I am officially the easiest antepartum patient, per the resident on call this morning. I mostly keep to myself here and try not to bother anyone. I know that other women in antepartum are big babies, whining about every little thing and as far as I know, I'm the youngest one here. I find that funny. How is it that some of these women are much older than me but are demanding much more of our nurses' attention? Technically, I have never been away from home this long but I try to look at it as good training for when Nick and I finally get our apartment.
But maybe I'm luckier because it's possible these other women don't have a support system as strong as mine. Between my mom, Nick and my grandma, I have everything in my room that I need to survive. That's the biggest piece of advice I could give anyone. Have your loved ones bring you everything you need to feel as normal as possible. I have pictures, my own bath towel, clothing and even my own pillow, which makes all the difference. I also have a fully stocked fridge and snack pile, so when the kitchen closes at 6:30 PM I can still snack if I'm hungry.
Sometimes I still struggle with my loss of independence. I have to rely on everyone else to bring me what I need and I'm so used to being able to do it on my own. Just the other day my phone charger broke and I cried on the phone to Nick because I wasn't able to get my spare and would have to wait until my mom could bring it up to me. It's easy to get "down" while being stuck here but I try to think of all the good things to be happy about. In fact, reading Tuesdays with Morrie by Mitch Albom, has really given me insight on how to get through this. Morrie, who is dying, stresses that you should enjoy being taken care of and that it is not embarrassing or scary. I know I'm not dying but that piece of advice is so true. Most people were never nurtured as much as they needed or wanted when they were young so this your chance to soak it up. Food for thought.
One thing I could get used to: ordering my food in the morning and having it delivered to me. Now I'm off to dominate my scrambled eggs and bagel. ;)
Friday, February 28, 2014
Wednesday, February 26, 2014
26 Weeks!
At midnight I hit 26 weeks in my pregnancy. Doesn't sound that impressive but every hour, let alone day, is a huge accomplishment. When I was admitted the doctors thought I only had hours left and that labor was imminent. Apparently, my body has had other plans and flash forward, here I am two weeks later.
I did her some good news this morning! Dr. Dykowski told me that there are no birth plans currently. It all depends on how the little lady is positioned when D-Day comes. If she's head down I can give birth vaginally but if she's in any other position I will have to have a C section. He did also remind me that premies sometimes have difficulty being delivered vaginally so I will have to keep in mind that an emergency C section is possible. Nonetheless, I am happy that I can prepare for either situation.
All in all, hospital life isn't that bad. I wouldn't say I'm too bored and luckily, Beaumont is a really good hospital. I have physical therapy and they even have a bed rest program here, which is birthing classes for women who are confined to their beds. Nick and I are pretty excited to participate in a class. It helps us feel more normal since we haven't been able to do the same things as other pregnant couples.
I can't help but feel guilty, though. I know it's nothing that I could have prevented but it's hard not to feel like it's my fault. As a woman, biologically, our sole purpose is to bear children. The fact that my body is unable to do that without medical intervention (bed rest, medication, cerclage, etc.) makes me feel like a failure as a woman. If this was 50 years ago, children wouldn't even be an option for me, so I guess I am lucky in a sense. I just have always wanted to have a lot of kids and now I'm forced to rethink my plans. I can't go through another pregnancy like this, especially with a toddler who will need me around to take care of her. It wouldn't be fair to her or Nick if I ended up on bed rest again. Just goes to show you that you can plan and prepare all you want, the universe will likely show you that it has something else in mind for your story.
I did her some good news this morning! Dr. Dykowski told me that there are no birth plans currently. It all depends on how the little lady is positioned when D-Day comes. If she's head down I can give birth vaginally but if she's in any other position I will have to have a C section. He did also remind me that premies sometimes have difficulty being delivered vaginally so I will have to keep in mind that an emergency C section is possible. Nonetheless, I am happy that I can prepare for either situation.
All in all, hospital life isn't that bad. I wouldn't say I'm too bored and luckily, Beaumont is a really good hospital. I have physical therapy and they even have a bed rest program here, which is birthing classes for women who are confined to their beds. Nick and I are pretty excited to participate in a class. It helps us feel more normal since we haven't been able to do the same things as other pregnant couples.
I can't help but feel guilty, though. I know it's nothing that I could have prevented but it's hard not to feel like it's my fault. As a woman, biologically, our sole purpose is to bear children. The fact that my body is unable to do that without medical intervention (bed rest, medication, cerclage, etc.) makes me feel like a failure as a woman. If this was 50 years ago, children wouldn't even be an option for me, so I guess I am lucky in a sense. I just have always wanted to have a lot of kids and now I'm forced to rethink my plans. I can't go through another pregnancy like this, especially with a toddler who will need me around to take care of her. It wouldn't be fair to her or Nick if I ended up on bed rest again. Just goes to show you that you can plan and prepare all you want, the universe will likely show you that it has something else in mind for your story.
