Pregnancy Update #4

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) , Pregnancy Update #2 – PJ's Projects (pjsprojects.com) and Pregnancy Update #3 – PJ's Projects (pjsprojects.com)

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

32 Weeks

This week wasn't medically eventful.

This hospital has attending physicians that switch rotations roughly every week. They technically work as a team, but I have found that instead of discussing their differing opinions with each other, they tend to just show up and provide their opinions on their weeks "on". This has led to some miscommunication and frustration over the time of my hospitalization. I do appreciate the opportunity to hear different viewpoints, especially when they are offered in a scientific and supporting way, but it does add more things to consider. This week was no different. 

The attending doctor noticed the treatment plan regarding the two courses of steroids prior to delivery. He didn't agree with this option. He expressed his concern about the risks of long-term developmental delays when multiple courses of steroids are given prior to delivery. I explained that I knew of these issues with multiple courses of therapy but that these detrimental effects from only two courses were controversial. He agreed and we discussed an on-going trial that is being conducted to test this very theory by comparing patients that received two rounds of steroids in utero and their developmental score at the age of four years. I appreciated his concern and understood his point of view as he is looking at the long-term effects of multiple patients in various scenarios. I was looking at this in a more selfish way. My biggest concern was for the safety of my little one at this moment. I felt more comfortable risking that there may be a chance that I would have to make alterations in her educational and developmental methods in the later years if by giving the second course of steroids would help her with immediate breathing issues during her most vulnerable time in the NICU. He accepted my explanation and stated that he would like to continue this conversation at a later time. I think he wanted to rethink his argument and find other resources to support his case. We both seemed to enjoy this theoretical, respectful, scientific debate. He became busy with other cases, and we didn't get to revisit the issue. It didn't really matter as I had made my decision. 

Another recommendation of this particular doctor was that given that I was so stable, he suggested pushing off the delivery date to 35 weeks. He provided his reasonings that delaying delivery would allow the baby to remain in the womb longer and avoid some of the issues from being in the NICU at 34 weeks. I was intrigued by this suggestion. There are even some babies born at 35 weeks that do so well that they don't require NICU admission at all! I agreed to consider it as we progressed and really hoped that this would continue to be an option. I discussed the recommendation with the hubby. He was against pushing our luck, so we agreed to wait until the end of the 33-week mark to make any final decisions on the topic. 

On another note, I felt the baby making her way downward more into my pelvic area. This led to less heartburn but more pelvic/back pressure/pain. 

33 Weeks

Week 33 was a bit more eventful. 

- The defect was difficult to see on the ultrasound due to the shadows from the position of the baby's head. They were able to do another growth estimate and discovered that she is proposed to be up to 4lbs and 12 ounces! This is still much smaller than my other gigantic babies but, in her case, this was a triumph! 

- I received my second course of steroids. 

- During this week, my doctors switched again, and I had Dr. Talks-A-Lot. We appeared to have come to an understanding. I didn't try to ask for her medical advice and she didn't offer any. We had a treatment plan in place and she simply followed it and made her daily rounds to talk a lot but not say much. It worked for us. I'm glad that we came to this understanding and no longer had any outstanding animosity between us. 

- As the week continued, I started experiencing an increase in Braxton Hicks contractions (7-8 per day). They weren't overly painful but more a feeling of uncomfortable tightness.  

- Towards the end of the week, the hubby and I sat down to discuss our options. We made the decision that with baby moving downward, increased pressure, increased contractions and the reassuring ultrasound that we wanted to follow the suggestion from the doctor that was on rotation for 31 weeks. We kept the scheduled surgery at 34 weeks with this specific doctor. We then scheduled babysitting, the hubby's work schedule, etc. It felt good to have an end date in mind and we felt that our reasonings were sound. We even scheduled a small, family pizza party in the hospital room the night before the surgery to celebrate!

- Well, as has been the case with this kid, her ways of making any plan that we devise more difficult, she decided to cause a few wrinkles. Over the weekend, she experienced several episodes of concerning NST monitoring. She started showing low heartrates (called decelerations), little to no variations in heartrate (not showing accelerations) and decreased fetal movement. All of these were caused by unknown reasons. They weren't always consistent but occurred enough that it led to increased monitoring times and concerns that we may not make it to the scheduled delivery date (just a few days away). The stress and increased monitoring led to a bit of sleepless times. They obtained a good IV access to have in case we needed to go into immediate surgery.

