Consistancy...

I can't tell you how upset and relieved I am right now.

I went to see my regular OB yesterday, the one who really knows me, and she did an exam and I had an ultrasound. Not only is my cervical length the same it was on Tuesday (3.3 cm) but I'm not soft and certainly NOT dilated. She can't explain why the resident told me I was... but that's why she's my doctor and the resident isn't.

I went to the hospital for reassurance on the increased amount of pressure/pain in my hips and instead left thinking I was going to have another 28 weeker. I have Symphysis Pubis Dysfunction which basically means my hips feel like they're on fire all the time - most likely my hips are out of alignment due to some injuries I suffered while skydiving (bad landings on my butt, nearly breaking my tail bone etc.) - so for the remainder of my pregnancy I will have severe hip pain and it will mostly likely get worse. How fair is this? How fair is it that I'm already neurotic about every twinge and have to deal with this? It's not fair but lots of people deal with stuff that isn't 'fair' in life and I just have to suck it up. At least I have a name for it now and know that I'm not really crazy - this really is painful and there isn't much they can do.

So, not only am I not helping my neurotic/paranoid high risk pregnancy thoughts, but the hospital didn't help either. My doctor was really nice about all of this and simply said "I'll see you next week but you're doing really good, there isn't anything happening right now out of the ordinary"... she, thankfully didn't say "try to not worry" because I think she knows that's impossible.

Thanks again for the kind thoughts everyone - they seem to do the trick because, once again, it was a false alarm :)

25 weeks

I narrowly averted getting admitted to L&D last night. My hips were absolutely killing me - walking hurt, sitting hurt and I was getting contractions. I took 10 mg. of nifedipine but after an hour nothing seemed to help my hip pain so I went to the ER.

My cervix is 'soft' and finger tip dilated... and I'm officially freaking out. I had a negative on my fFN test. I have an appointment with my doctor at 11:15 today. Tuesday I had an ultrasound and was 3.3 cm which was a loss of 1/2 cm. in one week. Things are happening fast now and the doctor covering for mine said he was very worried about me tearing through my cerclage. The resident I saw at first talked about steroid shots....

I just started crying - how did I go from 3 cm and everything great to them talking about steroid and admitting me?!

Bedrest is a given, I started that as soon as I got home and I'm fortunate that my work will allow me to work from home.

I'm getting scared now - I'm only 25 weeks. Even the resident didn't express confidence I'd last another 10. Although no contractions showed up on the strip it wasn't all quiet so they think I'm 'irritable'... and I didn't feel any of it.

ugh - Please keep me in your good thoughts today. I hope to update this afternoon!

Percentiles of Sonographic Cervical Length

Please click the picture to see the bigger version

Ya... I'm below the 10th percentile right now. I'm very glad I have a cerclage!

Great new come-back

This story comes from a new-preemie mom and I thought she created a great story!

So a mom at the playground approaches me to ask how old my 29 week preemie is.

"3 weeks?" she guesses.

"No, 3 months." I reply.

I sit and wait for the normal look of confusion that comes over people's faces when I tell them my preemie's age. It is quite humorous. I think they wonder if I have forgotten my own baby's age.

The look appears and then I go into the whole explaination of his age, birth weight, NICU stay, blah, blah blah.

Then she looks at me through her Dolce sunglasses and asks me what has to be the most retarded question I have ever heard.

"So when do you celebrate his birthday?"

"On the day he was born."

"Even though he was early?"

"Yes, most people celebrate their birthday according to the day they were born." I am really irritated at this point by now.

"Oh, I suppose that makes sense."

Oh my God, is this conversation really happening?

Then she procedes to go on and on about her baby was a larger weight when he was born than my baby is now.

I just wanted to look at her and say " Congratulations! I guess you get the loose cooch award for the day!"

Ok, I can't stop laughing - I wish I could have used that one of the multi-tude of times comments were made about Arianna's size...

I just can't respond...

I belong to a message board for women due at the same time as me - September. Earlier this week, unfortunately, a mom gave birth to a little girl at 24 weeks. I can't imagine being in her shoes and my heart really goes out to her, she will have a long/hard road in the NICU and beyond.

I can't respond to the messages of support - I feel badly about not being able to reach out to her but the majority of the other posts are "my cousins friends sisters finance's brother's wife had a little girl at 23 weeks last year - she's 12 months now and TOTALLY PERFECT! No problems at all!" (really, at a year old you can say that?) or "My sister and I were born at 29 weeks 30 years ago and we're totally fine now" (Can you really compare 29 weeks to 24 weeks?), and the most hurtful "Preemie's do so well now - they just need time to grow outside for a while and she'll be just fine!"... ya, that's what my daughter NEEDED... she needed to be outside of me in order to grow.