Sunday, February 23, 2014
What is Cervical Insufficiency?
In simple terms, Cervical Insufficiency is a condition where the cervix prematurely shortens, dilates and effaces before a pregnancy comes to term. In normal pregnancies the cervix will begin to shorten, efface and dilate around 38-40 weeks of pregnancy. In my case, my cervix began to shorten around 19 weeks of pregnancy, when my baby had gained enough weight to put pressure on my cervix. I am one of the lucky ones because the ultrasound tech noticed it at my routine anatomy scan. Most women are not so lucky and when CI is not caught, most likely leads to a second trimester miscarriage or preterm labor.
CI occurs in 1-2% of pregnancies, making it an infrequent but devastating condition. Now you may be wondering, how do women get Cervical Insufficiency? Well, there are a multitude of reasons. Women who have had multiple second trimester D&C's are at risk, as well as women who have had surgical procedures on their cervix. Some women are simply born with it. I am the latter. CI is not something that you can get rid of either. It follows you forever and thus, I will never have a "normal" pregnancy.
Cervical Insufficiency was first noted around the 1860's but there hasn't been many advances to prevent the problem other than a Transvaginal Cerclage or TVC. TVC's were first studied in the 1950's and are still considered controversial because what works for one woman may not work for another. TVC's are a small stitch placed in the cervix and pulling it tight like a purse string to keep the baby inside the uterus. Many times women still efface (thin) right down to the stitch which means bed rest at that point. One other advancement has been made, a better and more effective version of TVC, a Transabdominal Cerclage or TAC, which is a surgical procedure where the doctor makes an incision at the bikini line and places a small, woven synthetic band high on the cervix. The TAC has a 95% success rate and can be done pre-pregnancy or in very early pregnancy. TAC's can even be left in for future pregnancies but the downside is that you are only able to have a C-section. Vaginal deliveries are not possible with a TAC. Unfortunately, there are only a few doctors in the United States that perform the procedure. Dr. Haney, out of University of Chicago Medicine, is one of them. If I decide to have another baby, I will most likely travel to Chicago to have this procedure done.
Other than TVC and TAC, the only other treatment for Cervical Incompetence is the use of progesterone. Progesterone can be administered via suppository or for women who meet the criteria, as a shot known as P17. In my case, the Maternal Fetal Medicine specialist at Beaumont prescribed me 200 mg of progesterone via suppository. Along with the medicine, my personal OB put me on bed rest that went from two weeks to the rest of my pregnancy. Even with the progesterone and bed rest, my cervix shortened, effaced and dilated.
At a cervical ultrasound at 21 weeks, I was whisked to Triage and the doctors there gave me a grim diagnosis. They did not believe I would make it to 22 weeks and sent me home to wait for a miscarriage. Feeling like all was lost, I had an epiphany when I felt my baby kick. I realized that she was still here and that it was not over until it's over. Doctors are not God. They don't have a crystal ball. So, armed with an I-Won't-Take-No-For-An-Answer attitude, I found a new practice of doctors that wouldn't give up on me. And despite my previous OB's doubts, here I am at 25 weeks and 4 days. Albeit in a hospital bed, I do feel safer here than I did at home. Beaumont is not close to where I live and if anything had happened, it would most likely be too far for the doctors to do anything. Luckily, my doctors admitted me when I was nearly 24 weeks on the dot since I was now at the point where my baby had a chance to survive outside the womb. In three weeks my cervix had dilated to about 1.5cm and was 90% effaced with bulging membranes, which means the amniotic sack is now protruding into the vaginal canal. In L&D, they administered magnesium sulfate via IV to prevent preterm labor and gave me two steroid shots, one in each hip, to help my baby's lungs mature faster. Those 24 hours were long, exhausting and uncomfortable but I made it out and was transferred to antepartum.
