Verses to Remember

From birth I have relied on you; You brought me forth from my mother's womb. I will ever praise you.

Psalm 71:6

Wednesday, March 9, 2011

Almost to 27 weeks.... & a NEW little cousin!!

Today we hit 26 weeks, 6 days.
(By the way I don't know what is up with the formatting, no matter how many spaces I put between paragraphs, blogger is apparently deleting them... I apologize & thank you for reading!)
That is so close to 27wks (tomorrow for those of you who don't like math) that it's making me quite excited. Of course we'd love to keep Annie inside for 3-5 weeks past the 27wk mark, but once we officially hit 27 we not only will be past the worst of the statistics for viability and long term difficulties, we will finally get to find out how she's doing in there! We'll get to see how much she's grown over the last 3 & 1/2weeks, and we'll be able to assess her umbilical blood flow to see if her AEDF has stayed the same (intermittent) or has progressed, and if so how much. I can't believe we're almost there!
3 weeks ago when I was sitting on the exam table and the doctor told us that his recommendation was to go home, rest as much as possible and then come back in 3 weeks to check our little girl; I had no idea how I was going to make it through 3 long weeks without knowing anything about how she was doing, if she was getting the blood & oxygen she needed, or if she was growing. 27 weeks seemed like this huge goal, almost unreachable when we hadn't even hit 24, but God is good and we are almost there! And not only did we make it, but God was good enough to give us one big dose of reassurance by starting to feel our Annie move.
When we first got the news that there was a major problem with her blood flow, I was only showing if I really tried, :) and I had not yet felt a flutter. (This was due to her being small for her age as well as having an anterior placenta, which basically buffers the movement until she's bigger.) Being told that our little girl was at risk of needing to be born months early, and that the best option was just to wait & check her again was really difficult. We agreed to follow his advice, with no way of knowing if she would even survive the 3 weeks. The doctor's best estimation was that her complications wouldn't progress that quickly, but there were no guarantees. We pretty much went home in shock.
Over that weekend I began feeling a little odd fluttering while lying in bed on my side. I wasn't quite sure what I was feeling, but on that Monday it was like Annie decided (or God did, more likely!) to remove any doubt and make it very clear that what I was feeling was HER. She started kicking and not only did I recognize exactly what it was, but it was so strong that Jeff was able to feel it as well. I cannot tell you how reassured we were by that. Not only did it mean she was stronger and bigger than she'd been the previous week, but also that we'd have some way to know how she was doing over the next 3 weeks.
While we still don't know how much she's grown or the exact status of her AEDF, we are going into this appointment tomorrow with the knowledge that our little girl is at least big enough and strong enough to make her presence known several times a day (and sometimes all night, not that you'll find me complaining!). We know that while the news might not be as good as we are hoping for, we also will not be getting the news every parent dreads to hear, that our little girl didn't make it. Because if these jabs in my ribs and tickling on my side tell me anything, it's that our little girl IS making it! She's a fighter. And we thank God every minute of every day for that!
What happens next is very hard to predict. There are several different possible outcomes based on Annie's status, size, and many other factors. The most likely of options are: a) that I will be hospitalized to allow the doctors to monitor us both on a more constant and consistent basis, with the goal to delay delivery as long as her health holds out, b) that I will be hospitalized due to a worsening of Annie's blood flow problems, and that she will be monitored while I receive shots of corticosteriods to prepare her for early delivery, and c) that Annie's situation will be stable enough to allow me to continue with home bedrest, along with follow-up clinic visits to monitor her once or twice weekly.
We, of course, are praying for the third option, because it means Annie is doing well despite her condition, and would allow her more time to grow & develop before we move toward delivery. Whatever happens, however, we are confident that God is preparing her even now for what is going to occur, as well as giving her doctors and us the wisdom to make the best decisions. If she does need to be delivered within the next week or two, she would have over an 80% chance of surviving, with good long term odds for normalcy. It would mean a long NICU stay, most likely months, but most babies born between 27 &29 weeks do very well. If I am able to receive the full 48 hours of steroids prior to her delivery, that would increase her odds & help to significantly decrease the amount of time she will need to be in the NICU.
It's amazing, but even with the possibility still there of her needing to be delivered soon, Jeff and I both are feeling pretty good about this appointment. We are anxious to see our little girl again, but we are much less stressed than we expected to be. We trust our doctor to know the best route to take, and to give us all the information we need to make our decisions. And we know, of course, that the One truly in charge of the outcome never makes mistakes!
Now on to the other news :) Our little Annie isn't the only baby with a surprise or two up their tiny sleeves! My brother Chris & his wife Lisa were expecting their third little one, and because they live quite a ways from any hospital (over an hour in any direction!) and their first two came early (one in the ambulance!), they decided to schedule an induction almost a week before his actual due date, just to be safe. Well, apparently someone forgot to tell the baby that his arrival was scheduled, because at midnight exactly one week before the scheduled birth, my sister-in-law Lisa's water broke. Thankfully they were able to get to the hospital by 2 and their little man made his appearance shortly after 4 am.

