Sunday, December 30, 2012

Should Old Acquaintance Be Forgot

Here at the end of 2012...
  • Christmas was a hit. Except for Santa being declared "scary," the presents he brought were welcomed and the rest of the holiday has been devoured by Jackson. He loves the snow, rearranging the tree ornaments (how many can you fit on one branch? there appears to be no upper limit), driving around to see the Christmas lights ("I want to see an elephant!" and dammit if I didn't find one, lucky me). It's cool to see his reaction to all of it now that he's so much more aware and interested in participating.
  • Matthew is giving me a 4-hour stretch of sleep followed by 3-hour blocks every night. I'll take it. He is still difficult to put to bed on time (between 7-8pm in our house), and usually doesn't go down until closer to 10pm. It's a work in progress. But he goes down quickly and easily after night nursing, so I'm back to bed within 20 minutes, usually. I'll take that, too.
  • Jackson has flipped a switch in his head and is now massively interested in the potty. In the past 2 days he has, voluntarily and by his own unsolicited suggestion, peed and pooped in the potty. It's quite a thing to high-five your toddler for dropping a deer pellet in the plastic chair. He was so proud of himself. He asked to try on his Yoda underpants and then aborted that effort halfway through the dressing process -- "too tight!" He'll have to get used to how they feel, I guess; the next learning exercise. We celebrated with ice cream (okay, fruit smoothie but what does he know). His teachers at school will be thrilled. (Don't they have the worst task at hand in the toddler room this time of year? Ten toddlers all in various stages of potty training to move up to the primary room in the fall. Better them than me.)
  • Life is starting to resemble the best of having kids (baby is sleeping! baby smiles! toddler is pooping! everyone gets along!) and some of the best of not having kids (sex! glass of wine! watching tv at night! going to movies!). It's sinking in that we are done having babies, done trying to have babies, done thinking about trying to have babies. It changes everything. As I lose the baby/IVF weight this time, it is for good. No more visits to the RE clinic in my life. Back on birth control for the first time since 2008 (I don't want to find out the hard way that "maybe if you just relax" has any merit). The biggest baby-related drama we have now is telling Jackson, "Don't squish the baby" and, "We don't poke eyes." It's exactly the right kind of drama. It's good. It's the end of something and the beginning of something better.
  • The drama of my extended family, I am choosing to try and ignore as best I can. It's hard. My sister visited and spent as little time with my kids as could be gotten away with. She feigned illness to get attention. She left unceremoniously. That wraps up our relationship right now and for the foreseeable future. Neutral at best. And KB's family, most of them, are actually helping out except his mom, who hasn't been to our house one time since Matthew was born. She's seen him on holidays only. She's just too busy. Unless we're willing to pack up a carload of baby stuff and haul our family over to her house on her schedule. Oh well. She goes to Florida soon for the winter and it will be a nonissue for another 6 months. Perfect.
  • And for 2013...I go back to work part-time, maybe keep the baby home while I do, plan a couple of family vacations (travel, hotel/rental house sleeping...oy), keep working on blocking out the background noise of my extended family and focusing on my chosen family. I hope for that for you, too. If this year has been good to you, then please have more of the same. If not, then hold out for better. Cheers.

Tuesday, December 18, 2012

Merry Christmas, Baby

6 Weeks Later

I just had my 6-week postpartum checkup with my OB. All clear to fornicate. Yippee! Hope my busted vag is in the mood. Cause my exhausted brain....and the sleeping baby radar....

My OB asked first and foremost how the baby is doing; if he's healed, if he has any long-term issues in his prognosis. He is fine. All healed. No chronic problems currently or expected. Then my OB told me he lost sleep over this delivery, that it was one of the hardest (he used the word "scary" a few times) he's had in 20 years of practicing. Huh. Did not expect to hear that. This final reminder of the big event made me think about some of the worst moments again, brought back some things I had forgotten about or failed to notice at the time. I had forgotten about the nurse asking whether she should call for blood to transfuse me. I forgot about how many people I saw hovering around the foot of the bed waiting to see Matthew emerge, waiting to ensure he WOULD emerge. I'm so glad today was the last tangible reminder of this delivery. I'm content now to let the bad parts fade into momnesiac obscurity and just focus on that moment when he was handed to me, crying that little billy-goat cry, and let my brain pretend not much happened before that. (I still have the 1-year follow-up with orthopedics, but I presume the trauma of this shizz will be a distant memory by then.)

I also left with a prescription for progesterone-only birth control pills today. Not taking chances and not ready to schedule the vasectomy just yet. My OB cautioned me that if we have another baby, I will need to have a C-section because all of the complications I had in the pregnancy and delivery are highly likely to reoccur and way too dangerous to risk. I told him there's no need to lose any more sleep over us. We're done. I'm good with the two healthy babies I have and no need to hoard more.