Now I await the day until my little lady decides to make her appearance or more accurately, when my cervix gives up. We are hoping for at least 28 weeks. Right now she's diagonal in my abdomen, with her head in my hip. If she stays that way I will have to have a classical Cesarean section, where the incision is vertical rather than at the bikini line. If that is the case I will never be able to have a VBAC but as long as my baby is okay, I don't care. What I've learned about motherhood thus far, even before my baby has been born, is that it is almost completely sacrifice. I have sacrificed my dignity (bed pans are not fun), my life (work, shopping, eating out) and my body. I had dreamed of an uncomplicated pregnancy and vaginal delivery but now I am faced with C sections, the NICU and the reality that my baby will have to be on a ventilator and feeding tube to survive. So much for the birthing and breastfeeding classes or the hospital tour. The hospital is my home now and every day is a new day and one step closer to a healthy baby. For the first time in six weeks I know that everything will be okay.
CI occurs in 1-2% of pregnancies, making it an infrequent but devastating condition. Now you may be wondering, how do women get Cervical Insufficiency? Well, there are a multitude of reasons. Women who have had multiple second trimester D&C's are at risk, as well as women who have had surgical procedures on their cervix. Some women are simply born with it. I am the latter. CI is not something that you can get rid of either. It follows you forever and thus, I will never have a "normal" pregnancy.
Cervical Insufficiency was first noted around the 1860's but there hasn't been many advances to prevent the problem other than a Transvaginal Cerclage or TVC. TVC's were first studied in the 1950's and are still considered controversial because what works for one woman may not work for another. TVC's are a small stitch placed in the cervix and pulling it tight like a purse string to keep the baby inside the uterus. Many times women still efface (thin) right down to the stitch which means bed rest at that point. One other advancement has been made, a better and more effective version of TVC, a Transabdominal Cerclage or TAC, which is a surgical procedure where the doctor makes an incision at the bikini line and places a small, woven synthetic band high on the cervix. The TAC has a 95% success rate and can be done pre-pregnancy or in very early pregnancy. TAC's can even be left in for future pregnancies but the downside is that you are only able to have a C-section. Vaginal deliveries are not possible with a TAC. Unfortunately, there are only a few doctors in the United States that perform the procedure. Dr. Haney, out of University of Chicago Medicine, is one of them. If I decide to have another baby, I will most likely travel to Chicago to have this procedure done.
Other than TVC and TAC, the only other treatment for Cervical Incompetence is the use of progesterone. Progesterone can be administered via suppository or for women who meet the criteria, as a shot known as P17. In my case, the Maternal Fetal Medicine specialist at Beaumont prescribed me 200 mg of progesterone via suppository. Along with the medicine, my personal OB put me on bed rest that went from two weeks to the rest of my pregnancy. Even with the progesterone and bed rest, my cervix shortened, effaced and dilated.
At a cervical ultrasound at 21 weeks, I was whisked to Triage and the doctors there gave me a grim diagnosis. They did not believe I would make it to 22 weeks and sent me home to wait for a miscarriage. Feeling like all was lost, I had an epiphany when I felt my baby kick. I realized that she was still here and that it was not over until it's over. Doctors are not God. They don't have a crystal ball. So, armed with an I-Won't-Take-No-For-An-Answer attitude, I found a new practice of doctors that wouldn't give up on me. And despite my previous OB's doubts, here I am at 25 weeks and 4 days. Albeit in a hospital bed, I do feel safer here than I did at home. Beaumont is not close to where I live and if anything had happened, it would most likely be too far for the doctors to do anything. Luckily, my doctors admitted me when I was nearly 24 weeks on the dot since I was now at the point where my baby had a chance to survive outside the womb. In three weeks my cervix had dilated to about 1.5cm and was 90% effaced with bulging membranes, which means the amniotic sack is now protruding into the vaginal canal. In L&D, they administered magnesium sulfate via IV to prevent preterm labor and gave me two steroid shots, one in each hip, to help my baby's lungs mature faster. Those 24 hours were long, exhausting and uncomfortable but I made it out and was transferred to antepartum.
Now I await the day until my little lady decides to make her appearance or more accurately, when my cervix gives up. We are hoping for at least 28 weeks. Right now she's diagonal in my abdomen, with her head in my hip. If she stays that way I will have to have a classical Cesarean section, where the incision is vertical rather than at the bikini line. If that is the case I will never be able to have a VBAC but as long as my baby is okay, I don't care. What I've learned about motherhood thus far, even before my baby has been born, is that it is almost completely sacrifice. I have sacrificed my dignity (bed pans are not fun), my life (work, shopping, eating out) and my body. I had dreamed of an uncomplicated pregnancy and vaginal delivery but now I am faced with C sections, the NICU and the reality that my baby will have to be on a ventilator and feeding tube to survive. So much for the birthing and breastfeeding classes or the hospital tour. The hospital is my home now and every day is a new day and one step closer to a healthy baby. For the first time in six weeks I know that everything will be okay.
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