Saturday, June 8, 2013

Pre-Term Labor...Part 2

Where I left off last time was the point where I was about to be admitted.  It was becoming pretty real that I wasn't going home that night, and I wouldn't be hanging out in triage.  After all, I'd heard (not actually seen, since I'm behind a curtain in a 3-walled room, and so is everyone else) several people come and go since I'd been there.  Even the lady doing the admissions stuff was telling me to just drop by if I wanted to pay whatever balance was on the account when I came back thru.

I called my parents, warned them of a potential for little crashers at their house.  Honestly, I was thinking along the lines of maybe they'd be there for a few hours, Mike would get them and we'd all go home again.  Again, not even close (see a pattern here?)

I got changed into a very official hospital gown (I'd been able to keep wearing my nice little dress all throughout) and was moved to a room in the maternity unit...pretty sure it's the type where the mothers are in a holding pattern, not the ones that are going to deliver that day, hopefully.  I waited for Mike to come and we waited in the room some more.  When the doctor came in, it really started to hit me that I wasn't just here for the evening, but I'd be here for a few DAYS.

It seemed like I had a ton of tubes and wires running everywhere.  Monitor for contractions.  Monitor for the baby (which, at first, I hadn't realized those were two different things).  Pulse-ox monitor on my finger.  IV in my arm with two bags of magnesium sulfate, one of the standard Ringer's saline.  In triage, I just had to ask to go to the bathroom (which they easily was a few steps down from where I was, but I still needed to be disconnected from the monitors).  After admission, they asked if I needed to go (at that point, I realized that I did).  But this time, rather than being able to just up and walk a few steps to the bathroom in my room, I needed some major help getting there.  My knees were wobbly and my head not really so clear.  I pee'd like there was no tomorrow...a good liter...which they were now measuring.  This would become my next few days.

The first night was long.  I ate dinner, I felt contractions.  I didn't think the magnesium was really SO bad, but occasionally I'd get a slight feeling of nausea, and I still was wobbly on my feet.  Around 11pm, a nice nurse practitioner from the NICU came in and gave us a run down of "what to expect", the good, the bad and the ugly.  It was a long talk, but she was thorough, and Mike asked quite a few questions, and I had a few too...good to know, but in my head it still didn't seem like it was "real".  In my head, I'd finish the course of steroids and magnesium to stop contractions, they'd release me and I'd take it easy for a bit at home, and then (again, my perception) I'd maybe get to add things back and just see how each activity treated me.  It's things like this that make you realize how much of a busy body you might be!

After the NICU nurse left, and I was settled back with everything, it was time to try and sleep.  The biggest part of awkwardness was the monitoring.  The baby would move and they'd lose her heart rate on the monitors.  At first it was just a quick adjustment, and I'd doze off in an uncomfortable position.  I'd wake up, and the nurse would come in, asking if I needed a bathroom break (which I usually did), they'd do my vitals, and readjust the fetal monitor again and I'd get settled back in bed.  At one point during the night, the baby was apparently VERY the point of having TWO nurses in my room, having me move this way and that way, adjusting the monitor, jury rigging the positioning and so on.  I actually dozed off during part of this.

I think I was getting an hour or two of sleep here and there, but it happens in the hospital.  I figured from previous experience, although post-partum, that typically the nurses did their checks on the vitals at certain times.  Then about 6am, one of the residents would come in and ask me questions about how I was doing, and maybe an hour after that one of the doctors from the practice would come in and chat for a brief bit.  Food arrives at certain times, and so on and so forth.  My first morning after was pretty much like that.

Overnight, I was still having contractions...with the worst period being only 6 or 7 or 8 contractions an hour, which is still not good, but it wasn't one every 5 minutes.  Mike got up and had to go get the kids from my parents to take them to daycare (they had an appointment with a realtor at 10, and the kids probably needed some normalcy of getting up and going about their daily routine).  I had visitors from work, which did WONDERS for my morale, in all truthfulness, and awaited Mike's return.  I was able to doze in and out, and it was a pretty restful day.  Mike came back for a while, before once again having to get the kids from daycare and deposit them at my parents.  I got the second shot of steroids for lung development around 4-ish, making things better in my head knowing that in 24 hours, the full effect would kick in and the baby's lungs would have a better shot at functioning if something were to happen that day.  Thursday wasn't shaping up to be a bad day, really.