Thursday, December 13, 2012

Have to Admit It's Getting Better, All the Time

Oh, ho -- not the sleeping. We're still up every 2 hours like clockwork all night. But Matthew is going to bed a little earlier (Jackson goes down by 7:30 and we're putting Matthew to bed by around 8-9 or whenever the closest feeding to that time is done). Which means we have some grown-up time not spent juggling a baby in one arm and eating late dinner or dessert one-handed with the other. We used our grown-up time last night to watch part of the 12-12-12 concert (I finished watching the fifth hour of it today). (I can summarize thusly: The Boss, yes. Bon Jovi, no. Roger Waters and Eddie Vedder, yes and yes. The Who, please die so we can miss you already and also put a shirt on Daltry because your waxed orange chest is fucking gross. The Stones, yes [side note: is Mick's hair real? We love playing a good game of "real, plugs, or piece" and he is an enigma; same question for Jon Bon Jovi...]. Kanye, is Hefty paying you to wear their garbage bags as clothes? because you've worn Hefty-bag inspired clothing too many times now for it to be a coincidence. Billy Joel, yes [and the tip jar!]. Chris Martin, dapper [love or hate Coldplay, that chap is fucking charming] and also thank you for giving Michael Stipe something to do on a Wednesday night. Macca, always yes. And Nirvana reunion, well I only saw 2 minutes of it because that's where TiVo cut off the recording. KB and I also kvetched a great deal about how all the quality seats up front near the stage were obviously comps from corporations, as everyone in those seats is clearly in their peak earning years and wearing polo shirts. Shame.) So our family evening routines are shaping up and causing less stress. The morning is still tough, trying to nurse one and help KB get the other fed and clothed and ripped away from his toys (I WANT MY GUITAR! he yelled as we dragged him to his room to put on pants), not to mention finishing the school lunch packing and ensuring all school items make it out the door and trying to avoid the need for bribe treats to get the toddler into his carseat (I WANT FRUIT BUNNIES! he yelled as we nudged him into the car and buckled him in). It's coming together. It feels like KB and I are gritting our teeth a little less, and snarling at each other a little less, too. Parenting both a newborn and a toddler is like learning a new job in a foreign language and there is no training (or pay) (or time off).

I am figuring out for myself how to parent two children a little better. Jackson is letting me reintroduce myself into his routine (I got some painful "No, Mommy, I want Daddy!" pushback for a while). Jackson is also being pretty patient about Matthew needing hands-on attention and approaches him across a spectrum from adoration to indifference; but there's no animosity (yet). I'm trying to invent Jackson-centric activities he and I can do together over the holidays, like decorating felt ornaments with stickers and cutting out sugar cookies, without having to completely switch with KB to cover Matthew duty (we're both trying to find ways to manage both kids so the other can have a's not easy when the newborn needs to nurse and the toddler is Krazy). Pretty soon (after Christmas) I will need to develop a routine for dropping Jackson off at school that includes schlepping Matthew with us, in the Michigan winter, and across a busy parking lot in the mornings. And then some time in February I need to start thinking about picking up freelance work again (maybe just one or two projects to start) and will have to decide whether to keep Matthew home with a part-time nanny (up to 2.5 days per week of coverage, but on specific days which can be a challenge when clients can call/email or try to schedule meetings whenever) or send him to the Montessori school. For the latter, I can send him part-time (say, MWF) and that would be on par with the cost of the nanny. I could also send him full-time, but I don't see a need for that with me only working part-time and him being a relatively easy baby (so far). But to send him to school, I also would have to pump to keep him breastfed. As long as he's at home with a nanny, I can take a break to nurse him every couple/few hours. BUT...I also admit it would be nice to have the peace and quiet of working in an empty house sometimes. I'll have to see what wins the day on balance. They both seem like perfectly fine options.

There I go, getting ahead of myself. For now and the coming weeks/months, I am doing my best around the lack of sleep to enjoy this squishy little baby and my moppet of a toddler.


Wednesday, December 5, 2012

What To Say

So many things.
  • Matthew had his second (and next-to-last) orthopedic follow-up yesterday. His bone is healing and though it's "curved" (the fracture was displaced slightly) it will remodel and straighten out over the coming months, without causing him any problems and unnoticed by the casual observer (you can feel the knobby callous on the fracture site and the curve of the bone if you palpate it carefully). His next (and final) follow-up will be at one year, to do one last x-ray and confirm the bone is healed and straightened out. He's already good as new; he moves his left arm as much and with the same range of motion as his right. Babies are a miracle.
  • He's not colicky but he does get pretty fussy in the evenings. The poor thing has been gassy and has an every-other-day pooping schedule that makes him uncomfortable until the shitstorm arrives. And oh, how. He likes being in the Moby wrap, so at least I have that in my arsenal. And he loves nursing. (Wish my nipples didn't mind it so much.) 
  • He's nursing like a champ. We still use the occasional (pretty rare now) bottle of formula, mostly at night when I've already been nursing him for freaking hours on end and he still won't sleep. KB steps in with the bottle and lets me go to back to bed. It's a decent trade-off for all involved. I think the formula has been exacerbating his gassiness, so less of that is better. But my nipples, lordy are they sore from all the nursing. And the occasional gummy chomp when he's a little too enthusiastic about his milk from this mama cow. Ow. But also, good that it's happening (the nursing). But also, ow. I'm holding off on pumping until my nipples are less chomped-upon-feeling and/or we decide to send him to the Montessori school (and I still don't know when I will do that, since we have a part-time nanny now whom I love and can stay with us through the spring and maybe the summer; but Jackson has done so well in school that I want Matthew to have that experience, too, so we'll see).
  • Sleep. Who is getting any? Jackson and the dog. Matthew naps well during the day for hours at a time, waking up to nurse about every 3 hours or so, but in the late evening is wide awake and not at all interested in sleeping. So I nurse and nurse and nurse him and he just stays awake. And then is up every 1-2 hours (we get the occasional 3-hour stretch a few times a week). I hope it turns around soon. It's frustrating.
  • My sister's visit over Thanksgiving was just meh. She's still not trying very hard to find a job and remains insistent that she "deserves" to hold out for her dream job. I wish she could understand that most of us are doing something short of a dream job, because we have other adult responsibilities that require income and benefits as a priority, and/or that most dream jobs turn out to have downsides like any other. They are better as fantasies, usually. And not worth draining every penny of scant savings and cashing out a meager 401K and living off of benefit-free unemployment indefinitely. But alas. She also played a good game of Top That! even when she asked about my labor. I barely got out the words, "Well, it was kind of rough..." before she started in with stories about her friend so-and-so and HER labor and her other friend so-and-so and HER labor. She didn't even hear the story at all (other than me interrupting her to say it culminated in Matthew having a broken arm, so she would know to be careful with him) until some friends stopped by and asked me about it and then listened(!) to the story. As KB said, perhaps this was an example to my sister of how a conversation is shared between two people, that it is not a soliloquy for one. She actually did pay for her hotel stay but complained about it (even though I prepaid, she let them charge her card which was required for incidentals and is now claiming that Marriott requires in-person presentation of a card and will not permit pre-payment, which of course is bullshit; she's constantly and habitually lying about stupid things like this just to argue) -- I am calling to move the charges to my card and will pay for her stay in a couple of weeks. I'm still pissed that she could afford THREE vacations and twice-weekly bar crawls and concerts with friends since losing her job, but apparently can't afford an inexpensive hotel stay for family, but it's not worth the hassle of never hearing the end of it. And I am *thisclose* to telling her how tired I am of her Top That! routine, the constant lying/exaggerating about everything (if we disagree, or present reality as an alternative when she's ridiculously off-base, she argues, pouts, and throws a hissy fit; it's a delight). Her upcoming stay is just a few days and they're filled with plans to see the city light displays, Christmas dinner at my sister-in-law's house, and playing with new toys. So she can either get on board and enjoy or sit around and be a lazy lump, it's no matter to me. She's headed back down a bad road and I will not follow. I've dealt with over 20 years of this up and down cycle and I'm Seacrest, out. I've reached my limit for bullshit tolerance.
  • Left field: I'm contemplating whether I want to keep this blog going or not. I'm not sure there's anything left for me to say about infertility, being pregnant, giving birth, or whatever. There's plenty to say today and every day going forward about parenting a toddler and a newborn, but I don't know if writing about it is useful or worthwhile. So, thinking.

