Last Prenatal Appointment!

So today we had our last prenatal appointment for this pregnancy!

NST first....

It went perfect. Ashlyn was showing off with a bunch of beautiful accelerations. And she got the hiccups at the end! The nurse who did the NST this week was so friendly and compassionate too.

Ultrasound next....

Head size is still measuring big. Ventricles are well over 30mm this week. Luckily, the increases in the head and ventricle sizes are not terribly alarming. With her big head size, the estimated weight was 10lbs 2oz! Yikes!! Good thing I am getting a c-section. Taking into consideration how I feel her in my belly and my mother's intuition, I think she will probably weigh around 9lbs....I guess we will find out on Monday!

Doctor Appointment....

You would think at the last appointment before our c-section, we would see a doctor. Nope...nurse practitioner again. I wouldn't mind seeing an NP, but this one didn't do anything. She just asked me what questions I had and that was it. No physical assessment of any kind since I got an NST and ultrasound already.

C-section is still on for Monday, June 1st at 9:30am...unless of course I go into labor on my own (keeping my fingers crossed that doesn't happen!). I just need to have some pre-op bloodwork done tomorrow morning and show up on Monday at 8am. I cannot believe in 3 days, we will meet Ashlyn Grace!!

My Prenatal Marathon

Well, Braeden will be a big brother by June 1st!!

Today, I had my 36 week appt...it was a marathon day of appointment NST, ultrasound, appointment with the doctor, and visit to Strong's NICU. First we had the NST, which was perfectly reactive. Then, an ultrasound was done. The ventricles in her brain are continuing to increase in size (not good...but expected to happen at this stage). Her head circumference is measuring 42 weeks....Yikes! The estimated weight was 8lbs 4 oz! Granted that estimate is calculated using the disproportionate head size...but still....she is going to be huge! Braeden weighed 8lbs 5 oz when he was born on his due date, and I thought that he was a big boy.

Based on the ultrasound, my doctor discussed needing a c-section. We decided to schedule it for 39 weeks because as she will most likely need a shunt, we want her to have optimal time to mature and develop her lungs fully. This will give her the best chance of having a complication free surgery. But we don't want to schedule the c-section too late where I go into labor on my own....because her head is not going to fit!

So June 1st is the big day! It is great to have a date scheduled...but now I have a plan in action, I am afraid she will have other plans and try to come early. My doctor said that if I were to deliver this weekend, there is a good chance I could try to deliver vaginally. As much as I wanted another vaginal delivery, I am now terrified of the thought seeing the latest measurements...Let's just hope she stays put until June 1st.

Ashlyn will have to spend some time in the NICU after she is born and after her surgery. We got the tour this morning....and my goodness she will look out of place there! Imagine my big (probably well over 9lb) baby girl with all the preemies weighing barely 2lbs....She will look like a giant! At least, I feel lucky that she will be a healthy weight and age despite the one set back. The NICU visit was very helpful, and I really liked the attending doctor we met with. He seemed very compassionate, knowledgeable, and helpful.

Today, I officially am on maternity leave! Now, I just need to get that nesting instinct going....14 days to get everything ready!!

SURPRISE!

I am freaking out! Today, I was shopping at Babies R Us when a women comes in to return a bunch of baby stuff. Eavesdropping, I learned that she is a new grandma and is helping her daughter return all girly baby items. Apparently, they were told the baby was definitely 100% a female. Fast forward to delivery day....SURPRISE! The baby definitely 100% had a penis!!

I know I know...I have had like 50 million ultrasounds....But they don't look at the genitals anymore. So for all I know, Ashlyn could turn into an Austin after all....Scary thought! If I wanted a delivery day shock, I would have opted to keep the gender a secret.

Seriously though, I don't doubt Ashlyn is a girl...that ultrasound picture of her girly parts is pretty obvious! Still, this encounter just got me thinking about the what ifs and has be freaked out. Ugh, as if I didn't have enough to stress over right now.....

Friday at my next ultrasound, I am going to ask for a final verification that my daughter does not have a penis! In the meantime, I am hanging on to all my receipts!

Oh, I am 36 weeks today. I cannot believe how soon Ashlyn will be here. I am so not ready.....I need at least 2 weeks to prepare. Luckily, I am officially on maternity leave starting May 15th!!