Then, things evened out. Her NST monitoring started evening out and fetal movement increased a bit. We are now back on track for our scheduled surgery. 

- As we were starting to see returns in normal NST monitoring, a new doctor started her weekly rotation. As was typical, she had her own opinions on my case and decided to pick the day after a stressful and sleepless night to discuss them with me. She disagreed with the surgery scheduled at 34 weeks and wanted to push it even further to possibly 36 weeks. She spent this time informing me of the risks to the baby associated with a chosen delivery date at 34 weeks. She was adamant that I was making a mistake and that by letting the baby stay in the womb longer would be better for her health. I agreed with that point. I really wanted her to be in the womb longer. I just wasn't sure that it was possible. If I go into labor or rupture, this delivery will be considered an emergency with additional complications and risks. If we deliver on a scheduled day under a controlled atmosphere, the delivery will be safer, but we are risking more interventions for the baby being born at an earlier than the "have to" date. She didn't discuss any risk factors of pushing the delivery date but wanted to ensure that I knew what I was doing by forcing my baby out of the womb earlier than absolutely necessary. 

It was very bad timing to have this conversation. I was exhausted and had been wrestling with these exact concerns for weeks. I told her that I was confident in my decision in order to get her to stop her lecture and leave the room. But I continued to let her words ring in my head and they made me rethink everything. I was finally somewhat confident in my decision and now I felt the overwhelming guilt again. I know that whatever interventions that the baby will endure in the NICU will be my fault for making the choice to deliver at this early date. I will have to live with that decision and any unknown consequences for the rest of my life. 

I also know that if I push the date and we have extended complications, that I will have to live with those consequences. I will always wonder if I had chosen a more stable delivery if those consequences could have been avoided. 

None of these decisions have been easy. I am such a horrible and selfish individual that I even wished to go into labor prior to the delivery date so that I could avoid making this decision. I wanted to avoid responsibility. I wanted to play the victim and not be an active participator in my life. What kind of mother wishes to go into early labor, knowing that it is not optimal for her baby, simply because she is scared of dealing with the consequences of making the wrong decision? This one! I regretted it soon afterwards, but I let my selfish fears get the best of me.

I burst into tears. The poor nurse taking care of me had to listen to this snot-nosed, ranting lunatic as I tried to pull myself together. She was extremely comforting and supportive. I am grateful to have had her shoulder to cry on. 

Later, I sat in the room by myself and just cried and prayed. I found the verses:

    - 1 Chronicles 16:11 - Search for the Lord and for his strength; continually seek Him. 

    - Proverbs 3:6 - Seek his will in all you do, and he will show you which path to take. 

    - Proverbs 3:5 - Trust in the Lord with all your heart; do not depend on your own understanding. 

I would like to pretend that I immediately discovered the right thing to do and that I am confident and cured of my selfish thoughts, but that would be lying. I am humbled in that I know that my strength is very limited. I am truly a weak person. I am still conflicted in my heart and worried about the upcoming outcomes. However, there are so many things that I cannot control right now. I have to rely on the Lord to be my strength. I am trying. I wish that I was better at this part, but it is difficult for me to give up a sense of control and just be faithful.

Maybe this is why I'm being tested in this way? Maybe I needed to learn this difficult lesson? Maybe I needed to also learn patience and acceptance? I will probably never know God's reason for this part of my life. I just hope that whatever the reasons, that I am capable of learning from them and becoming a better person in the end. 

We are approaching the 34-week mark and plan to continue with the scheduled surgery. I will try to keep you updated but it may be sporadic as I don't know what to expect in the next several weeks. 

If you have kept up with my posts regarding this topic, you may have noticed the emotional ups and downs that accompanied my writings. I can blame it on hormones, being incarcerated, stress and many other things but the blame really doesn't matter. I have tried to be real in my thoughts and feelings in hopes that someone may be able to relate and find comfort in the fact that there are other people in this world that are a confused mess. I hope to find answers and become stronger in my faith as I mature and learn. Others may have it all together, but I'm still a work in progress. I'm beginning to accept that I may never be a completed project, but I can try to be just a little bit better every day.