Monday, November 26, 2012

The Office now a nursery. Jackson had sock monkeys, and Matthew has owls. I wonder if this is shaping their personalities at all (we have supporting evidence for n=1 so far...).


Tuesday, November 20, 2012

Sweating Bullets

Orthopedic follow-up appointment number one: done. And another in 2 weeks. Hopefully the last.

It took for-fucking-ever to get to the office, thanks to a traffic accident literally just outside the medical office building that narrowed the road down to one lane (and Detroit drivers are Grade-A assholes, so merging peacefully and in an orderly fashion is for suckas). Then the parking lot was 100% full so I had to circle until someone was leaving, and didn't she just take her sweet time rearranging some shit in the backseat, and in the trunk, and then checking her makeup in the rearview, and then adjusting her seat. I hope she saw me flip her off while I waited. And then we sat in the waiting room full of elderly patients comparing notes on how bad off they were and playing Top-That with their injuries...

...and then finally, we were called back to see the pediatric orthopedist. It was a long, anxious time to wait to find out if your baby boy will regain full use of his teeny arm, and I have the pit stains to prove it. They opted not to do a follow-up x-ray today (but will in 2 weeks), but the knobby lump on his arm is evidence of healing bone and he passed the nerve function exams (fingers wiggled; elbow flexed; when pissed off enough, shoulder lifted). Although he doesn't voluntarily use his left arm much at all (only slight movement when he's repositioning or stretching) the current prognosis is that he probably does not have a specific nerve injury, and will gradually use that arm more over the next several weeks as it heals more. Between 6-12 weeks old he is expected to be good as new.

For reference, on his birthday, his arm looked like this:
It's still kind of a wait-and-see game, since there's no definitive test or treatment for any of this. But I feel encouraged. Now, I ask you, how do I explain this to my Munchausen-esque hypochondriac sister, visiting tomorrow, without letting it get sucked into her vortex of medical drama? And how do I keep steam from blowing out of my ears when she inevitably interrupts me to tell me about her friend so-and-so's kid who has/had/is having a worse diagnosis of something more awful (Top-That!). (We're putting her in a nearby hotel -- oh, she just got back from her third vacation since losing her job, but do you think she offered to pay for the hotel? -- so we don't have to deal with her 10am-wake-up and sit-around-all-day shiftlessness all week long. It's maddening.) And how do I stop feeling annoyed that my mother-in-law assured us she would come over and help and hasn't been here once since we left the hospital, and won't even try to hold Matthew? (I know she may be concerned about jostling his arm, but the sleeve is pinned down so his arm doesn't move. Anyway, after Jackson was born she mostly brought food. That would have been nice.) I can let that slide, since we have a part-time nanny starting next week. And Matthew is a quiet baby so far, so I think I'll be fine. Once I get past the holidays. Because holidays, man. They are the cause/cure for crazy.

But honestly, whatever, I'm thankful Matthew is okay and is expected to make a full recovery. And that's enough for me. Happy Turkey Day, all. Eat, drink, be merry, kiss the babies.

Oh, and today was his due date.


Saturday, November 17, 2012

The New Normal

We're settling in. Slowly. Some days feel like a gift, and others a chore. That is the way, I suppose.

Jackson is staying in school during the week and Matthew and I are holding down the fort at home. KB had the first week off, but because of some exciting once-in-a-career projects happening for him at work he's been back in the office this week. The part-time nanny is starting after Thanksgiving. Mama needs to make an appointment to get her straggly hair cut. And as soon as these cankles fully deflate, maybe a pedicure. Me-time. Not that having an infant on your tit or screeching through diaper changes every other hour isn't the best, but an hour or two here and there of solitude is bliss.