NST and Impromptu Ultrasound

This afternoon I went to my first ever non-stress test sans Braeden and hubby. The doctors have decided to do weekly NSTs because of my blood pressure being elevated and the fact that this pregnancy is already complicated to begin with. During an NST, they look at baseline fetal heart rate, the variability of the fetal heart rate, accelerations or decelerations in the fetal heart rates, kick counts (you have to press a button whenever the baby kicks), and contractions. The NST is considered reassuring if the baby has two episodes of accelerations during the 20 minutes of monitoring.

The very nice nurse hooked me up to the monitor (just like the one you get put on when you are in labor) and positioned me comfortably on my side reclining in a chair (so much better bedside manner than at the fetal MRI last week!). Right off the bat, Ashlyn had a beautiful acceleration. Good, I thought, this should be easy! Unfortunately, she proceeds to start having decelerations soon after that....She would drop lower than her baseline fetal heart rate, but very quickly recover. I read online (since I didn't end up getting a great explanation as to why this was happening) that these variable decels can be related to the baby movements or to cord compression. Sometimes the decels correlated to when I indicated that I felt a kick.

Toward the end of the 20 minutes, there was only one good acceleration so the nurse tried some manual stimulation by pressing on my uterus. This did help Ashlyn have another good acceleration. No contractions at all during the test. The nurse took the tracing to show the doctor in the office because of the frequency of the variable decels. Here is part of the actual NST tracing from today:


The nurse came back pretty quickly and asked how I would like to get another picture of my little girl. Another ultrasound? I just had one last Monday! Of course, I did not complain...I love getting ultrasounds and seeing my princess. I had to wait 5 minutes, but they squeezed me in for an impromptu ultrasound. I was nervous worrying that something was really wrong causing my baby to be distress....but the nurse was very reassuring. The ultrasound checked out according the tech after she reviewed the results with the doctor. According to the tech, they were just checking the amount of amniotic fluid, which was completely normal.

During the quick ultrasound, I watched as she measured the ventricle size again....We are up to 19 and 22 mm (up from 16 and 19 mm one week ago) and 7.8 mm for the third ventricle (up from 6.6 mm...keep in mind this is the ventricle that is barely visible on an ultrasound normally). No one commented on this significant increase in one week, but it is obvious that this is a problem that will keep getting worse in a short period of time. The head circumference was not measured this time around...but her head is starting to look bigger than normal on the scans....

Luckily, in 4 weeks I will be 37 weeks and if needed Ashlyn can be delivered so that she can be monitored on the outside. I was content of waiting as long as possible before delivering...but now I feel like it might be in her best interest to come out earlier so evaluations and interventions can be made. It makes me nervous knowing her ventricles are getting further dilated causing fluid to accumulate in her brain. As the pressure in the brain increases that is when you have to start wondering what kind of non-reversible neurological damage has been done....This just keeps getting harder and harder to deal with. I know we can handle it, but I just wish that my daughter did not have to go through all this. For goodness sakes, she is not even born yet.....I just want her to have a normal life because that is what every child deserves.

Here is the latest picture of Ashlyn Grace:

32 Week Perinatal Appointment

We had to get up bright and early today for our 8am doctor's appointment and ultrasound. My first thought for the day....who the hell scheduled the appointment this freaking early (Braeden had a bad night...he has a cold and did not sleep well)! After rushing to get myself and Braeden ready, I was out the door by 7:30am (albeit sans makeup and doing my hair), only to find 390 was backed up already. Traffic stresses me out in general....but when I have to be somewhere on time, it really irritates me! By the grace of God, we got to the parking lot at 8:02am without mommy having a major meltdown or getting a serious case of road rage.

Chris drove separately and also got caught in traffic so he was 10 minutes late. While we waited for his arrival, I gave a urine sample and then proceeded to throw up my breakfast (fruit and orange juice....nasty!). I guess the stressful morning affected my sensitive stomach.....

They called me back for my ultrasound soon after Chris met us in the waiting room. The ultrasound tech took all the necessary measurements, but she didn't really make any comments (technically the ultrasound techs can't tell you much of anything anyway). According to the measurements, Ashlyn weighs about 4lbs 9oz right now! What a big girl..she is right on target to be over 8lbs like her big brother. The tech also said that the amniotic fluid levels were within normal limits.

