Induction scheduled for Monday morning

In. gulp. FOUR. days.

OMG.

OB says with the gestational diabetes issues + thrombophilia issues + my age + my loss history, she does not want to wait any longer.

Plan is to start with cervadil and then move on to pitocin.

I will be 39 weeks and 2 days.

This is really not at all how I wanted this to go down. Was really hoping to do this naturally. Trying to wrap my head and heart around this new plan.

Trying.

Mo



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As the Cervix Turns

A little newsy update this morning.

I just saw my OB.

I am now 70% effaced and the doctor said that although I am not dilated, she was able to put her finger inside my cervix (tiny bit ouchy!), so it is really soft. Baby has moved down to a -2 station (from -3), so a little further down.

I'm definitely feeling like things are happening down in my pelvic region. A bit crampy, a lot of pressure, sometimes a clicking sound and feeling when I bear down (my geriatric pelvis trying to figure out how to open a bit? - I imagine it like a creaky, unoiled gate.)

Unfortunately, I tested as Group B Strep positive despite doing the somewhat yucky garlic protocol that my doula recommended, so I will be getting antibiotics when I'm in labor.

Today the OB said the absolute latest she'll let me go before inducing is my due date (and this is of course assuming everything looks good with baby's biophysical profiles and non-stress tests). She's on call that weekend, which would be much nicer than having a different doctor I don't know as well. She'd previously been saying 39 weeks for induction, so 40 weeks now sounds like such a reprieve! Funny, it's all about perspective!

Glucose numbers look good, she said. So that's a phew.

Biophysical profile later today...hoping Magpie passes as usual with flying colors!

Mo


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Full term and full steam ahead!

As of Saturday, I am 37 weeks.

Wow. Still unbelievable.

Little Miss Baby is doing well. She measured in at 6 pounds, 5 ounces at her growth scan on Wednesday, which I believe is around the 50th %ile. She passed her biophysical profile, no sweat. She aced two additional non-stress tests. She is almost as good of a test taker as her mama! She remains head down, facing to the right (right occiput anterior position). Perfect position to be born.

So Magpie is doing great.

I, however, am unbelievably tired.

Bone tired.

A tired that sleeping doesn't seem to solve (I should know. I slept over 12 hours Saturday night and then napped another two hours Sunday.)

I am starting to be fairly uncomfortable physically. When Magpie moves, I can feel it between my legs, which is a strange, strange sensation. It is difficult to get up now from a reclining position. And I look super goofy getting out of the bathtub or off of the floor. I have gained 18 pounds, so not so much, but my goodness, I have more and more in common with a beached marine mammal as the days tick by.

This is it. The full monty of late pregnancy.

I am so, so lucky to be here. Can't believe I am here. Can't believe still that we are about to be parents. Can't believe I will ever be comfortable again. Can't believe how fortunate we are. Truly. My gosh.

In addition to grateful and tired, I am swamped, thoroughly swamped, both at home and at work.

At work I still have a few patients I am trying to get safely and conscientiously transferred. I had expected this to be taken care of by now...but the wheels are turning slower than I would like. I give my last presentation next Friday and am annoyed I got roped into yet another public speaking event this close to my delivery. It should be fine, but I could do without the stress. I am busy training two junior people to take over some of my clinical and research workload. I am also still trying to get three writing projects done and out the door (two chapters and a peer-reviewed article) and get all my charting finished and my office clean as a whistle. Not to mention emails telling my colleagues where everything is and what stage everything is in so that when I need to bow out, they can pick up the pieces.

The homefront is edging closer to ready but is not there yet. Will and I have gone through and pared down dramatically almost everything we own to try to make space for the baby. Space is so tight here - 1,000 square feet fills up so fast! It is like we are moving, except that we haven't actually gone anywhere. We have gone through everything and gotten rid of or given away a massive amount, and it's amazing how much we've accumulated in the 6 years we have lived in this apartment.