Once again, we settled in for the evening.  At that point, it became even more clear that I wasn't going home that day...or Friday...but I was still hopeful for Saturday now!  It was really hitting me hard how much I missed the boys at home.  Thursday they decided to take the fetal monitor off overnight (just have it on periodically here and there), which meant that I didn't have to worry so much about shifting my position to sleep.  I had dinner, dozed a little more and was feeling more relaxed.  Still feeling a few contractions, but I was told that they went down to maybe 3-4 an hour.  However, the biggest thing overnight was the addition of oxygen...for me!

Since magnesium sulfate relaxes muscles, they noticed that my pulse-ox was dipping a little bit low (they'd set the alarm to ring at 95% or less), especially overnight.  So they put me on a nasal canula with oxygen, which is quite bizzare.  I don't usually breathe thru my nose at night, so I was making an effort to breathe that way whenever I heard the alarm start going off.  I figured if anything, the oxygen was getting blown out of my nose too, probably, so I'd eventually inhale it overnight.  They also gave me a little device for exercising my lungs/diaphragm that I used every hour or so before I slept.  Around 4am, I remember being awakened because it felt like I had inhaled liquid...and started coughing and gagging.  After that was cleared up (the nurses came in to check on things), I was sort of in and out of sleep.  5am rolls around and someone from the lab came to draw blood.  I really wish I could have slept through that, but that was over and done.  Then 6am, resident shows up and talks to me (at which point I can barely focus...I feel bad because I don't think I did a good job of answering their questions or listening in general).  Nurses arrive a little while later to do a NST (non-stress test) on the baby...essentially putting her on the monitor and trying to stimulate her heart rate to go up.  With all of the magnesium in both of us, it wasn't surprising that her heartrate wasn't super high (in the 120s).  They had me drink orange juice, and they'd buzz her with a little noise maker to get her heart rate up (the "passing" is when heart rate goes up by about 15 beats per minute for 15 seconds or so...twice).    She did as well as could be expected.  Then the doctor from the practice comes in.

Taking a sidebar here, I have to say that I really, really like all of the doctors at the practice.  There isn't one there (that I've met...I think there's maybe one or two I haven't seen, but who knows) that I don't love.

Anyway, the doctor comes in and goes through everything with me.  It was a bit comforting (well, that's probably not the right word...but I'm looking for the word that means "having first hand understanding of the particular situation that you're in") that she had gone through the same thing with pre-term labor, the magnesium,'s interesting to hear it first hand from those who have experienced it.  As she's talking with us and answering more questions, we get to the parts discussing when I'm due to get out of the hospital, what's going to happen afterward and so on.  Of course, the topic of work comes up...and I realize (if I'm reading that right) that she was gauging how "good" I was going to be if I was allowed to go home on bedrest.  If I wasn't "good" or didn't think I could stick to it, I have a feeling that I'd be still sitting in the hospital right this moment.  The stuff about work just happened to be a side thing (it's quite emotional for me to even talk about without totally losing it...I'm having a hard time just typing this without tears streaming down my face), but I feel like it really helped to get some of that stuff out (with the help of Mike, who did most of the talking).

So the doctor does another cervical check...still at 1-2cm...and orders a full ultrasound.  The tentative plan at that point is to ween off of the magnesium (from 3mg to 2mg). 5pm was the time I'd be off of the mag, and at that point the plan was to give ibuprofen.  Monica from work came to visit (another happy diversion...amazing how much visitors brighten things up!) and by that time I was starting to come down a little off of the magnesium.  Around 3 or so, the transport people came to get me for the ultrasound (which was done back down in triage).  It was fun to see the baby again, and see that she was doing just fine.  It wasn't quite as "fun" as the typical ultrasounds, as they were getting some pretty detailed measurements, but still good.  Returning to the room a little after 4, they took off the magnesium drip totally as well as the other IV fluids (just left the IV in my arm though).  I got to take a shower!

All fresh from the shower, and able to wear something other than the hospital gown (I had grabbed a pajama bottom and a nursing tank that I sleep in at home before heading to the hospital).  All I had left attached to me was the contraction monitor for the night.  Settling in for the night, things went pretty well.  Mike and I watched random things on TV, we played on computers a bit and so on.