During the scan I studied the measurments, and I did notice that one of the ventricles measured over 18 mm now (the other was over 14 mm) and the third ventricle measured over 6mm....which means that the ventricles are increasing in size at a faster rate now. The various head measurements were listed as 34weeks 5days and 36weeks and 2days, while I am 32 weeks pregnant.....her head is continuing to get bigger than expected....

After the ultrasound, we went back to wait to meet with the doctor. After showing off for all the other patients in the waiting room, Braeden had a mini meltdown when we would not allow him to tackle another little boy. Chris took him to the hallway to let him roam around and burn off some energy. Finally after waiting forever (actual time...probably 30 minutes), I was called in for my appointment.

First, my blood pressure and weight were checked. For some reason the tech checked my weight twice....I think she just had a "case of the Mondays"...hopefully she wasn't trying to torture me! BP was 142/80....still high. Ugh.....When I met with the doctor she said that right now, my BP does not seem to be related to preeclampsia (phew) because there is no protein in my urine and my 24 hour urine screen was normal. But I do have to watch out for the warning signs....headaches, epigastric pain, vision changes, etc. However, it is recommended that I do biweekly non-stress tests from here on out just to make sure Ashlyn is doing okay in there! So next week I will go for my first non-stress test.

I saw one of the resident doctors first. She was very nice and friendly, and she didn't mind when Braeden wiped his grubby yogurt melt covered hands all our her white coat. She checked the fetal heart rate, which of course put Braeden in a trance and then made him dance once he heard a beat! My fundal height measured right around 32 1/2 weeks. She told me that my 3 hour glucose tolerance test was normal, but that a high 1 hour can indicate a level of insulin resistance so it is possible that Ashlyn will be on the bigger side.

She asked some of the routine pregnancy questions, and then asked if I had any questions. Duh...."can you please tell me the results of my ultrasound please?!" "Oh let me look in the computer here......when was this ultrasound done?" "Hmmm...Around 8:15am...." Seriously, does this doctor's office not communicate effectively or what? It seems like the practice is kind of scattered and rushed....The doctor told me that she would go over to where the ultrasound office is and get the results.

20 minutes later she returned. I would complain that it took her so long, but she brought one of the SPA attending doctors with her so I figured we were waiting to meet him. This guy had the worst stutter....I am not trying to be mean or anything, but at first it was very offputting. But he seemed like a good guy and was very knowledgable. I have to give him credit for how hard it must have been for him to pursue a career in medicine...but it still was hard to take him seriously when he could barely spit out the word "ventricle." I am such a bitch....I should keep these thoughts to myself from now on I think!

So basically, he tells me that in fact the ventricles are getting bigger faster. But he says that in the 3rd trimester that is expected as fluid continues to build up. The head is also getting bigger faster, and he expects it to get too big to deliver vaginally. He basically told me that unless I go into labor prematurely in like the next couple of week, I am more than likely going to have a c-section. We will try to wait until 39 weeks (June 1st), but it might be necessary to go as early as 37 weeks pending an amnio to check for lung maturity. As far as if Ashlyn will need a surgically placed shunt, he says that it is usually only the extreme cases where a shunt is placed right away...but we will not know for sure until she is born.

We will be getting a fetal MRI, which could possibly give us better insight into the situation (more than likely it won't tell us anything new though). The secretary just has to work with my insurance before she can schedule a date. Luckily, I already called my insurance and know that they will in fact cover it for a $40 co-pay. I will get an ultrasound at every doctor's visit from here on out. I go back on May 1st for my 34 week appointment. After that, I will go in every week until I deliver.

Now, I am feeling overwhelmed with everything again. Things were looking reassuring with the last ultrasound, and I was optimistic that I could have her vaginally with no complications. Now, I know that is not necessarily the case....Some women (who are crazy) prefer to have scheduled c-sections, but I am seriously stressed over that possibility. My labor and delivery experience with Braeden was very fulfilling. Granted, I labored forever, needed pitocin, freaked the crap out of Chris, ended up with an epidural, and tore my va-jay-jay....but I felt so proud and accomplished after he was born. Words cannot explain how empowering giving birth vaginally is....and I just cannot imagine feeling that way after having major abdominal surgery! I want to do what is in the best interest of my baby girl...but I still cannot keep myself from whining "I do NOT want a c-section!!"