Introducing Ezra Brian Fisher!
Welcome to the world, little Ezra!
And apparently Annie was anxious to come out and play with her newest cousin,
because the day he arrived was her most active day yet! I don't blame her,
this little sweetie is just too adorable to not want to cuddle & play with!
And while Annie will get to play with you soon, little Ezra,
we're all praying that it won't be too soon!

Wednesday, March 2, 2011

A Blanket of Blessings!

I have learned a lot about preemies in the last few weeks, and I am currently reading about what we can do to prepare for Annie's delivery & hospital stay, and specifically what Jeff & I will be able to do to help Annie grow as much as possible once she gets here.

When premature babies are born, they are taken from either Labor & Delivery (for vaginal births) or the Operating Room (for C-sections) into a room known as the R Room, or Resuscitation Room (this is the procedure for our hospital, though most NICUs follow a very similar pattern). This room is kept warm & humid to help with their breathing, and the babies are placed on an incubator (also called an isolette) under a warming light, so their temperature stays stable while the docs & nurses monitor their status.

The incubators they use in the NICU are very versatile. They remind me of a gift box that can be unfolded to lay flat, or folded up to seal up tight. When the baby is first brought in the table is "open," meaning the top or "lid" is raised up high, above the doctors' heads, and the sides are folded down from the bed. Then when the baby is ready to be moved to their spot in the NICU (and no longer under the warming light) the sides are folded up and the top is brought down to seal the incubator. The sides have portholes that nurses, doctors and parents can reach through to touch and tend to the baby, but depending on the baby's age & needs the incubators are most often left closed until babies are able to maintain their own temperature. (Babies can be taken out of the incubator to be held skin-to-skin or be fed by parents once they are stable enough; this usually occurs within the first week, and can even happen if the baby is on a ventilator!)

The environment in the NICU is kept dimly lit & quiet to help prevent overstimulation of the babies, but still needs to be bright enough for nurses & doctors to perform their duties. Because of this, parents often bring blankets from home to cover the lid of their baby's incubator overnight or whenever the baby needs less stimulation. This also helps the baby's "area" or room to feel more like a real nursery, and less like a hospital. There are also blankets & positioning devices inside the incubator, but those are only used for the baby to lie on. Obviously anything that is thick enough to keep out some light & noise would work for a cover, but most parents like to use a blanket either from their child's nursery or that has special meaning to them.

In hearing & reading about this, a thought began to develop. If this blanket is going to be covering our baby during this critical time when she is trying to grow and finish developing, wouldn't it be great if it was something meaningful. Something scriptural, even. And I came up with this idea of creating a blanket covered with Bible verses; verses with God's promises to his children, verses of blessing, of protection and of peace. I just love the idea of Annie being "covered," literally, with God's promises while she is in the hospital.

So this is where you guys come in. :) I would love to create this blanket with verses that our family and friends find meaningful, hopeful or reassuring. You can either email or comment with verses that you think would be perfect for this purpose, or if you would like to actually write (or even embroider) your verse on a piece of fabric that will be added to the blanket, let me know that and I can give you the specifics.

We feel so blessed that our little girl is not only going to be surrounded by loving family and friends, but also that she is cherished & guarded by the King of the universe! And while we of course want to do everything in our power to keep her safe and help her grow, her Heavenly Father is actually the only one who can protect her fully! After all, he created every tiny part of her and has kept her safe this far! I trust that he won't stop now.

Tuesday, March 1, 2011

Monday's outing to the hospital

We're already 25 weeks & 3 days!

Yesterday was a long day for a girl used to bedrest! It's surprising how 2 weeks of bedrest makes such a difference in my energy level and lightheadedness/shortness of breath when I'm up and around longer than my normal very short time limits! We had an appointment with Dr Jenkins, our favorite perinatologist, and walked around the birth center at the hospital. Everything is going fine, but the reason for the appointment was that some test results from a couple weeks ago had shown a bit of concern regarding possible Preeclampsia (pre-e), which is a pregnancy complication that can be very serious, and can also inhibit a baby's natural growth in utero. Since Annie is already small, the doctors were checking for any possible issues with my health that might also affect her.