And the parents-of-two thing. It feels like we're each single parenting one child most of the time, but it's a game of divide and conquer. Jackson is still being lovely toward Matthew and likes to tell us when he's crying (in case we've become selectively deaf and can't hear it for ourselves) and tries to helpfully shove a paci in his mouth at random times. But every morning he runs into the baby's room to check on him (he calls him "my baby") and every night before bedtime wants to kiss him good night. It's sweet. What is not as sweet is the new tantrum phase Jackson has entered, which largely centers around getting into his carseat, getting dressed in the morning, and going to bed. He always capitulates as long as we (really, 99% KB) are patient and steadfast and ride it out for a few minutes. Like at bedtime, he throws a fit about getting into his crib and then merrily sings along to Daddy's goodnight song and crashes immediately. Another phase, maybe precipitated or exacerbated by the arrival of competition for attention. It's stressful, but we're all hanging in there and no one has completely lost their minds. Not yet. Stay tuned. There's always time for crazy to set in.

And Matthew. He's the anti-Jackson of newborns. Mostly quiet, happy to nap the day away without demanding I hold him the whole time, content in a swing or on a boppy. He hates being naked and having his boy bits wiped after a poop. Typical. He still isn't moving his left arm much, altough the bone should be healed/healing by now, but there's probably some nerve injury (the brachial plexus getting stretched is the most common injury after shoulder dystocia, followed by collar bone fracture, followed distantly by humerus fracture; FYI shoulder dystocia occurs in 0.5-1% of births and humerus fracture only in 4% of those cases -- stuck the landing on the shit side of statistics). Our orthopedic follow-up is on Tuesday and I'm hoping to see a healed bone on x-ray and that he'll confirm the nerve injury (they're calling it "pseudoparalysis" right now) will heal spontaneously over the coming weeks, which is true in 90% or so of cases. Need to be on the right side of statistics now. We paid our dues.

Not much sleeping for me, and it wakes KB up when I do the hourly feedings for the first half of the night. We get more sleep after around 1am or so, when my hungry hungry hippo sleeps for 2- or 2.5-hour stretches. He takes nice long naps during the day. I don't feel like a zombie in need of mainlined coffee during the day, which is my measure of acceptable sleep, so all is well. He'll start to sleep longer when he's ready. Not being clingy during the day offsets it a lot.

And then nursing. He still takes quite a few bottles of formula, but only because he seems to get so worn out by breastfeeding that he takes frequent breaks and/or gives up after 5 minutes or so. During the day I can be patient and let him do his nurse/rest/nurse/rest routine for a while, but if I did that at night I'd get zero sleep at all. Refer back to part about him being a hungry hungry hippo. He's getting a little better at nursing for longer periods every day, and he seems to really prefer nursing to the bottle overall, but he also never seems to get full from the boob. So we're supplementing and continuing to work on breastfeeding as best we can. He roots, latches, and sucks and swallows, so it's just an endurance thing. We'll get there. Or not. Whichever. As long as we feed the baby. And I'm just not willing to spend all my free time attached to a pump. Not this time. It made me a miserable human, and gave me mastitis. No thanks. A friend of mine had a similar issue with her first child (no L&D injuries, just a big, hungry boy) and supplemented for about a month or so, then didn't need to anymore. I'm hoping for something like that. Anyway, he's getting breast milk with all its goodies so there's that.

One day at a time. Only a few postpartum tears from time to time, and a beautiful family all around me. I'm doing alright. With some good news for Matthew on Tuesday, I'll be doing better.


Tuesday, November 13, 2012

The Longest Six Hours (Ever)

As one L&D nurse put it, Matthew did not make a graceful entry into the world.

My water broke at home last Monday morning (although it may have actually started on Sunday afternoon), but it was just a teensy trickle, enough to make me question whether it was really amniotic fluid or some random gross fluid that emerges late in pregnancy. I'd been having erratic contractions for days, and they didn't really pick up the pace or become semi-regular until Monday evening. We put Jackson to bed, watched our TiVo'd episode of Homeland (I wasn't about to be a whole week behind!) and called our neighbor to come stay at the house while we trudged over to triage to see if we were staying the night to have a baby, or coming back home. At L&D triage, sure enough I tested positive for amniotic fluid (and glory be, the internal exams, even with speculum, didn't hurt like hell as they did before...). I measured 3cm dilated and about 50% effaced, but contractions remained irregular and mild so augmentation with pitocin was required. Since I wasn't sure when the slow trickle of fluid had begun, it was assumed that we were on the clock and that I would need multiple rounds of antibiotics (I tested positive for group B strep again). Fair enough. I braced myself for a long night.

So off to our room, Lucky Number 13 (I should have seen that as a sign). The OB resident broke my water (the sac was still intact) and there was meconium. Strike one. Nobody panicked, though, and I measured at 5cm, so we figured things were progressing nicely and the baby would be out soon. I requested an epidural and the next hour was spent in agony as the anesthesia resident poked me no less than 5 times trying to get one started. Every time, he hit bone and/or fireworks shot down my right leg, so he would start over. His staff doctor came in and ordered him to stop and give me a rest, and I spent the 20 min break freaking out over the possibility of a fast, augmented labor with no pain relief. Around this time, the back labor started. Hoo boy. So they returned and the resident was told to take a seat, and his boss got the needle in on her first try. Ladies first, y'all. The flood of warm fuzzies down my spine into my legs was the most welcome relief I've had in ages. (Besides finally having my first postpartum poo at 6 days after birth. Whew.) Then of course, the itch began, and I spent the next hour rubbing the itch all over like a crackhead. But the pain relief, good sweet fancy Moses.