Newest Ultrasound Pictures

Here are my most recent ultrasound images from March 3rd (26 weeks 1 day). Enjoy!

Ultrasound #1 Million?

We had yet another ultrasound this morning. After not being able to see the doctor last month, I was looking forward to meeting with the perinatologist (Dr. M) today. I had a bunch of questions in hand ready to be answered. Unfortunately, my questions are still unanswered as he was in a meeting again this week. Ugh! So frustrating!

The ultrasound tech said that the ventricles measured about the same as last time. So that is good that things are not getting any worse. She took a good look at the heart because I needed to have an official fetal echo, but the doctor was not available to perform it. The tech said everything looked fine though and that Dr. M could follow up next time we see him (hopefully that will be before I go into labor...note the sarcasm!). I need to get a fetal MRI scheduled, but apparently that is something the doctor needs to take care of. But the ultrasound tech promised me that he would be in touch with me, either directly or through my midwife office.

So I am officially in a pissy mood today....So frustrated and sick of waiting for answers. I am trying to stay positive. I feel like Ashlyn is thriving and will be happy and healthy....but I do not like feeling like we are not being adequately prepared by the medical team. Being in the medical profession as a nurse, I feel it is very important for patients and family members to be in the loop regarding their medical conditions, prognoses, etc and be able to ask questions and get appropriate responses. I am trying to give them the benefit of the doubt....after all I am still a patient of the midwives (not that they are getting much more information than I am!) and so far nothing is alarmingly wrong with Ashlyn. On a positive note....we got a cool 3D ultrasound of her face! I'll post it later when I scan it in. Oh and according to the ultrasound machine, she weighs 2lbs 4oz! What a big girl!!

On the way home, I became even more enraged when I saw a van in front of me with a toddler (probably just a little older than Braeden) who was unrestrained in a women's lap. He was swaying and squirming all over the place. How can people be so stupid?! In addition, the driver of the van was hitting another passenger....and it didn't look like they were just fooling around. I didn't know what else to do so I took a digital picture of the license plate. I called 911 and reported the incident once I pulled in my driveway. Hopefully, the police were able to locate the van...I could not live with myself if I didn't report it and later found out they got in an accident and that little boy was injured. He doesn't deserve to suffer because this parents are morons....

23 Weeks Ultrasound

We had another ultrasound today. Too bad nobody told me that Dr. M would be in a meeting the time they scheduled my appointment. The ultrasound tech said that the ventricles just measured a little bigger than last time...really nothing new to report. I jsut wish the perinatologist was there to kind of give us a quick update of where we stand. More waiting I suppose.....

And now for the not-so-good news....

We had our ultrasound today to follow up after our devastating scan a couple weeks ago. The baby was not so shy this time around so as I previously posted....IT'S A GIRL!! I haven't had much of a chance to get overly excited worrying about everything...but YAY!!

So basically, the lateral and third ventricles in the brain are still dilated....not much more than last time though so that is reassuring. Dr. M was able to get a better look at the whole brain and found that the cerebellum and spine looked completely normal ruling out conditions like Dandy Walker or Spinia Bifida. He concluded that most likely the ventriculomegaly is being caused by aqueductal stenosis (never have a googled a word so much in just a matter of hours...). Aqueductal stenosis is one of the most common causes of hydrocephalus (excess fluid in brain). It is basically a blockage of the aqueduct of Sylvius, which is a small channel connecting the 3rd and 4th ventricles (refer to my Dec. 30th post for more info on the boring anatomy stuff). At this point, the brain is not measuring much bigger than expected (21 weeks...we are 19 weeks) so that is good news....but Dr. M did not really feel that we will be able to avoid hydrocephalus. Another reassuring point...so far there are no other obvious abnormalites that might indicate a chromosomal abnormality. Phew....

As far as the outcomes for Ashlyn, we really have no more information other than the diagnosis of aqueductal stenosis. Dr. M recommends to continue getting ultrasounds every 3-4 weeks. No amnio will be done at this point per our request. Right now, it is not clear if Ashlyn will have any neurological impairment and if she will need a surgically placed shunt. Only time will tell....

So for now....we wait.

Good news first....It's a......

GIRL!!!

