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YAHA (Yet Another Hospital Admission) - Karen's Musings
Random Rambling
estherchaya
estherchaya
YAHA (Yet Another Hospital Admission)
Saturday I got admitted to the hospital again for contractions that wouldn't quit with multiple and frequent terbutaline boluses.  Fortunately, I was allowed to go home mid-morning on Sunday as I hadn't dilated any more and the contractions stabilized.  We discussed using Mag Sulfate, but ultimately decided the risks outweighed the benefits.  I had an OB sono w/BPP (biophysical profile) and cervical assessment around 4am.  The sonographer had a really difficult time waking the baby up for the BPP, so it was almost a problem (sono has to see baby movement to give the baby credit), but ultimately, everything was fine.  

In the morning, my doctor  came to talk to me and then he consulted with the perinatologist.  They ultimately let me go home, but not without a long discussion with my doctor first.  The good news is that I'm not dilating further.  The bad news is that I keep doing this, and other weird things.  He doesn't understand why my blood sugar is all wonky (neither do I), he doesn't understand my propensity for severe and frequent contractions (neither do I), he doesn't understand why this isn't easier (neither do I).  He said his hands are a little bit tied in terms of how to treat me because I have such a hard time keeping oral medication down.  Prescribing Indocin would have been a logical step to take  on Saturday, but I'm having a hard enough time keeping the Gylburide and Procardia down regularly (fail on Glyburide, in general; 60% or so success with Procardia).  Since their normal arsenal of treatments are severely limited by my hyperemesis (which also limits my ability to hydrate, another common treatment for PTL contractions), their options are to keep upping the terbutaline dosage, or do periodic "mag washes" (sometimes the body grows resistant to terbutaline, which is usually temporarily fixed by pulling the terbutaline and running mag sulfate for 24-48 hours before restarting the terbutaline).  If Mag were a benign drug, we would have just done that immediately on Saturday, but it's not.

He also wanted to talk to me about the "method of delivery."  Baby is still breech. Under normal circumstances, the answer would be "there's PLENTY of time for the baby to turn before your due date!" But in my case, it's becoming less of a question of whether there's time to turn before my due date, and more a question of whether the baby will turn before I have to deliver this baby. I never thought I'd live in greater fear of delivering my singleton prematurely than I did regarding the triplets.  He's not willing to deliver a breech singleton - as far as I know there are others in the practice who would, but honestly, given everything that has gone awry in this pregnancy, it's not a risk I'm willing to take anyway, to be honest (and please don't regale me with stories of how your breech baby was delivered and is perfectly fine - it's not something I have an issue with other people doing, but the way things have been going with me and *my* pregnancy, I know that for *me*, this is not a risk I'm willing to take).  Obviously, if the baby turns, VBAC is still on the table.  Yes, I know the baby can still turn - I don't need you to tell me that.  But it wasn't unreasonable for the doctor to bring the topic up.  His biggest concern is that because I contract so much, it would be easy to blow things off and say "oh, but you always do that" and not bring me in for monitoring when things get worse.  The last thing he wants is for me to come in 5-6 cm unbenownst to me and have a cord prolapse and a premature baby.  So the abundance of caution will continue to prevail (I'm fine with that).

Every week that goes by he gets less and less worried about the outcome of this pregnancy.  I'm moving closer and closer into a "safe" zone.  At this point, the odds are good that if I delivered a baby today, the baby would be fine in the long-term, but would spend a good deal of time in the NICU.  Obviously, I want to avoid another NICU stay, if possible, but there's some small comfort in knowing that at this point the baby is in a developmental stage where the medical community is well-equipped to care for  him or her, should I deliver this baby today - or in the near future.  

All this being said, I'm still half-convinced that left to my own devices, I'd have a 42 weeker, just to spite me.  I won't be left to my own devices, though.  Between the VBAC and the (ridiculously illogical) gestational diabetes, I won't be allowed past 40 weeks, and they won't induce.  Some doctors *will* do an induction for a VBAC, but my doctor will not - and again, we're on the same page there.  I wouldn't let them induce me for a VBAC either.  He has no issue with me going into labor on my own and delivering a healthy (vertex) baby, but all other scenarios are out.  Also, they want me to labor at the hospital, not at home, so I can be better monitored in case of rupture.  I'm not sure how I feel about that, but at this point it seems to take a special kind of hubris to even entertain the notion that I could ever get close to 40 weeks with a vertex baby.  My guess, though, is that this baby's just messing with us, and it'll all be fine.

I hope so, anyway.

The doc said "your body does really weird things when you're pregnant; I wish I understood why!"  I replied that I think it's G-d's way of emphasizing that I need to never do this again, EVER.   He said "that may be a good idea."  I told him not to worry, I'd never again darken the doorstep of my RE's door - "oh, well, he has the easy part!  He gets to cut you loose at 6 weeks and then we've got to figure you out!"

I still feel like everything is going to be completely fine in the end.  But I still feel... cheated?  lost? I'm not really sure what the emotion is.  But I really do wish I could have a non-anxiety-inducing pregnancy (and to be fair, I do think I handle the anxiety relatively well - but this pregnancy is all about testing how well I can handle it!).  I know that not every woman enjoys pregnancy anyway, but the thing is there are still plenty of things I love about being pregnant.  But this has been far from an enjoyable experience overall.   It is cliche to say that all that matters in the end is a healthy baby.  It is certainly true, but it doesn't make the here and now a whole lot easier to take on a day-to-day basis.  I just wish that I had much hope of smooth sailing from here to the end.    