So the OB resident returned to check me a while later and I was stuck at 5cm. I don't know what time it was at this point, but hours had gone by and the pitocin dose had increased and there was no progress. I nearly cried. Then we all put 2 and 2 together and realized that my back pain prior to getting the epidural surely meant the baby was turned posterior, and we starting repositioning me every half hour or so to encourage him to turn so he could start to descend. Somewhere during that time, the resident and nurse waltzed in calmly to tell me he was having fetal tachycardia and that I would need to wear an oxygen mask and internal monitors and that we would need to get more aggressive about repositioning, considering moving to all fours if needed (it never was) to get him to turn faster so we could deliver him sooner. So, fetal distress. Strike two. I'm not sure how much time passed after that, only that I wrestled with the closest thing I've ever had to a panic attack inside my head as I focused on every single contraction, willing it to help the baby turn and move. Then around 3:30am (?) the pressure began. I felt him move very fast with each increasingly painful contraction (what epidural?) into the birth canal, and with every contraction the urge to push was stronger. I called for the resident to check me and I was only at 6cm. I gave up the pretense of "nearly" and just cried. Into my oxygen mask. With the urge to push getting unbearable, and only dilated to 6cm, I was full-on freaking out. About 3-4 contractions later I told the nurse I absolutely could not hold back from pushing anymore and I needed to be checked again, NOW. Within less than 10 minutes I was already at 9cm and "stretchy." Now tears of relief. My OB came in (he had popped his head in periodically to check on us) and I told him I really, really, was going to push now and couldn't stop it and he calmly replied, "Okay, let's see what you can do." Well. What I could do was push and scream like a crazy person because this was happening unbelievably fast, like nothing I could have been prepared for, and was unbelievably painful, in considerable contrast to Jackson's second stage labor during which I had felt no pain and was joking around with a med student in between pushes. The second stage contractions this time remained like transitional labor contractions, long and intense and little break in between. So I kept pushing while the OB and resident set up their tray of goodies, and after just a few pushes delivered the baby's head. That's when my OB called for an assist with "a shoulder."

Shoulder dystocia. Strike three. His shoulder was completely stuck behind bone, and 2-person maneuvers were required to free it, quickly. My internal panic bubbled over and came full circle, as I realized I had to pay attention and do whatever they said exactly as it was said, to deliver this baby in the next couple of pushes. Pain be damned. While they applied pressure in places I didn't know were capable of such pain, I pushed through it as hard as I could until I felt him emerge on the final push. No one even bothered to wipe him off, they just handed him to me, sludge and all, so I could hold him. And immediately he cried and rooted. No greater relief has been felt by anyone, anywhere, ever. His APGARs were 9 and 9, but his left arm was obviously injured as he wasn't moving it much at all. I just held on to the relief that he was here, he was (mostly) okay, and labor was over.

Oh. And he nursed right away, like a champ. Rooted for a breast and latched on like he was a pro. This gave me a fleeting moment of joy and additional relief. Until they checked his blood sugar, and it was super low. Even after nursing. So, hypoglycemia. In the game of birthing, strike four.

It turned out that all the maneuvers to free his shoulder failed, and so my OB had to (in a last ditch effort to beat the clock) reach in and essentially yank his shoulder to free it. Rather than taking my baby to my mother/baby room with me, we had to drop him off in the NICU for an x-ray and for formula feedings to stabilize his blood sugar. I spent the rest of the early morning and day alone in my room, getting updates from the nurses in the NICU and traveling by wheelchair to visit him when I could. I wasn't able to hold him until orthopedics had evaluated his arm. But I got to see the x-ray, which was heartbreaking. A complete and displaced fracture of the humerus shaft. Poor baby. After ortho came around and decided that they would not splint the arm, just pin his sleeve to hold it in position, I was allowed to hold him for bottle feedings but advised not to try to breastfeed just yet, since it requires a lot of repositioning that might cause him pain. I was encouraged to pump, but I honestly just felt so beat up and depressed about this whole turn of events, and have such a hate-hate relationship with the pump, that I told them to continue formula feeding and that I would work on breastfeeding him once we had a better shot at it (eg, when I could move him around a bit more and when milk came in). I felt surprisingly okay with this decision, but a few nurses and even the pediatrician on call gave me shit for it; although I'm sure they viewed it as "advice," it pissed me off considerably. I followed my gut (and guess what? Today I have milk in, with a vengeance, and he's nursing!) and didn't need to be questioned. Anyway, this ain't my first rodeo. I did my best to ignore them.

So now we're home, he's nursing and taking occasional bottles, I'm battling engorgement (bless his heart, he's still nursing even with that obstacle) and swollen feet and constipation and exhaustion, and his arm is healing. Our follow-up with ortho and an x-ray is next Tuesday and the surgeon expects to see a healed fracture. Babies are miraculous.

I've had a few pretty hard cries over how all of this happened, how traumatic it felt at the time, how alternately scared and determined I felt through the process. But he's okay, I'm okay, Jackson loves "his baby" to pieces, and we're figuring out this parents-of-two-children thing one day at a time.

Oh, and today was the scheduled induction day.


Thursday, November 8, 2012

Election Day Surprise

Matthew Emerson B____, born at 4:09am on November 6th and weighing in at 8lbs 5oz, 20 in long.

Labor was....well, that's a discussion for another day. [Context clue.] But he's here, we're all recovering, and we are most definitely in love. Even Jackson can't deny Matthew's charm. And it was a pleasure staying up to watch the election results with my new pal. He's pretty great.