When we first discovered her AEDF 2 weeks ago I went through a bunch of labs, including a 24 hour urinalysis, to check pretty much everything that can go wrong during pregnancy. Everything came back normal except that the urinalysis showed a slightly elevated level of protein. That can indicate pre-e, so our initial perinatologist (Dr Robertson) called us early the next morning and wanted me to go to the hospital for 24 hours so they could monitor my blood pressure. Pre-e is usually diagnosed by both protein (usually higher levels than mine, every pregnant woman will 'leak' some protein into their urine) and high blood pressure.

Normally I wouldn't think there could be any downside to being hospitalized, other than being inconvenient, but after our conversation with Dr Jenkins the day before we really didn't want to do that. Dr Jenkins had informed us that once I am hospitalized, the chance that Annie will be delivered early is much, much higher. The reason for that is that when they are monitoring both Annie & I around the clock, they are much more likely to find a "red flag" that indicates a problem. Often times these issues resolve themselves within a few hours, but being in the hospital at the time might increase the chance that they will take action to deliver, rather than waiting to see if the issue resolves.

Once I am further along and Annie's chances are better, this will be more a relief than a concern, because being labeled as an extremely high-risk pregnancy causes them to take any red flags very seriously and to move quickly to save her if there are problems. However until she grows & has a better chance of viability, staying out of the hospital can help to prevent an unnecessarily early delivery.

We called the doctor on-call at the hospital (since it was the weekend) and told him we'd rather do the 24 hour blood pressure monitoring at home. He basically said alright and to call if it is ever over 140/90 (and that we should expect Dr Robertson to be annoyed--we thought it was weird that he said that but we've learned that the other doctors and even the nurses seem to think Dr R overreacts to things.) That made us feel better, and after my bp never even got close to 140/90 (averaged 110/65 with the highest being 121/80 right after the dr called!), we felt even better about our decision to monitor at home. Dr Robertson had her nurse call us first thing Monday and we went over the blood pressure readings. She said the immediate concern was no longer, but she wanted me to keep up with daily bp readings (only 3 a day, much better than hourly!) and come in to get my labs re-done in a week to be sure that pre-e doesn't sneak up on us.

Luckily we were able to see Dr Jenkins for that appt, and hear his take on the pre-e issue. The best news is that all my labs from yesterday looked perfect, so while we will still probably keep checking for preeclampsia every couple weeks, Dr Jenkins does not think I'm at high risk for it, or that it is likely to be what is causing these problems. All good news! (Pre-e can progress very quickly & is a common cause for very premature deliveries.)

My mom drove me to the appt (since the hospital is close to Jeff's office, he just met us there) and afterwards we went for a (short) walk up to the Family Birth Center, Labor & Delivery and NICU. I had toured the NICU with Jeff and the neonatalogist at our first meeting with him 2 weeks ago, but I hadn't really noticed much more than the tiny babies in the isolettes, since I was still reeling from the news that our baby will most likely end up there soon. I was hoping to tour it again, with my mom this time, so we could both get a better mental picture of what is likely to be Annie's home away from home, as well as things we can do/get to prepare for her stay. I also wanted to show my mom the areas that I would be in once I was hospitalized (Family Birth Center), and then for the birth (L&D).

It was very reassuring to visit the Birth Center and Labor & Delivery, since the nurses that we spoke with were very encouraging and sympathetic. They were able to give me quite a bit more detail regarding what my perinatal stay (before the birth, basically hospital bedrest) and postnatal stay would entail, as well as my C-section delivery & recovery. I was able to see the actual rooms I would be staying in, and even ask questions of the lactation supervisor regarding pumping while Annie is in the NICU, and getting a good hospital grade pump to use at home. We weren't able to see the NICU because our timing coincided with an emergency delivery, but they did say that if we call ahead the next time I come for an appt, they would have someone free to give us that tour as well (the normal tour guide was busy with the emergency).

I was pretty pooped after all that, but it was a very good kind of tired! I feel more prepared for the time I am in the hospital, as well as getting ready for Annie's possible extended stay. It was nice to talk to nurses who see problems like mine every day, and often see much more serious problems that are still able to be handled well. I feel very blessed that God is giving us the opportunity to prepare for the upcoming hospitalization/birth/NICU stay, because most moms in that situation have no idea that they might need such specialized care (or deliver their baby so early) until they are rushed into delivery. They have to learn what is happening with their baby while trying to recover from delivery and the trauma of learning something went wrong. I really do thank God that our situation is not that emergent, and we are able to prepare, as much as you can for a situation like this.