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...
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...