Monday, November 5, 2012

The Prodigal Son

Oh, that's right, I have a toddler, don't I? He's swell. Here's what he's been up to:
  • He talks and talks and talks now. We understand him about half the time. He also repeats a lot of words he hears, so my potty mouth needs to wise up and shut up.
  • He's obsessed with playing guitar. We let him watch youtube videos, which started out as Sesame Street and Pooh Bear, and has progressed to concert footage of our favorite bands (puppetmastering parenting at its finest!). So he studies Avett Brothers and Neil Young and Aimee Mann and Queens of the Stone Age and then strums away on his guitar. It's freaking awesome. He's starting to learn the words and sing along. Best thing ever.
  • Every night before bedtime (which is still around 7pm) he goes up to the window and asks about the moon. He likes to find it in the sky. Sadly, it's been cloudy for several weeks, and we have to deliver this disappointing news, but he takes it well.
  • He picked out a teddybear as a present for his little brother, and selected a giant version of the same bear for himself. Actually, the process was reversed as he saw the big bear first and declared, "MY TEDDYBEAR!" then picked up the wee version for the baby. The big bear is named Georgie. Georgie now sleeps in Jackson's crib along with Elmo, Abby, two blankets, and a pillow. Oh, and a Detroit Lions nerf football. It's an episode of Hoarders.
  • He has peed in the potty exactly once, and it was at school. We made a huge deal about how awesome that is and encourage a repeat every night before and after bathtime, but no dice. It was a one-time performance, for the time being. I'm not too concerned about potty training right now as even the pediatrician advised we should wait until after the baby is here. Otherwise, regression and accidents and frustration and setback. But we still encourage him to sit on the potty and let him in the bathroom when we go potty so he can see how it works. He really wants to wipe with paper, and will grab a square and pretend to do it over his clothes, so we've got that move down. That's something.
  • He seems to understand the baby is growing (boy, is he) in Mommy's tummy and will lift up my shirt to pat the baby, or kiss him (way to slay the pregnant lady....), and recently started holding up his milk cup to my belly to feed the baby. Hilarious. He tries to pour milk into my belly button. But then he quickly loses interest and yanks my shirt down, declaring, "Put it away!" So fickle. He can say "brother" and can even say his brother's name. I've been telling him in recent days that soon Mommy will go to the hospital where the doctor will help take the baby out of my tummy, and that Daddy will bring him (Jackson) to see us and then after that we'll all be home together. Whew. That's a lot for a kid to process. After explaining this slowly and earnestly a few days ago, he nodded his head and asked, "Where's my guitar?" Keeping it real. I guess we'll find out how this affects him in real time. Huh.
  • We're not shy about nudity around here, not yet anyway, and Jackson has never paid much attention until the past few weeks. He just noticed (or at least finally articulated) that Daddy, too, has a penis. And he delights in pointing out the similarity to his own anatomy. And when asked if Mommy has one, he excitedly screams out, "No penis!" And last week he walked in my bedroom as I was getting dressed and he noticed my breasts (probably due to darker nipples, thank you pregnancy) and ran up to point and ask, "What is that for?" I explained that Mommy makes milk there for the baby to drink and that he used to drink milk that way. Cue hysterical toddler laughter. But now he tries to grab my shirt and peek down to see where the milk comes from and laugh about it like it's our inside joke. Hahaha.
  • He's been an all-around pretty fun kid lately, minus a few tantrums here and there. I'm really excited to see his reaction to becoming a big brother. I think he'll take to it.

Sunday, November 4, 2012

Wednesday, October 31, 2012

Happy Halloweening

Meet Elmo's Halloween pumpkin doppelganger, Hellmo:
Jackson went trick or treating as....Jackson:
We weren't in the dress-up mood today. Though we did learn that his favorite dress-up item at school is a fancy handbag he likes to carry around. His murse. He does like to accessorize.


Tuesday, October 30, 2012

Triage is the Ninth Circle of Hell

No labor today. No baby out yet. Nothing interesting at 37 weeks. And yet I got to spend 2.5 hours in triage at the hospital just for giggles, I guess.

The NST at my 37-week appointment was fine except for some little blips every so often -- the test was reactive (which is good, it means his heart rate accelerated appropriately with movement) but every now and again, about 5-6 times within 20 min, there was a little downward spike of deceleration. One or two of those and no big deal, but 5-6 and my OB wanted me to be monitored for a while near L&D ("just in case") and have a biophysical profile. So, off to triage. Baby is good after all. His heart rate was fine without any additional "variations," and he passed the BPP with flying colors. The blips at the OB's office may have been from his position -- maybe leaning on the cord or something. So that was that. I got to lay on the super-uncomfortable gurney for over 2 hours and listen to the loud nursing staff jibber jabber at the desk and hear the first-time mom next to me who was SURE she was in labor get sent home 0 cm dilated and then listen to a worried first-time mom who was just discharged last week for possible preeclampsia and was right back in for hypertension. My first half hour was spent worrying about whether I'd be having a C-section tonight, or at least getting induced suddenly, and then after the midwife came in and reassured me that the monitoring and BPP looked fine, I just wanted off that stiff cot and to get home. Around 4pm, I finally got to go. In all this mess, there was never an internal check to see if I was dilated or effaced, but I know we'll do all that next week anyway. And since the baby's room STILL isn't done, I'll take the time. I have acupuncture tomorrow and a prenatal massage on Thursday. Let's encourage this the relaxing way, shall we?