It was almost weird to have no interruptions through the night, mostly.  I slept fitfully, but pretty well (no good way to get comfortable sometimes!).  Around 6am was the first time I saw someone...the nurse...and got up to use the bathroom.  I kept expecting more of the usual "parade", but that didn't really come.  Breakfast arrived.  One of the residents came in (at least I was awake and coherant enough to answer questions!).  When the new nursing shift came on, it almost frightened me that we were going to have to wait longer than the morning before discharge, but after the doctor from the practice came back, she set everything in motion and it was finally coming true...I was busting outta there!

So finally around 12:30 or 1pm, we're heading home!  Mike got me set up in the bedroom, did a few things and went to get the boys from my parents house.

Anyway, that's the story, in all of the nitty-gritty, scientist like detail.  It seems like such a long road ahead, and today is only day one (or day zero) in a long string of days until the baby arrives.  I can't even begin to get into the day-by-day count yet, as it's hard enough to think of things in terms of WEEKS until delivery. a warning...I'm probably going to be killing a LOT of time blogging!

Friday, June 7, 2013

28 Weeks and Pre-Term Labor

I'll take a bit of time to share a little bit about the latest the sense that this sort of thing could happen to anyone, apparently including this pregnant post-doc!  So, cutting right to the chase, here's the blow-by-blow of the events of the past few days!

Still not fully recovered from the news of last week, I think the stress of it all hit EVERYONE pretty hard.  There is no way of knowing how much of an impact that had on what happened/what is happening...I hate to speculate on that...but it's hard to deny that stress can manifest in physical ways.

At my 24 week check, I reported to the doctor that I was having Braxton Hicks contractions, but they didn't seem regular, and definitely not painful.  Occasionally, I'd have one that would throw me for a loop and stop me in my tracks, but it was less than daily.  Stress levels increased at work last week, and I noticed that I was having the same contractions, but the painful ones turned to once a day, to a couple of times a day.  Frequency picked up on Monday and Tuesday, and I was going through all of the things to try and calm them down (laying down when I could, sitting more, drinking lots of water, etc).  In fact, drinking water was making them WORSE, anecdotally speaking, but everything I was doing was not changing them.  But, at this point, I figured they were just BH contractions, benign and normal practice contractions.

Wednesday I almost looked forward to because I had a meeting with HR to discuss the terms of my departure.  I thought that having answers and a timeline would make me a bit more relaxed (so I could plan for the future).  Instead, no change.  I debated long and hard about just waiting until my 28 week appointment the next day, but decided to call the nurse just to see if there was something I could try to make myself more comfortable (and see if I was just missing out on doing something I should be!).  Instead, they had me come in, just to be on the safe side and be checked.

I had my appointment at 1:30, expected the standard vaginal check and figured I'd get a reassurance that everything was OK.  I wasn't leaking amniotic fluid (I didn't figure that I was, but hey, easy test!), and they were going to do a fetal fibronectin swab just in case (I also expected that to be negative).  Cervical dilation, well, I am a master dilator and when they start the checks usually I'm usually a pro in that department.  I don't know if I was shocked or not that I was, indeed, a cm or so dilated.  So, just because it was available, and possibly convenient, or she wanted a good measure, the doctor sent me to the ultrasound tech.  There, she found that my cervix was about 1.5cm dilated, but also shortening...down to 1cm in length, instead of the usual 3-5cm that they see at that point.  More as a precaution at this point, the doctor sent me with the fFN test to the hospital to get hooked up to contraction monitors and await the results of the test.

As a bit of a breather here, and each of these occurred, I kept thinking that I'd be heading home soon.  I figured I'd go thru triage at the hospital, maybe it'd show the 4 contractions I clocked each hour, mentally, get the test results and then go home.  Maybe it'd earn me a bit of time off of work and orders to take it easy.  Who knew.

Instead...the biggest piece to the puzzle came back, and adding up all of the changes that my body was undergoing earned me a 3 night stay in the hospital.  Fetal fibronectin came back positive.  I was contracting a few more times an hour than I thought.  Cervix dilating.  I was on track to potentially deliver SOON.

At which point, I was prepared for admission...IV started, first shot of steroids, magnesium sulfate to stop contractions.  I went from being uncomfortable from my belly having "false labor" contractions (or so I thought) to being hooked up to wires, tubes and monitors.  I was in pre-term labor...and it was the most serious thing I can ever think of happening to me, possibly in my lifetime.

(to be continued)