So how do I respond with "I'm very sorry you are in this position - your NICU rollercoaster will be very hard and you can expect lots of ups and downs. You'll have a big learning curve but don't underestimate how well your daughter can do or even if she falls in with the normal course of a 24 weeker and has trouble for a while. I wish you the best and feel free to email me if you want to talk"... I did and immediately got pelted with all sorts of messages from others saying I was being too negative blah blah blah.

It's amazing how prematurity wears such rose colored glasses to the general public... well, no its not really amazing in a good way.

Seeing pictures of her little girl - with a preemie diaper up to her armpits despite an umbilical line - make me so sad for all preemies. Who's life needs to start being poked, prodded and having a tube shoved down your throat? I cried seeing her pictures. I'm so very scared of putting another baby through that but its practically out of my control and thats even more scary.

24 weeks

Today marks 'viability'. I'm trying to not celebrate making this point because it was never my goal. My goal is to make it further than I did with my first pregnancy and we're still 4 weeks 6 days from that. But at least I know that bean baby could arrive now and we may bring a baby home.

I'm doing well - no repeats of last week (knock on wood) and I'm still as active as I have been. I'm measuring big and carrying pretty high so I'm out of breath alot and even now, just sitting here, I'm out of breath and its really annoying. I hope its just the position bean baby is in today.

Otherwise everything is progressing just fine and I get to complain about normal pregnancy stuff... so I'll start that here for levity.

* Whose stupid idea were maternity jeans? Seriously - the stretchy band is either too low causing your pants to FALL OFF when you bend over or the band is high causing the top of the jean material to totally dig into your stomach making you look 'fat' when you sit down! I'm sick and tired of them but its all I have minus one dress and one black skirt - so I'll be investing in some skirts and summer dresses tomorrow because they're much more comfortable and cute than jeans/pants.

* I didn't have a foot swelling problem with #1 but boy oh boy do I have it now! I haven't been able to wear sneakers for a good month now and I need a pedicure! My heels are nasty. To save money I usually do it myself but its SO hard to bend down to do it now and there is no way I'm letting hubby near my feet (he's a little 'rough'). Spend the money on a pedicure or pay off the car before kid comes so I can stay home in the fall? Hmm... I think I'll invest in lotion and wear socks to bed.

* Bloody noses - I'm really sick and tired of waking up with one EVERY DAY, not to mention that my nose is ALWAYS stuffed up. I've been using a nasonex nasal spray for months now but its not really being very affective anymore. At this point in pregnancy #1 my nose wasn't bothering me at all - what's up?

* Weight gain. I've stopped looking at the scale because I know it ain't pretty. I tell the nurse every week "I'm closing my eyes, tell me if there's a problem, otherwise I don't want to know". I did this with Arianna too and by the time she was born I was up 30 lbs. I probably am this time too :(

I guess I'll just have to suffer through it - and its worth it if I get to term.

Meeting with my doula this weekend and I'm very excited! I hope everyone has a great long weekend!

Thank you!

Thank you so much for your good thoughts - they must have worked!

I'm very glad my doctor is conservative. I had my ultrasound yesterday - baby is great, and big! S/he is already 1.5 lbs. I can't believe that! She checked my cervix by abdominal ultrasound and didn't tell me the results - said she wanted to do a vaginal ultrasound instead. That had me worried but I didn't have to be. She later told me she wanted to do the vaginal ultrasound because she didn't believe that my cervix could be 'that good' on an abdominal ultrasound.

My cervix is measuring 3.8 - I have a 'wonder cervix!'. That's a fabulous measurement and I'm so happy!

Yesterday afternoon my OB called me after getting the preliminary report from the ultrasound I had earlier in the day. Since my cervical length is 3.8 she doesn't want to see me before my next appointment in 2 weeks - which I'm ok with. I have an ultrasound to check length again next week.

I've been getting lots of cluster contractions which are almost never painful but concerning because I get LOTS of them - Thursday, Friday and Saturday I had lots but nothing since then and my cervical length is still really good - awesome in fact. Its a mystery. Last Friday this was my contraction counts:

10:21
10:32
1:01
1:16
1:25
1:28
1:30
1:34... and nothing for the rest of the day.

Saturday DH and I went up to NH for a convention and I had dozens on the way there. Then Sunday the 3 of us went to the zoo and walked around ALOT, I had not one contraction the entire time!

I talked to her about going on nifedipine around-the-clock and she doesn't think its necessary. I agree. At this point my cervix isn't being affected by the contractions and it may just be what my body does when pregnant now. Lots of women have many BH like contractions and go on to have full term pregnancies.