Nursery-wise, we finally have a crib and changing table. Some wonderful friends have sent hand-me-downs so that Magpie won't be naked. We have received a few gifts as well, that are all so adorable. I have gotten out a bag that will be my hospital bag, but I haven't packed it. Someone is coming to complete painting Magpie's room tomorrow (I hope).

I don't expect to finish everything at work or at home before her arrival...but I will do my best.

My insulin needs keep creeping up. I am now on 10 units NPH at night, but expect them to increase the dosage again this week as my fasting levels remain higher than they want (higher than 90). I see the OB weekly now, in addition to geting one biophysical profile and two non-stress tests. It's a lot, but I am glad both baby and I are being carefully monitored. The OB is now saying she wants Ms. Magpie to arrive between 39 and 40 weeks because of combo of the insulin-dependent diabetes and the thrombophilia issues...which seems awfully soon, and sounds like it will likely mean an induction...something I had really hoped to avoid. She told me we will pick a date soon to hasten her arrival if she isn't here yet, but I am dragging my feet. I would so prefer to do this the natural way if Magpie and I can safely do so.

The OB this week did a cervical check and said that I am 50% effaced. (Maybe this is why I can feel Magpie between my legs now when she moves?) No dilation yet. Miss Magpie is at a -3 station...so she has a long way to go to move down into my pelvis.

So just moving along. But moving ever more slowly at this stage in the pregnancy! Trying to get done all that needs to get done.

Sorry for the silence. I've been a bit overwhelmed. But I'm so glad you all are out there. It means a lot. We are almost there!

Mo

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35.5 weeks update...with pics

Thanks for all of your thoughts about last names. Great food for thought. Will and I will continue to discuss and we'll let you know what we decide on : )

In other news, the most well-monitored fetus in NYC continues to do well. She passed this week's biophysical profile with flying colors and she did well at her non-stress test today as well.

I'm now on 7 units of insulin...an amount that seems to be steadily creeping upward as my pregnancy progresses. At some point (maybe soon?), I'm told my insulin needs will stabilize but so far, my fasting numbers look ok for a bit but then start rising again, necessitating another insulin increase.

I've been switched over to heparin from the lovenox I was previously taking. It was a bit of a fiasco - first because my doctor didn't specify a dose (the Rx read "take 1 dose twice a day"), and then because the pharmacy dispensed heparin preserved in benzyl alcohol. According to the FDA, this preservative is contraindicated in pregnancy as well as for infants and pediatric patients, something my OB says she had never heard of (Oops!). So this took some monkeying around, but I am now on a preservative-free version. The heparin is a lot of liquid volume - or feels like it anyway - compared to the lovenox, but the needle (an insulin needle) is smaller and easier to deal with, which is nice. The 12 hour administration schedule is a bit of a drag but no big deal really.

I saw the OB this week, and will do so weekly for the duration. She checked my cervix and said it is high and closed but softening. Baby has not yet descended. She will check me for Group B Strep next week, and in the meantime I'm on a garlic protocol that my doula says will make it less likely I'll test positive. Google it if you want...it's a bit gross to me, not to mention pungent, but hey, if it works... And this may not affect Group B Strep, but at the very least I'm assured I'll have no vaginal vampires : )

Still hanging in there else-wise. I am starting to really slowdown and my legs are really uncomfortable and crampy, it seems no matter what I do. I am supplementing with magnesium and calcium, getting massages from Will, and soaking them in a hot bath at night. This part of my body will so appreciate this child being born!

We are busy still trying to get Ms. Magpie's room all cleared out so that she can have her own furniture, clothes, and decorations. Five years of infertility have made what was once deemed the nursery quite the storage room. But we're getting there! And in the meantime getting the rest of the apartment super organized as well. When you live in a very small space, you have to be very thoughtful about how much to keep and where to put it!

Here is the babe this week, in 3-D. I wonder if seeing all these pics will help me recognize her better when she comes?