And now I must dash off to another OB appointment - at which I expect to be told my blood sugar is still crazy and uncool.  Then the question is what to do about it?  Bah.  Stay tuned...

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Comments
ailsaek From: ailsaek Date: March 8th, 2010 03:14 pm (UTC) (Link)
*hugs* and I hope all goes well, or at least no worse than it is at the moment.
estherchaya From: estherchaya Date: March 8th, 2010 04:45 pm (UTC) (Link)
I'll drink to that. Um, except for the drinking part...
xiphias From: xiphias Date: March 8th, 2010 03:20 pm (UTC) (Link)
It may seem odd, but I'm reassured by your doctor being comfortable enough, and self-aware enough, to admit being confused. I feel like bad things mainly happen when doctors don't know what's going on, but either aren't aware, or aren't willing to admit that they don't know exactly what's going on.

Every time I've encountered a situation where a doctor was willing to say, "I'm confused, and here's why, and here's how I'd like to proceed anyway," it has worked out well. It's not the ignorance that causes problems -- it's the arrogance.
estherchaya From: estherchaya Date: March 8th, 2010 04:45 pm (UTC) (Link)
Doesn't sound odd at all - I quite agree with you. Frankly, if they all acted like the issues I have with this pregnancy were completely textbook, I wouldn't trust them.

I saw a different doctor in the practice today (I like them both) and I said, "Dr. B. said he can't figure out how I'm having blood sugar craziness if I don't eat." Dr. S. looked at me and said, "It's because you're diabetic. Very diabetic. And now we have to treat that." In my appointment with Dr. S. last week, we'd spent some time trying to figure out the root cause, and he ultimately ended with, "Ultimately, it doesn't matter WHY you're having these issues, though it's obviously an intellectual curiosity. At this point, the important thing to remember is that hyperglycemia isn't good for mom or baby, and we have to fix it, regardless of the cause."

I felt like that was a very reasonable approach. They're being rather aggressive about treating it, so I'm not super worried, and I *do* know that they're giving me the best care I could be getting. Frankly, I appreciate that they're just as confused as me, because at least they're taking me seriously, whether my body makes sense or not!
kalki From: kalki Date: March 9th, 2010 08:44 pm (UTC) (Link)
I have to completely agree. I knew my MFM was amazing the day he told me that he didn't know whether doing a cerclage on twins was a good idea or not. That the research is so few and that he would go back and reread it all b/c he wanted to make sure he made the best decision for me.

That to me, shows that he was literally "the best".

And I see that in your doc too K. *hugs*
estherchaya From: estherchaya Date: March 9th, 2010 09:44 pm (UTC) (Link)
cerclage with twins is actually pretty common. Not as common as with HOMs, mind you, but if you've got preterm cervical shortening, and it's not past 22/23 weeks, the benefits of trying the cerclage generally outweigh the risks. (after 22/23 weeks, the risks of the cerclage do NOT outweigh the benefits - that's why I didn't get one with the triplets; my cervix went to just under 1cm at 23+ weeks - really too late to make that call).

But I definitely prefer a doctor to tell me, "I don't have all the answers, but here's what we're going to do and why, and I'm going to check with some colleagues/research literature/etc. in the meantime" than to have him tell me "I am G-d! Do not question my methods!"
real_bethy From: real_bethy Date: March 8th, 2010 05:57 pm (UTC) (Link)
I wish I had something to say that would be really inspiring or that would make this all better for you. I don't know if those words exist. Just know that I think you are so amazingly strong and that your baby is so blessed to have you as his/her mother.

I'm glad that you and your doctors are on the same page and that they are being honest with you about what they understand and what they don't. I'm praying that you give birth in a good hour and that everything goes well!
estherchaya From: estherchaya Date: March 8th, 2010 09:20 pm (UTC) (Link)
it'll all be fine. It just wasn't what I'd imagined, is all.
buildin_a_bayis From: buildin_a_bayis Date: March 8th, 2010 09:10 pm (UTC) (Link)
im glad the baby is at least hanging in there and hope that whenever and however it does get delivered, it will be a safe and healthy one for all involved.

What are your plans for Pesach?
estherchaya From: estherchaya Date: March 8th, 2010 09:19 pm (UTC) (Link)
Pesach? My current plan is to stick my head in the ground, plug my ears up and scream "La la la! I can't hear you!" I mean, if I refuse to acknowledge it, then Pesach won't happen, right?
cleobatya From: cleobatya Date: March 9th, 2010 11:56 am (UTC) (Link)
on the bright side...at least you have an ob!
estherchaya From: estherchaya Date: March 9th, 2010 09:46 pm (UTC) (Link)
and thank heavens for that. Finally got an OB after six weeks of trying to find one when my original OB fired me. Six weeks! Sheesh. Fortunately, I think it's all worked out for the best - I love my current practice and absolutely feel like I'm receiving the best possible care.
From: atimesif Date: March 12th, 2010 05:58 pm (UTC) (Link)
Good luck with your appt. I'm glad you got released quickly this time.
Stay inside baby, stay insde!
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