends and new ones I have yet to meet with gifts to keep me occupied and brighten some of the darker days--- thank you!!!

As an overly-active young woman (is almost 31 still young? ehhhhh) one of the biggest issues I have been facing since my bedrest "sentence" is balancing the health and wellbeing of my unborn baby and minimizing my own physical deconditioning. Any woman who has had a baby can attest to the fact that pregnancy and labor alone do a number to your strength and conditioning, but adding being immobile for a month, and we are beginning to face a real challenge. I need to be physically able to care for my children when this is said and done.

Each year, 1,000,000 mothers-to-be in the United States are placed on some level of reduced activity at some point in their pregnancy. While bedrest is a hot topic amongst physicians globally, universally it is agreed upon that inactivity and bedrest are unnatural states for the human body.  Except for extreme circumstances (like being 2 cms dilated at 24 weeks!) most doctors, including the American college of Obstetrics and Gynecology, encourage reduced activity but not full bedrest due to the harsh side effects for anyone at risk of premature labor. 

According to a study done by the University of Florida in 2003, the average rate for deconditioning of muscles is "1-3% per day, in 3-5 weeks looking at 50% decrease in muscle strength." According to a 1993 study by the NIH, other major concerns include pain from having muscle fiber and connective tissue in a shortened position over a longer period of time (I can barely flex my feet... my calves are so tight and I cannot use bands or do isometric exercises as these engage my core which could cause contractions and further dilation). After about 3 weeks of bedrest (where I am now) the connective tissue around my joints and muscles is becoming dense instead of loose which means once I get off bedrest, I will have challenges walking, balancing and overall mobility. Today I weighed in 3lbs lighter than when I first arrived. 3 lbs may not sound like much, but my body composition has quickly transformed from being muscle to all fat (and muscle weighs more than fat)-- and this is during a period of pregnancy when I should be gaining about 1lb per week. Working daily on basic physical therapy exercises (ankle rolls, one foot at a time, while not engaging my core) has helped, and I honestly don't feel as weak as the numbers tell me I should. 

In addition to muscular deconditioning, the biggest issue I have been facing is "disuse osteoperosis" caused by lack of gravity, weight bearing exercises and muscle activity on the bone mass--essentially everything we are doing to keep the baby inside me is weakening my bones. Pathophysiologically, bedrest patients see an increase in the excretion of calcium into the urine - which makes kidney stones a major risk factor (something I have lots of experience with unfortunately-- 15-30% of patients on bedrest for more than 5 weeks have had to be treated for kidney stone pain due to incomplete bladder emptying- I believe this statistic calculates the number for those using bedpans and not having restroom privileges though). According to the UFL study, after 12 weeks of bedrest bone density is decreased by up to 50% - causing increased risk for broken bones - especially in labor (interestingly 9.5lb Gracen broke my tailbone during our 23 hours of labor... so I'm also prepared for this ha!) 

Cardiovascularly, bedrest patients typically see an increase in resting heart rate of about 4-15 beats within their first 3-4 weeks; and a decrease in blood volume (5% in 24 hours, 10% in 6 days and 20% in 14 days) which is why the fetal monitoring non-stress-test is so important as a pregnant woman's body is supposed to be doubling the amount of blood volume during this period. I've become fascinated with my monitoring sessions. Blood clots are another major concern, but fortunately technology has assisted here with the awesome "moon boot" SEDs I wear 23 hours a day. I also do hourly training on my peak flow meter to maintain an ample lung capacity (something crucial when it comes time to push!)

So, that is basically where I am at- becoming crippled but for a great reason. As my pregnancy progresses, I will be encouraged by the doctors to do greater activity as the risk of me decomposing will begin to outweigh extra time for the baby to cook. Crazy!

Stress and Pre-term Labor

This image was posted in the Incompetent Cervix Awareness group on Facebook and I felt compelled to share. During my physical therapy, one of the surprising tidbits I picked up was just how important it was for me to destress, as tension is often held in the pelvic floor (for both pregnant and non-pregnant women) which can lead to premature dilation/ early delivery in women who are pregnant. 