The Day a Blog was Born

This day marks the birth of a blog.....On this day, my life was turned more upside down than I could ever imagine, and I decided that I needed to capture the moments, the emotions, and the struggles in way that would be cathartic for me, enlightening for others, and hopefully informative for mothers in similar situations. Read on....but be warned this is a long (but crucial!) entry....

Today was the BIG day....our second trimester ultrasound. Chris and I were so excited to find out if we were having a boy or girl. My mom and Braeden came along for the fun too. However, a day that started off full of lively optimism dramatically turned into a day full of utter despair.

The ultrasound starts off like another other routine anatomic scan. I drank a ton of water....and some orange juice in hopes that our baby wouldn't be shy! My bladder ready to burst, I hopped on the exam table ecstatic that the day for our big ultrasound was finally here. My mom had the video camera pointed right at the video screen so as not to miss a second of it. The ultrasound tech started the scan, but the baby was very curled up. Great, I thought, it is going to keep its private parts a secret.....Little did I know I had more to worry about....

The scan continued...The tech took the measurements that she could. Some things she couldn't get a good view of because of baby's position. She told me to empty my bladder and walk around in order to get the baby moving. I did as I was told, and she returned and continued poking and prodding me in attempts to get baby to move for her. Not much luck...but I didn't really think anything was amiss. The baby has been moving like crazy, and the heartbeat was nice and strong.

After trying another 15 minutes to get the right views, she told me to again walk around and try to get the baby moving. So I danced with Braeden and got a little silly.....As I was shaking my booty, the u/s tech walks in with Dr. M (Chief of OBGYN at the hospital). I quietly moved over to the table with my mind racing about what could be the matter. Chris and my mom did not seem phased by the turn of events...I don't think they realized that a stubborn baby is not a reason to have a perinatologist come in to do the scan. As Dr. M focused on the brain of my baby, I was devastated. The 15 minutes he spent trying to get the images he needed felt like an eternity.

Finally, he told me that he didn't get everything he needed, but he definitely had a big concern. In a straight forward, here are the facts, he informed us that the lateral and third ventricles in the brain are dilated. The high side of normal for a lateral ventricle is 10 mm, and our baby's measured over 12 mm. Unfortunately, because he couldn't get a good look at the cerebellum and spinal cord, he could not rule out certain conditions like spina bifida (I will call SB) or dandy walker (I will call DW). If the cerebellum and spine are found to be normal, he says the dilated ventricles most likely are due to aqueductal stenosis (I will call AS). I won't get into the details of what I have learned about those condition....I will wait until our next ultrasound when we hopefully can get a better idea of what the problem is.

So you wonder what is the big deal about the ventricles in the brain being big? Here is a little anatomy review: The brain continuously making cerebral spinal fluid (CSF). CSF is produced in the choroid plexus, which is found in the lateral, 3rd, and 4th ventricles. The fluid is normally drained from the lateral ventricle to the 3rd ventricle via the Foramen of Monro. The 3rd ventricle then connects to the 4th venticle by the Aqueduct of Sylvius. From there, the CSF can flow into the spinal cord where the fluid is reabsorbed into the circulatory system.

Problems arise when there is an interruption in the drainage of the CSF or excess production of CSF. The fluid backs up into the ventricles causing them to appear enlarged on the ultrasound images. If the condition progresses, it can lead to hydrocephalus ("water on the brain"....really "CSF on the brain"). In hydrocephalus, the head measures bigger than normal. This is dangerous because it can lead to an increase in pressure in the brain (increased intracranial pressure), which in turn can cause neurological problems.

Because I am a nerd, here is a diagram of the brain:

According to Dr. M, there is a 1% chance that the baby could have a chromosomal abnormality such as Down Syndrome, Trisomy 13, and Trisomy 18 (the latter two which are considered incompatible with life). An amino is generally recommended to rule out any chromosomal abnormalities because if there is something amiss chromosomally, the prognosis will obviously be different than with AS, SB, or DW. I am just over 17 weeks so I was told that I need to decide if I want an amnio right away in case something is severely wrong, and I wanted to terminate. Never could I have an abortion so I declined any further discussion of an amnio in favor of an indepth pediatric evaluation at birth. I just could not risk the health of my baby (who by all accounts could turn out normal) by having an amnio right now...it is still too risky. Maybe in the 3rd trimester, I will reconsider just to give myself peace of mind that we are not dealing with Trisomy 13 or 18.