And then I arrived home to find my dog had shat in her crate. She has to be crated when we're gone for more than a few minutes. With me working from home, now not working at home, she rarely needs to be in the crate. But. In the past month she has shat in there 3 times. She was weird around the time I was ready to birth Jackson, so I'm convinced it's behavioral in the same way. Although she's getting old (8 years now), so who knows. So I let her outside and dragged her crate out there to start cleaning it out. I called KB to complain about the shit-stained crate and remarked offhandedly that I hoped the high winds hadn't blown the fence gate open. Dunh dunh dunh. I suddenly decided to go check and discovered the creaky old gate swinging in the goddamned breeze. And no dog. So 15 minutes of pacing up and down the street with a fistful of treats and a leash later, I hopped in my car and started driving around -- and called KB to unintentionally pile onto his stress a little more. (My asshole neighbor across the street -- who doesn't work and is always home and spies on all the neighbors and knows what time I come and go every day -- as usual didn't even open her front door to ask if I needed help. This is the third dog escape, and she's been home during all 3, and she never offers help. And I saw her walking by her front window so I know she knows. Asshole.) AND THEN. Thankfully. I got a call from a neighbor around the block who captured my refugee dog and called the number on the tag. Relief. That the day didn't get any worse. Although it's not over. Sheesh.

Back to my regularly scheduled kvetching about the pains of full-term pregnancy and hoping we get spontaneous labor in the next 13 days. Rain and barometer changes and a full moon this week. Hell yeah.


Sunday, October 28, 2012

What the What

Almost a full 24 hours now of contractions somewhere between Braxton Hicks and the "real" ones I remember from early Stage 1 labor. This is no fun. I tried timing some last night but they're all over the place and I fell asleep in my effort, so I guess whatever they are, they aren't very organized yet. Haven't lost the plug and no signs of amniotic leak. Just annoying random contractions.

And I just made a list of things I planned to do this week, not the least of which is finish the baby's nursery (move in furniture and hang pictures). Crikey. Guess I'd better make Monday a hustle day. I haven't even carved a pumpkin yet. Add that to Monday's list. (I wanted to be ambitious and carve a Bert and an Ernie because obviously, but maybe just a Cookie Monster will do.)

We'll find out if these are real contractions on Tuesday, since they'll show up on the NST monitor. Really, I need to make it until Tuesday so we're not considered "pre-term." Not that they'd stop it, and not that my 6+lb baby wouldn't be just fine, but you know, "high risk" yada yada yada. Although my favorite OB is on call tomorrow. Hmmm. Silver lining. We'll see, won't we?

Pregnancy blows for me, from start to end. The finish line is so close and I am hitting the wall. Bam.


Wednesday, October 24, 2012

For the Love of OBs and Therapists

Lest anyone think my OB practice is a bunch of pushy surgeons, I should clarify a few things. Things I realized in therapy today. (Last sesh until after the baby. And then right back on the couch with a baby at my teat to deal with the likely postpartum anxiety. It's how I roll.)

It's clear to me now that my OBs weren't dwelling on the what-if scenarios because they don't expect them to happen. Scheduling the induction for 39 weeks was a placeholder move, in case we mutually decide it's the right thing to do (ACOG does recommend 39-week delivery via induction for gestational diabetes to minimize ongoing risks to mom and baby). Given my history of A) early labor during the 38th week and B) uncomplicated vaginal delivery of an 8-lb baby, my OBs are actually quite optimistic that a second labor, even if it's a big baby, will be both timely and fine. And as for C-section (which ACOG does suggest should be offered for babies expected to be in excess of 9-10 lbs), I have been absolutely reassured that I can labor through the ol' vag and that again, my history is encouraging since we know I can easily deliver a baby this way. If this was my first L&D they would be a bit more concerned, but this philly has produced results.

So my big realization was that *I* was the one blowing this out of proportion due to anxiety. Not that I don't deserve more info, which I am now getting having spoken up to request it, but my OBs really are just expecting a straightforward labor for me and were acting accordingly. If any of the what-if scenarios manifest, I'm sure (in the absence of recent conversations) they would give me the same non-pressured talk about options. It's just not my personality or in my comfort zone to wait and see and find out *then* what the options are. I need to know *now*. So now I do. Keep calm and carry on.

My OB practice is great, and I'm happy with them despite the recent hiccup (which was exacerbated by an idiotic scheduling nurse -- her, I could do without). After years of trying to conceive and a total of 4 IVF cycles followed by difficult (to differing degrees) pregnancies, I've not had the cajones to even consider a home birth, and wouldn't have been a candidate for either pregnancy anyway (hypertension during delivery with Jackson and gestational diabetes with this baby -- no midwife practice in this area would touch me with a 10-foot pole). And birthing centers are out for the same reason -- they only take low-risk pregnancy/L&D presentation. All of which is moot as I am perfectly content to have a hospital birth. I don't want my recent outbursts to stoke any anti-hospital/anti-OB fires or to suggest that a midwife or homebirth approach would be any better -- for me, it surely wouldn't. The same miscommunication could occur with any internist over even the most mundane medical issue, but because this is about having a baby, it's emotionally charged. I amped it up in my overly analytical way and let the stress of recent complications make it a much bigger problem in my mind than it was in the OBs'. Lesson learned, sometimes it's really not you, it's me.

But it does not escape me that this is my last one -- last pregnancy, last birth -- and I want to remember it well, not with remorse or panic over hastily made decisions or traumatic responses to complications. I have limited control over birth, as is true for any delivering mom (the tiny tyrant calls the shots, more or less), but I want to strive for the best possible experience. So these recent conversations with my OBs have at least led us to that request, laid out bare, so they understand that this is special. I fought as hard for this baby as I did for Jackson, and have suffered through a hard pregnancy at least as much (and here at the end, a bit more) and want the conclusion of it to be something I can remember fondly (just as I remember Jackson's birth).