Magpie at 34 weeks 4 days, her hand up at her mouth

Mo

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Growth scan, BPP, and pic at 34 weeks

Magpie is now 34 weeks gestation (and change).

She is in the 35th%ile for weight - I think they said she weighs about five pounds, which my providers are very happy about, given the gestational diabetes.  And she passed yesterday's biophysical profile with flying colors - practicing breathing, kicking, having a good (but not too much) amount of amniotic fluid - another sign that the GD is not raging too much out of control).

That's my girl!

She is also kicking up a storm these days. Her head is down and her feet are up under the right side of my ribs now. She also seems to like to do what Will and I call "butt thrusts." Maybe it is the downward dog yoga position?

We also got another 3-D picture of her while we were at the growth scan. Magpie is looking very much like my husband Will. In fact, Will can do a Magpie impression by puffing his cheeks out that looks dramatically similar. It's quite something. My impressions only make me look silly, but don't resemble her in the least. Perhaps she will be a Daddy's Girl (not surprising. Moxie the Boxer is definitely also a Daddy's Girl).

Here she is, in all her glory...

Magpie at 34 weeks, 2 days

Magpie in a hoodie. Thanks, Will!

Mo

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Insulin...and the start of nighttime feedings already?!

Just to keep things interesting, I started on a long-acting form of injectable insulin late last week.

I saw my OB, who blessedly came back from her two-week vacation, and she agreed with me (and the nutritionist....and some of you...) that my blood sugar was not adequately controlled - most particularly the fasting levels, which were often mid-90s, with occasional spikes into the low 100s.

So insulin it is. I started on a low dose - 2 units - last Thursday night.

And instant amazingness!! My fasting numbers were great!! Around 90. Sometimes in the high 80s! (The goal is below 95.) All my post-prandial (after eating) levels were also awesome!

Sounds wonderful, doesn't it? Enter the next major snafu...

Ketones

Ketones: they look pretty, but are not a good thing at all.

I started having ketones in my urine, which means I am breaking down fat instead of glucose for energy. The highest levels were first thing in the morning (often measuring "moderate," but once measuring "large"--akkk!), and there were small amounts present when I tested throughout the day as well.

I tried reading up on this and found that ketones + baby = badness, particularly for later intellectual functioning of said baby. Many websites referred to this information...but I couldn't find any actual research discussing exactly what we were talking about here - how severe are these cognitive problems? what levels of ketones in the urine are an issue? Is a day or two of high ketones dangerous or is it more a problem over the long haul? Who knows... because pubmed.gov failed me, or I failed to use the right search terms.

I do know that my OB has gotten very aggressive with me all of the sudden, which is both comforting and a little alarming. I saw her last Thursday. And she wanted to speak to me Saturday and then again yesterday on the phone. She also wants to talk tomorrow. And she wants to hear every glucose number throughout the day and to hear about the ketone levels. And she has upped my antenatal monitoring to twice a week. And I'm referred to an endocrinologist, who I will be meeting with this Friday.

So yeah, based on her behavior, this is clearly something not to be messed with. (Not that I'm messing with anything; I'm truly trying my darndest. I just have been trying to figure out how worried to be).

Right now I'm experimenting with adding a middle-of-the-night snack to see if it helps with the ketones.  It is pretty weird to set an alarm for the wee hours of the morning and to then get up and eat. And my heartburn...well, yeah, not so great.

Will has set an alarm that actually talks, because he was worried I'd be so disoriented with just a tone that I wouldn't remember why it was going off. So at 2am or 3am, suddenly this mechanized voice says, "It's 2am, time to get up and eat your yogurt." It's rather strange, but effective. Who knew I would be doing middle of the night feedings for the baby already?! The midnight feedings helped some the first couple of days, but not enough. I was still testing positive for ketones.

