Tuesday, September 25, 2012

Day to day.

Yesterday I had 3 appointments.

My OB was annoyingly calm about everything. She still thinks we can make it to 37 weeks (and even started lecturing me about some difficulties 36 weekers can have, like I'm just tired of being pregnant or something...) And then she mentioned she saw my protein level test results and called it "good" and nonchalantly mentioned I was spilling protein again on their diptest and didn't raise an eyebrow that I'd gained 4 lbs in a week and 10+ lbs in 2 weeks (that day when I gained 7 lbs between the two appointments? I really did gain 7 lbs between the two appointments. Yesterday my weight was exactly the same at my OB and MFM, so the difference was probably not their scales.)

She is so frustratingly calm that it makes me question why I'm even wasting the time and money to see her. And so calm it makes me again think back to three years ago and wonder if things would have been different at all if I had been seeing a different doctor, if I had asked to see a high risk doctor, etc. I mean, the Friday before I got sick, I called begging them to take me out of work and put me on bedrest. The nurse was going to call me back on Monday after talking to the doctor who was out of the office. Monday I went into the hospital at 3 am and came out almost a week later with a dead baby. The week before, I saw my OB for the extreme upper right quadrant pain I was having. She suggested I try prenatal yoga. Then we did the ultrasound and saw Olivia was extremely far behind in growth, so she saw me again, and said that I was probably developing preeclampsia. I was only 22 weeks with a severely growth restricted baby, in severe pain, and she sent me home because my blood pressure was normal and my urine was clear. She even mentioned that slow growing babies are at risk for being stillborn and that we may have to deliver as early as 24 weeks because even that early, some babies are better off outside where they can grow rather than in utero where something major is wrong. She didn't order bloodwork or a 24 hour urine. She didn't send me to a high risk doctor. She let me keep working. (In fact, I specifically asked about bedrest. She mentioned it wasn't proven to help...which is true...but it would have been better than doing nothing.) I was supposed to follow up in 4 weeks, and I was 22 weeks, so I was relieved because I thought that that at least meant we should make it to 24 weeks. I know she had no idea how bad it was or would get, and I do really ultimately think that *most* ob's would have done the same thing...my blood pressure was good and my urine was clear. And I don't think it ultimately would have made much of a difference, even if I had been put on bedrest then, we were in such bad shape, bedrest probably wouldn't have made a difference, or maybe just bought us a week, but even a week longer likely wouldn't have saved Olivia. But still...she disregarded some pretty serious stuff...stuff that could have ended up killing me before we ever even made it into the hospital. So it's not only frustrating that she seems to be on another planet at this point in this pregnancy, it's triggering some feelings I thought I had resolved a long time ago.

My high risk doctor is not nearly as relaxed. I asked if she thought we were still okay to deliver at 37 weeks and she stared at me like I was crazy and said, "I'm a realist. Let's just see how your monitoring goes downstairs."  I pressed her about it a little more and she elaborated that while she would LOVE for me to make it all the way to 37 weeks, she has no intention of walking on egg shells for an extra week unnecessarily and the best case we are probably looking at...if everything stays status quo and we can limp along a few more weeks...is delivering at 36 weeks with no amnio. Because at this point, I have steroids, and the baby's lung development is secondary to the risks of preeclampsia and/or HELLP...seizure, stroke, placental abruptions, etc., so if she decides it's time to deliver because of my symptoms getting worse or signs that the baby is starting to have issues, whether his lungs are completely ready just yet is irrelevant (they likely will be fine anyway) and we don't need the added risk of the amnio putting me in labor (again). She is also really nervous about my weight gain, which she said is definitely swelling, and was not happy to hear that I had protein again in my urine that morning. (Though I had a clear test there.) Luckily she decided not to do another 24 hour urine just yet, I think she doesn't really want to know if that's much worse yet, since there is no recommendation or guideline on delivering for protein levels alone and the baby is doing well and my blood pressure has been good and I haven't had any symptoms of HELLP, yet. And probably, if I'm able to have some clear tests at least, it isn't that much worse yet.  But still, she had pretty much the opposite attitude of my OB, which was actually kind of reassuring that I'm not crazy.

The baby keeps doing really well on his nonstress tests, except for the pesky fact that my amniotic fluid levels have gone from 18 to 15 to 13 to 11 over the last 4 times they were checked. A lot of things can affect measuring fluid levels, (especially the baby's position and the person who is doing the measuring) but they should stay relatively constant, generally speaking... (With Luke they were around 15-16, sometimes up a little from that, sometimes down a little from that, but right there in the middle with no pattern up or down, just some minor variation.) They want them a 10 or higher, so if this trend continues, on Thursday my high risk doctor is not going to be happy. I don't think they'll deliver at this point for fluid levels unless they get really bad, but I wouldn't be surprised if it earned me bedrest officially or even getting admitted with iv fluids to see if that might help. I distinctly remember one person on the Preeclampsia Foundation forums who was in the hospital because of low fluids and they were trying to get them up with IV's and drinking, when she had a placental abruption that her doctor happened to be right there in the room watching the baby's monitors and they managed to get the baby out just in time via emergency c-section and probably saved his life. In some cases, low fluid levels can proceed other things going haywire, so while this trend is still within a perfectly normal range, I'm not incredibly optimistic that I'm going to be leaving the hospital Thursday after my monitoring in lieu of everything else going on too.

On the bright side, we are really close to October, I'm really close to 33 weeks (Friday), and I'm still feeling pretty good, overall. Fingers crossed we can make it a few weeks more. Or at least till October.


Jessica said...

Hang in there sweetie!

I can't imagine the stress of not feeling your doctor is on the same page as you! I am glad to hear the high risk doctor is on top of things. It is not ideal for your baby to arrive before 37w, but as I sit here snuggling my healthy, normal little guy that arrived at 34w I know that it can turn out just fine.

Wishing you all the best as ou wait for the arrival of your baby!

Brooke said...

Yay for Dr. M. She's not messing around!

My fluid levels were all over the place (ranging from 13 to 18) and I asked about it and was told that variation is normal depending on baby peeing, position, and person doing the measurements. I would not stress about the variation, unless of course, it drops below 10.

Sorry about the frustration with your OB. I don't know what she's thinking. I guess that's why you pay to see both doctors!

SG said...

Right, so your OB kind of needs a kick in the pants?
Glad you are being watched closely overall though. It's almost October!

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