At the talk of termination, my mom who was not holding up very well started to break down.....Surprisingly, I was calmly discussing the situation with the doctor trying to not let my true emotions show. Anyone who knows me knows I am overly emotional and not above crying in public for the littlest things. Plus, I am a hormonal, pregnant, sleep deprived mess....You would think the tears would be flowing....but for some reason I bottled everything up. I don't know if it is because I was discussing medical stuff. Maybe my experience as a critical care nurse allows me to segregate myself from the situation. At work, there is rarely a situation that causes me to cry at work....I am not the nurse that cries with her patients and family (which I actually feel really guilty about). I think that I am a compassionate and competent nurse, but because of that latter quality, I don't want my emotions to interfere while on the job. However, this baby is not a patient....it is my own child....The doctor and u/s tech must have thought that I am a horrible mother.....

Dr. M. boiled down the situation with a statistic that is not sitting very well with me....1/3 of babies with the enlarged ventricles (ventriculomegaly) will have normal neurological development, 1/3 will have mild to moderate neurological impairment, and 1/3 will have severe neurological impairment. Hearing that there is a 1/3 chance that my baby will he severely handicapped was very hard.

A big question I am sure on everyone's mind (mine especially) is what could have caused this? Dr. M reassured me that there is nothing I could have done differently. Most likely something by chance went awry when the brain was developing. Infection, tumor, and stroke could be other possible explanations. Despite the reassurance, I still fear that I caused this....Did I not protect myself at work properly? I could have been exposed to x-rays, chemo drugs, or infections.....

As for the course of action, Dr. M recommends serial ultrasounds....every 3-4 weeks to track the progress and look for any other abnormalities. We will go back in a couple weeks to see if the baby will cooperate for us. Fetal MRIs can be done, but he says that in his experience they rarely offer more information especially because of how high-tech ultrasounds are. Of course, he mentioned an amnio is something that is usually recommended. He said that for now, I can still see the midwives as long as I am being followed by him with the frequent ultrasounds.

He touched on the treatment options....mainly surgery after birth to place a shunt that will drain the excess CSF. As we get closer to delivery day, we will know more information...if a shunt might be necessary, if I need to deliver at Strong (the bigger hospital with a NICU and where the surgery would be performed), if a c-section is in order, or if early delivery will be beneficial.

I intended on going on a shopping spree after the ultrasound....since we couldn't find out the gender and given the disheartening news, we decided to head home. As Chris was driving on 490, I broke down. I started sobbing uncontrollably. I cannot even put into words the emotions I feel right now....so much disappointment, sadness, hopelessness.....I love this baby so much and want more than anything for it to be healthy and happy.

After all of this, I need to vent on one more thing (as petty as it might sound)....I only got 3 blurry u/s pictures! I know the situation was not the most common experience women have at a routine u/s...but come on! This is my baby.....I love this baby just as much as any mother loves her normal, healthy baby. Here are the pictures I got:

She's Definitely Got Heart!

Itty Bitty Toes!
Brainy Baby

NT Scan

Today was my First Trimester Screen. This is the optional genetic testing that utilizes an ultrasound and blood test to determine the probability that your baby will have a chromosomal abnormality such as Down Syndrome or Trisomy 13.

I am relatively young so I am not at great risk to begin with to have a baby with a genetic problem, but I like the peace of mind that doing such a non-invasive test can give you. Plus, I got to see my baby again! I cannot believe how after only 4 weeks, the baby looks so much more human now! This ultrasound picture was great....it looks like he or she is waving at us! So cute!! We won't know the results for a week or so, but it was great to see our baby with a strong heartbeat looking very healthy!

Addendum: After 10 days, we got a call back with the results. Negative! Less than 1 in 10,000 risk of Down Syndrome and Trisomy 13. Woo hoo!

My Little Gummi Bear!

We had our first ultrasound today. Right off the bat, I saw the flicker of the heartbeat. Such a relief to see that! The FHR (fetal heart rate) was about 150 BPM (beats per minute). As it turns out the baby is measuring a little smaller than expected. So my due date was changed from May 31st to June 8th. We are not concerned because I only had 1 period after giving birth to Braeden so I was unable to determine if my cycle was regular yet (guess not!). So despite backtracking a little in regards to my due date, today was a wonderful day! Yay!!