Pregnancy Update #3

I have discussed our pregnancy issues in the following posts: The Unexpected Diagnosis – PJ's Projects (pjsprojects.com) , I Am Tired – PJ's Projects (pjsprojects.com),  Pregnancy Update – PJ's Projects (pjsprojects.com) and Pregnancy Update #2 – PJ's Projects (pjsprojects.com)

I appreciate all of the many words of encouragement and support. This post is another update. 

30 Weeks

Week 30 was pretty boring, which is good considering the alternative. The weekly ultrasound didn't show any changes except that the amniotic fluid level was on the high end. This isn't concerning by itself and everything else looked good. 

Physically, things were progressing, and I also had a mental change this week. It was the change from 29-week mark to the 30-week mark. I don't know what it was about that simply number, but I started becoming more optimistic about our future. I stopped thinking about the monotony of these four walls and started making plans for the fall. I began imagining the differences in my lifestyle in little ways; like keeping a newborn safe from the elements during soccer games, loading up the car with five kids instead of four and how we are going to change the house to accommodate this new arrival. 

I started making plans....and more plans. It gave me a positive focus that I didn't feel that I could risk before this time. I have decided to rearrange multiple rooms and furniture in my home and have drawn out pictures. I have signed the other kids up for some fall activities and added them to my calendar. I have made plans for a fall garden since I had to relinquish the control of the spring garden to my 11-year old. 

I started discussing the need to obtain some baby items. I have been blessed with friends and family offering their slightly used items such as clothes, car seats and an unopened breast pump. In my focus on tests, medical procedures and possible negative outcomes, I couldn't allow myself to think of these items. Now, I am able to open myself to the possibility of accepting their offers and being grateful for their kindness. I even ordered some nursing supplies for myself!

Something about this week allowed me to focus more on the positive rather than the negative. I can't explain it, but I am embracing it. It's much easier to be hopeful for the future than to be miserable in your present. 

31 Weeks

Week 31 has been slightly more eventful but not overly concerning.

The weekly ultrasound resulted in reports of fluid levels on the high side but also the tech mentioning that the defect looked larger than the previous two weeks. She stated that she wasn't sure if these findings were significant but that we would refer to the doctor for interpretation.

Due to how things sometimes run in a hospital, the ultrasound results were not reviewed by the doctor for about 24 hours. This gave me time to think. Thinking is usually good but sometimes it allows your mind to wander to areas that didn't need to be considered. I could only compare the defective uterus to a balloon and if the weakened area was larger and the pressure from the air (or fluid in the uterus) was on the high-end, this could increase the risk of popping the balloon (or uterine rupture). I knew that this may require some decisions to be made. 

The doctor reviewed my ultrasounds and determined that while the defect looked larger this week than the two previous weeks, this was due to the positioning of the baby. When the defect size was compared to measurements completed on admission, it did not change. Basically, the defect hadn't worsened, but the picture was simply clearer. No big decisions were necessary at the moment. 

We are coming closer to our goal of 34 weeks. It has been recommended that the risks of letting the pregnancy continue beyond 34 weeks is simply too dangerous. So, 34 weeks it is!

I realized that my knowledge of the use of steroids during pregnancy was limited to the dosing and urgent administration required in my professional experience. I knew that steroids given prior to premature delivery are proven to decrease the risks of brain bleeding and respiratory distress in the baby. But, I wanted to know more. I did a bit of research and discovered: 

     - Multiple, repeated courses of steroids are not recommended. 

     - Giving two courses of steroids are sometimes performed but not common. The most common indication of this use is when a woman is in premature labor, receives steroids but the labor is successfully stopped. Later, when labor restarts and is still early, another course of steroids are administered. 

      - The most effective range of steroid therapy is from 2-7 days after administration of the first dose. This requires 48 hours from the first administered dose to show the most benefit to the baby. 

I began trying to apply this information to my scenario:

       - If the uterus ruptures, it will require immediate surgery and steroids would not be an option as they would not be able to take effect in time to help the baby.   

       - If I started having contractions, they would administer steroids for the baby as well as other medications to attempt to delay labor by at least 48 hours to get the most benefit from the drug therapy. Stopping contractions with medication therapy is not always successful. 

I only had three weeks left. What if I got a course of steroids at 32 weeks and then another at 33 weeks? It wasn't a common dosage regimen, but could it possibly protect the baby in the event that an emergency delivery would be needed?

My attending OB seemed to have read my mind when she visited as she started talking about the use of steroids prior to delivery. Her initial recommendation was to administer steroids at 33 weeks if we made it to that date without any problems. She stated that she would place orders for steroids and that if I started having contractions between now and 33 weeks, that I should ask that the steroids be administered (she knew my personality and felt comfortable knowing that I would do so). 

I am lucky that this OB is more open-minded than some of the others and is willing to go outside of the protocols or treatment guidelines when they make sense. So, I proposed my far-fetched idea. She considered it as she discussed the situation with her medical students in the room. She explained to the students that in some cases decisions cannot be based solely on scientific literature as we simply do not have enough data. She told them that treatment plans must be made with therapeutic reasoning and patient preferences taken into consideration. If only all medical decisions were made with the primary focus on therapeutic reasoning and patient consideration rather than forced protocols and guidelines!

After addressing her students, the OB did state that the effects of the steroids will last for 14 days and that she was not comfortable dosing steroids in a shorter time frame. However, she understood my reasoning and offered another approach. She suggested that we start the first round of steroids today (31 weeks) and repeat the course at 33 weeks. This would provide the coverage desired for the best outcome for the baby from now until delivery since we all agree that the baby will be born no later than 34-weeks gestation. I was thrilled! This was simply another worry lifted off of my shoulders. I thanked her for her willingness to consider an alternative and quickly agreed to her plan. 

I have never been so excited to receive an intramuscular shot in the booty! The nurse was slightly concerned for my mental health when she saw my enthusiasm for this injection. I explained the reasoning of this alternative treatment plan and she seemed relieved that I wasn't slipping into a hysterical madness on her watch. 

Realistically, I know that we are not completely out of the woods regarding medical problems. I know that my baby will be born prematurely and that she will face obstacles unique to being forced out of the womb prior to the desired time. I know that this C-section will be more complicated than my previous ones and that the surgeon has his/her work cut out for them to ensure that things go smoothly. I know that even with a scheduled date planned, things could change, and complications could occur. Yet, I am more relaxed and optimistic about our future. I can see the light at the end of the tunnel. It's a good feeling. 

Next up, 32 weeks!