This morning, I thought I struck the magic point finally - no ketones!! But...sigh...today's fasting glucose was a smidge high again at 95. Aaargh.

I am feeling a bit exhausted and also somewhat mystified and frustrated. But I will get this under control, no matter what it takes. I will do anything to try to help this little one be as safe and snug as possible until she's ready to join us.

Mo

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Get your terms straight!

So it turns out, I may be elderly, but despite what my ultrasound report says, I am no primigravida.

"elderly" = older than 35

"gravida" = number of pregnancies

(and "para" = number of births after 20 weeks)

In shorthand, I am a G7P0 (7 pregnancies, 0 births). A more detailed way to write it is G7P0060 (7 pregnancies, 0 term births, 0 preterm births, 6 "abortions" -spontaneous and elective counted the same, and 0 living children.

Also, when you've been pregnant more than once, you go from being a primigravida to a multigravida

However...I should officially be labeled an elderly GRAND multigravida (because "grand" signifies being pregnant 5 or more times. I'm a little like Michelle Duggar, only way less successful). 

So I suppose I'm an elderly grand multigravida with poor obstetrical history. 

Ah hem, just felt the need to clarify. Even if the "grand" makes the "elderly" sound even older than it does by itself...

If I'm going to be labeled insensitive medical labels, let's at least get them right, you know?

Big thanks to Shannon and My Two Lines for the endocrinology-related comments on the last post - very VERY helpful. I've found what I think is the original HAPO study from the New England Journal in 2008...and if I'm reading it right, my numbers are really not good. Which is what I thought - that my fasting numbers are too high. Shannon, as you suggested, I've been eating a cup of ice cream before bed (full fat low carb ice cream) and it's not helping (this morning's fasting was 99 after a cup of this ice cream right before bed last night)...ugh!

Hopefully my regular OB will be responsive when I see her next week. Or at least will agree to let me consult with an endocrinologist even if she thinks the numbers are no big deal.

It feels like we are so close! I am a pretty active coper, as you may have noticed. I am not about to get passive or sloppy now if there's anything I can do to help be sure we have a good outcome - with a live and healthy Magpie at the end of this.

Stay tuned.

Mo

P.S. I promise - promise! - to post a belly shot soon. And to update on the insanity that is our apartment as we try to prepare for the arrival of a little person...all without jinxing anything by erring in assuming we are having a baby. Tricky business, I tell you...

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Elderly primigravida? Here!

Who knew that "elderly primigravida" is the official term for advanced maternal age? It was printed on one of my ultrasound reports, along with other inspiring labels like "poor obstetrical history" and "preg via assisted reproductive technology."

Ah well...so I'm a granny-mom-to-be with a poor obstetrical history. Not exactly new news, and not how I planned things, but here we are. "Elderly" or not, I am so, so grateful - and still incredulous - to be here. Thrilled through to my core.

So this "elderly" first-time mom-to-be went in for her latest OB appointment today, 30 weeks, 2 days.

My OB is on vacation, so I chose to see the partner of hers I hadn't yet met. Her other partner was my OB for our first four pregnancies and miscarriages, so I feel plenty acquainted with him and know I would feel comfortable if he is on call when I am laboring.

But I wanted to check out the third guy. And phew! I really liked this other partner as well. He was very thorough and went over my entire chart with me, noted my history of Hodgkin's, noted the history of miscarriages, talked to me about what we'd done differently this pregnancy (lovenox, corticosteroids, IVIG, gluten-free for first trimester). We agreed together that much of it has probably been voodoo, but hey, voodoo or not, why mess with success?

My blood pressure looked good (108/65), and strangely I seem to have lost 3 lbs since my  last visit two and a half weeks ago. Which must be water weight or something because I'm definitely not calorie restricting - if anything, I'm on a much higher fat diet with this gestational diabetes.