She gave the option of long term nifedipine (procardia) up to me. I don't think I want to take any medication if it's not necessary right now. We're going to continue to closely monitor everything and watch out for pre-term labor problems but right now I don't think I'll take the nifedipine long term. I can still take one if I get alot of contractions in a short period of time but that's it.

I'm surprisingly OK with all of this - but more importantly I'm ECSTATIC at how well my cervix is holding up despite the contractions. I am crediting the 17P shots and early cerclage with how well this is all going.

This weekend I have my first meeting with my new doula and I've drafted up a birth plan - how odd to be thinking of normal pregnancy stuff now. I remember at this point in my pregnancy with Arianna I was all about researching breastfeeding... so much for that. I tried for 6 long months to get Arianna to breastfeed and had to give up and ya know what - she was just fine with me pumping for 13 months! So I'm not stressing about that stuff now - now I just want to make it to 'take home' gestation.

Yesterday I called my mom to update her on my appointments and she told me "your brother was born at 34 weeks and was only in the hospital for 2 weeks!". I kinda snapped at her - "No, this one is coming home with me!"... I felt kinda bad but I don't think she understands how scared I am of leaving the hospital without my baby. I pray every day to reach 8/8/08 - 35 weeks and a great shot of going home with me.

Prayers today please

So this morning I had my bi-weekly appointment and was told two things:

1. I'm measuring pretty big (which I knew because I'm HUGE right now) - 26 weeks, when I'm only 23 - good if I have a preemie.

2. She thinks my cervix has done some serious shortening based on a manual exam so I have an 'emergency ultrasound' at 11 o'clock today. I'm still closed and the cerclage is still tight, so that's good news. I'm only in the office for about an hour and then off to the appontment. I really wish there were more ultrasound tech's so I could have gotten the ultrasound at my 8 AM appointment! So I'm really nervous now but can only pray for the best. I had felt I'd 'dropped' on Saturday, I was suddenly carrying really low and my mind was RACING with bad thoughts but I really didn't want to pay ANOTHER $100 ER copay and wait there for hours, so I just laid in bed all afternoon/evening. Despite contracting all day thursdya, friday and saturday...Sunday everything was good - not one contractions! Wierd!

So I'll ask you to all keep me in your good thoughts today and I hope to update when my appointment is over.

Physical Assessment guidelines to establish risk

Hi everyone,

I came across a study on pre-term labor that you will probably find really interesting and encouraging:

http://www.emedicine.com/med/topic3245.htm

Physical assessment guidelines to establish risk

The obstetrician should review previous preterm deliveries, including autopsy reports and medical records, if appropriate and available. Social stressors (including housing and food availability), social support in the family, financial stability, domestic violence, drug abuse involving the patient or her family, and death or serious illness in a close family member should be assessed.

The integrity of the cervix and the extent of any prior injury to the cervix may be assessed by speculum and digital examination. The presence of asymptomatic bacteriuria, STD, and symptomatic BV may be investigated.

In some patients, formal cervical length assessment may be of use in risk assessment.

Cervical length during prenatal care, particularly at 24-28 weeks' gestation, has been demonstrated to be the most sensitive prenatal predictor of preterm birth between both high- and low-risk women. In a mixed high- and low-risk population of singleton pregnancies, transvaginal ultrasound-measured cervical length at 24 weeks was highly correlated with the risk of spontaneous preterm delivery before 35 weeks. The relative risk of preterm delivery among women with a cervix 25 mm or shorter at 24 weeks was 6.2. Furthermore, at 28 weeks, a short cervix (=25 mm) was associated with a 9.6 relative risk of preterm delivery. Cervical length 25 mm or shorter at 28 weeks had a 49% sensitivity for prediction of preterm delivery at less than 35 weeks, a value markedly greater than that of cervical funneling.

Among high-risk women with a history of one or more spontaneous preterm births (excluding those with multiple gestation, uterine anomalies, and prior cervical surgeries), 20% of patients demonstrated a cervical length shorter than 25 mm by transvaginal ultrasonography at 22-25 weeks. Among these patients with a short cervix and one previous preterm birth, 37.5% delivered at less than 35 weeks. In contrast, patients with a cervical length longer than 25 mm had a preterm rate (<35 wk) of only 10.6%. Cervical length has similarly been demonstrated as the optimal predictor of preterm delivery in low-risk women. In an assessment of low-risk women, short cervical length at 24-28 weeks was detected in 8.5% of women.7 These patients demonstrated a relative risk of 6.9 for preterm delivery at less than 35 weeks. As compared with fetal fibronectin or Bishop score, cervical length demonstrated the greatest sensitivity (39%), with a specificity of 92.5% and a negative predictive value of 98%.
Whereas cervical length assessment by digital exam is a semisubjective measurement, a recent study has demonstrated the value of an objective cervico-portio length measurement using Cerivlenz, an intravaginal measuring device.8 These manually obtained cervical length measurements appear to be reproducible, accurate, and predictive of a short cervical length by transvaginal ultrasonography. Therefore, Cerivlenz may represent a low-cost, objective screening tool to identify at-risk patients for preterm delivery.