I remember at our first prenatal appointment with this baby, the doctor looked specifically at Grant and said, "This is going to be a really really tough pregnancy for your wife. Your job is to make it less stressful." and we kind of laughed it off. Come full circle, it has been a tough pregnancy- perhaps in a different way than she had imagined, but letting go of the stress, trying to keep light-hearted and positive and practice things like meditation has helped me along the way. 

Aside from the stress of being in the hospital for 21 days now and away from Grace, we have been battling getting our rental in Palo Alto sublet, renovating the new home in Los Altos we closed on the day before I was admitted, and being so far away from so many of our friends. It also didn't help getting a message from a high school friend this morning who sent a picture of the garage door of our new home wide open- and finding out my husband flew to San Diego for work this morning (a trip I thought had been cancelled with current circumstances) so I had to scramble from my hospital bed to get someone to close it. Stress could be at an all time high, but I really feel like this experience has challenged me to make the active choice in relinquishing what I could, and not let the negativity or stress of others affect me. I've been blessed to be able to so heavily rely on my mother and have the support of my girlfriends for those times when I just need to vent frustrations and be a bit crazy. And sneaking extra lemons & cucumbers from my hospital lunch tray into my water bottles has made the stay feel more like a spa...errrrr, or not... :)

Scientifically, stress-related "Corticotropin-releasing hormone plays an important role in the etiology of preterm delivery associated with maternal or fetal stress." (Am J Obstet Gynecol 1999;180:S264-6.) Managing hormonal reactions can lead to longer gestation by not putting activating the body into panic mode. According to the March of Dimes, high levels of stress can cause a dangerous increase in blood pressure and heart disease- as well as increasing the risk for a preterm baby (born before week 37) and low birth weight (under 5.5 lbs). Maternal stress can lead to fetal stress, which is why patients like myself are monitored every few hours usually. Maternal stress while pregnant has also been linked with anxiety and attention problems for the child later in life.

Typically, most of my medical decisions are based on hard data-driven science, weighing odds and risk factors and unfortunately there is not tons of conclusive evidence on leveraging stress-reducing techniques to prolong pregnancy, but I honestly believe my personal choice to be as stress-free as possible and prioritize the health of my baby has helped my body stabilize and keep this baby cooking. Food for thought at least. 

Celebrating 26 weeks! Camp Bedrest Day 12

Big milestone today as we have officially made it to Week 26! In other news, I also awoke to a 6am 3 hour glucose tolerance screening (ie blood drawn every hour + sugar drinks) but fortunately all happened in my new room- which is like a suite and has views of the garden and hummingbirds!! Room 166 for the win!

With this new week comes increased viability and decreased permanent disability - two statistics we are ever-so-grateful for! If born during gestational weeks 22-26, a baby is categorized as an "extreme micro-preemie". Next week we graduate to just "extremely Premature" which means most organs will be fully developed and functioning fortunately. I've included an image from the Penut Study below that provides statistics around viability and disability for week 26.

https://penut-trial.org/node/43

https://penut-trial.org/node/43

On Friday Grant & I toured the NICU and met with the doctors there. It was honestly heartbreaking. I have been trying to stay very positive, but seeing these tiny little loves covered in monitors and cords just stung- I had a very very difficult time holding back tears imaging our little girl there. It was a great incentive to keep her cooking, and to recognize the "magic" the NICU nurses and doctors perform watching over these sweet dolls. Most shocking was seeing a baby boy born at 29 weeks whose knee was the size of my pinky-- to think we are still 3 weeks out from being that gestation - I cannot begin to imagine if baby girl was born today.

On a happier note, to celebrate reaching the 26 milestone, Grant & Grace are coming by this afternoon with the ultimate indulgence: Domino's Thin Crust Pepperoni Pizza with a side of Ranch... yes, he has basically bribed me to keep my active self inbed, but it is working! I'd do anything for pizza (okay, really I will do ANYTHING for a healthy baby girl- but the pizza will be a nice change from hospital food!) 

Hope you and yours enjoyed a great weekend!