The covering OB pointed out that Magpie's growth has been slowing (she's gone from the 41st %ile to the 25th %ile at the last growth scan). Although overall he said it's not that big of a change, and Will and I aren't big people, he wants to keep an eye on things to be sure her growth is not trending downward. He's scheduled another growth scan next week to check on her.

He also wants me to start non-stress tests this week, whereas my regular OB was planning to start them in my 32nd week. Fine by me. I want a safe and healthy baby - so more surveillance is just fine with me.

I was expecting to hear that my fasting blood glucose levels have been too high, since that has been my (and my new nutritionist's) opinion. Sometimes my fasting numbers have been in the 106ish range and they are never lower than the mid to high 90s). I've been doing everything I can to get them to go lower...but this OB said the numbers are still ok in his book. That was a surprise. We'll see what my regular OB thinks.

I have another appointment next week to see my regular OB, by my request....it's been 3 weeks since I saw her (when she told me I had GD)...and now that I'm officially high risk with the GD, I just don't want anything to fall through the cracks.

But so far so good-ish. This is one well-monitored little girl!

Mo

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Third trimester is here!

Wow! I can't believe we are 28 weeks and 1 day. We are in the third trimester!! 12 weeks maximum to go!

This may sound strange, especially to all those still in the trenches, but I really had not thought we would ever get here. As the IVFs stacked up and the failures and miscarriages mounted, it had begun to feel out of reach - pregnancy beyond 10 weeks, the second trimester a difficult to imagine fantasy, the third trimester not even in the realm of possibility. I think that a sense of futility started to really set in around IVF #5 and our fifth loss. I felt this pervasive sense of hopelessness about ever being able to get out of the situation we found ourselves in.

And here we are...despite everything still going strong. Definitely looking very pregnant now. I promise to try to post a picture later this week...I know many of you have been asking. It is unbelievable to be this pregnant. I try to savor every single moment.

Will and I have been far upstate on a little road trip with Moxie the Boxer since Thursday - I had to give a talk training others in my area of expertise. The talk went well and was well-received, so that was nice, and the setting was absolutely gorgeous. Moxie loved running around in the hills and spent a good amount of time trying to dig up rocks from the shallows of a lake we were staying near (one of her favorite activities).

Here is Moxie leaning up against tree all tuckered out after running her little white socks off during our trip!

In terms of pregnancy, Magpie kicks and squirms up a storm two or three times a day now. I can feel her at multiple places in my belly at once. She's definitely in there, and she doesn't feel so small anymore! She is making her presence known. I think I am having more Braxton Hicks contractions as well, but am not sure, and sometimes am feeling pain around my cervix/low down in my pelvis.

With my increasing size, sleep is getting a bit tougher. I am uncomfortable and must sleep on my side. Left side feels better than the right, but after awhile, my left ear, shoulder, and hip start to go numb and my right calf starts to cramp. At that point, I usually go to the bathroom (again) or at least haul myself over the other side. And it does feel like hauling. My goodness. I may have to invest in one of those long maternity pillows to see if that helps with my nighttime comfort. I have been trying to hold off. Our apartment (and bed) is small and these pillows seem so large...but if it would help, I'm pretty game at this point.

I've been very conscientious about testing my blood glucose levels since I found out about the gestational diabetes. Mostly they have been good, but there have been a couple of meals where the level was much higher than I anticipated. I'm meeting with a nutritionist Wednesday, so am trying to view the interim days between now and then as an information gathering time to learn about what my body can tolerate and what it has trouble with. The couple of times the blood level has been high I have panicked, imagining Magpie at that very moment swelling to huge proportions. Unrealistic perhaps but motivating to try to keep to what seems to work for my body and make sure to add in lots of fiber and some exercise whenever possible. It will be good to learn more about how to achieve this balance while getting in all of the nutrition she (and I) need.

That's about it here for today. We are headed back to NYC shortly. A relaxed Will, ever bigger Mo, and tired and dirty Moxie. Things are pretty good. We are so lucky.

Mo






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