In addition to the 24-28 week assessment, evidence shows the value of early midtrimester cervical length measurement. Studies of Owen et al from the Maternal Fetal Medicine Units Network demonstrate the value of cervical length measurements between 16 weeks and 23 weeks and 6 days. Serial transvaginal ultrasonographic cervical length measurements in a high-risk population demonstrated that a cervix shorter than 25 mm resulted in a relative risk of 4.5 for spontaneous preterm birth at less than 35 weeks, with a 69% sensitivity, 80% specificity, 55% positive predictive value, and 88% negative predictive value. As the NIH Maternal Fetal Medicine Units Network is initiating a study of progesterone treatment for patients with a short cervix in the early midtrimester, a program of routine cervical length screening may soon be justified.

Among patients with a short cervix, education should be provided concerning the signs and symptoms of preterm labor, especially as the pregnancy approaches potential viability. Prenatal visits/contacts may be scheduled at more frequent intervals to increase patient interaction with the care provider, especially between 20 and 34 weeks' gestation, which may decrease the rate of extreme preterm birth.

22 Weeks!

Another week down and it was pretty uneventful, thank goodness. I didn't have any repeats of the 'Tuesday night contraction-fest' and got my 17P shot.

I have to vent about these shots - I don't know if its the nurse giving it to me or what but they really hurt. I have several black and blue marks on my butt and it takes 4 or 5 days for the HUGE welt to go away after I get the shot. The injection site is really itchy for a few days and it hurts to sit down. I'm getting really tired of it and I still have a long way to go! I don't know what to do to make it better because everyone else I talk to who gets these shots says they aren't that bad... what the heck is my problem then??!

Otherwise things are going well. Last night baby decided to hang out using my uterus as a hammock and it was really really uncomfortable - I ended up going to bed early because laying down on my side was the only thing that made me slightly comfortable. Not only that but s/he was still hanging out that way at 3 AM when I got up to use the bathroom! Luckily by the time I got up s/he had shifted a bit and it wasn't so bad. By the time I got to work bean baby was 'head up' and an hour later 'head down'... s/he must love moving around so much! I don't remember Arianna moving around like this at all!

I don't have another appointment until next Monday and I hope everything is still going well then! I'm coming up on 'viability' and that's super scary for me - baby is only a little over a pound right now! I'm not going to worry about that too much though - we're going to go much farther than last time. I dream of a take-home baby all the time, so it must be a sign! :-)

21 weeks

I'm getting big... and I'm letting myself enjoy it this time! I hope to post photos soon!

Last night was Tuesday and was the first, in the previous 3, that didn't end with me in the ER with contractions - it was such a nice change. Last Thursday I saw my OB and got my 17P injection and convinced her to give me procardia to help with the contractions so I didn't waste my time in the ER until 4 AM again. She agreed! I did end up taking one on Saturday when I got 6 contractions in about 10 minutes, but I haven't had anything since, which has been wonderful.

I saw my OB again on Monday where she did a cervical check and we talked for a bit. My cervix is SUPER HIGH (she actually had a really hard time reaching it) and long and closed which is the best news I could have heard. She told me she understands why I'm nervous and nothing besides getting through the next 2 months will help but she said she thinks its in my best interest to see her every 2 weeks instead of every week because she feels its too much stress for me. She wants me to keep my feet up when I'm home and continue to drink lots of fluids. Baby is very active now and I get kicked so much more than I did with Arianna - I bet this one will be the one that keeps me awake at night. Everything is going really well despite the contractions and I just need to focus on the positives.

I still can't believe that in one month the baby could be born alive - not that I want that but still, its scary close. We have nothing done in preparation. Last weekend we got some used furniture from my coworker to replace all the furniture Arianna will be losing to the baby but its all stacked up in the room that will be the baby's room which still has a ton of crap in it that needs to be moved out. I doubt we'll get it done before the baby arrives, even if its full term. H/She will sleep in a bassinet in our room until 15 lbs. anyway, so they won't need a bedroom for a while. I'll just need a big basket for clothes for now.

I hope everyone is enjoying the sunshine out there - today is a beautiful day as was yesterday. I love spring/summer in New England!