Acupuncture and prenatal massage are next week. Same practitioners I saw the same week when pregnant with Jackson, and then went into labor less than a week later. Bang a gong, get it on.


Monday, October 22, 2012

Deep Sigh

I got a call from the OB office's coordinating nurse today, a voicemail that truncated mid-message but included enough info to let me know that she had A) miscommunicated to my preferred OB (the one I wanted to move induction up by one mere day to have on call) that I instead wanted to move it BACK and regretted to inform me that B) her hands were tied with regard to C) hospital policy D) yada yada yada. I called back with the intent of bitching her ear off over this stupidity. And that I did. I told her I'm tired of being told different things by different people due to poor communication and wished to only speak to physicians about these things from now on, since it's their clinical judgement and diagnoses driving all of this. Also, I may have mentioned something about losing my shit if I hear "hands tied" or "hospital policy" one more time. ("Say 'what' again...") So she had my favorite OB, who happened to be on call today, call me to chat. And chat we did. All the things I was saving for a diatribe at my appointment tomorrow, I explained to her. I asked for some clarity around these "hospital policies" and to know what exactly was on the table as a recommendation, based on what criteria, and what might end up being considered emergent if it comes down to it. She filled in the picture nicely. I do not have to have an induction if I really don't want one, as it's not even indicated for macrosomia (giant-ass baby). It's indicated for gestational diabetes, but if I really don't want it we can just increase the monitoring past 39 weeks and play it by ear. It's not that I am opposed to induction in and of itself, it's more about the fact that a near-majority of inductions end in C-section. So you get to labor for however long and then have surgery anyway. Worst of both worlds. I asked her if C-section would at any point be strongly recommended or otherwise considered necessary for safe delivery due to macrosomia or the GD, and she said that if the next ultrasound (done in 2 weeks at an appointment with her) shows that baby will likely be >9 lbs, she would offer a C-section but that I would not ever be coerced into having one. Whichever doctor is on call when I deliver would simply keep me informed of pros and cons with a vaginal delivery versus a C-section, and if we encountered difficulty with the baby dropping or maneuvering through labor we would make decisions in real time based on whether I wanted to keep trying to labor or throw in the towel. Then, the $60,000 question: would the OBs be willing to start doing internal exams and stripping/sweeping membranes at 37 weeks to get things going al la natural? Yes. Apparently it's even ACOG guidelines to "encourage" spontaneous labor to avoid intervention.

So. Whew.

(On the one hand, I feel like I might be a total drama queen about this shit, and I don't mean/want to be. On the other hand, it's all very new and undesirable and after a second pregnancy-cum-gauntlet, I just want a straightforward birth for this baby. It just can't be too much to ask. Right?)

36-week Appointment Follow-up: My OB was unusually helpful today. Guess my chart has an asterisk now. Ha. He confirmed baby is head down, fluid levels look good, NST and heart rate look great. Given my last labor, we're still optimistic spontaneous labor will happen within the next several weeks. And if not, when the 39-week induction date rolls around in 3 weeks (!) we can decide what to do based on NSTs, ultrasound, and what my cervix is up to. If it's starting to dilate but without signs of labor, induction will be a consideration, since it will probably work if my body is already starting to prepare. On the other hand, I could continue with NSTs and ultrasounds for up to another week to see if it progresses on its own to start labor or break water. I'm hoping we'll go ahead and do an internal check next week to annoy my cervix enough to think about getting started...


Friday, October 19, 2012

Swell Season

It has begun. The Cankling. Being on my feet for any extended period of time past, say, I dunno, 15 minutes results in lower extremity swelling. Awesome. (At least *knocks on all hard surfaces that even resemble wood* there has been no upper extremity problem, like the painful neuropathy/numbness I had last time, that lingered for weeks postpartum.)

I'm also pretty amazed this baby has so much apparent room, being a mutant giant and all, to move around as much as he does. He shifts position constantly. And it feels horribly uncomfortable. I've tried to reason with him, have tried complaining to him, and have tried poking and pushing back on his wee giant parts from the outside, all to no avail. He's got the moves like Jagger.

My 36-week appointment is Tuesday and I'm going to initiate a frank discussion with the doctor about several things. 1) It needs to be noted in my chart that I have a medical education, am not a layperson, and do not want to be approached like I'm in the lowest common denominator and/or have a third grade education. I want facts, medically accurate information, options, and respect. There's a variation between doctors in the practice as to how I am spoken to and how much information, requested or volunteered, I receive. I'm also sick of hearing about "hospital policy" when what I want to know is about clinical judgement. When everything was fine, this was not an issue. Whilst shit is hitting the fan, this needs to be fixed. Especially in time for L&D. 2) I want to know if they'll support me in an effort beginning at 37 weeks to do whatever we can to kickstart labor for a spontaneous L&D experience, in the form of weekly (or more often, I don't care) internal checks and, if possible, membrane sweeping. This promotes release of prostaglandins that encourage the cervix to ripen and, to use a medical term, get busy. I can't imagine why they would be opposed to this approach, but you never know. I am interested in anything, medically validated or wives' tales, that helps us avoid the need for pharmacological or surgical intervention. I chose this practice in the first place for their minimum-intervention philosophy and statistics, but it feels like at the first sign of complication, that gets checked at the door. Imma get it back. (The OB I'm seeing at my 37-week appointment seems like she would be on board with my request, but I'm not 100% sure. The OB I'm seeing at my 38-week appointment with follow-up ultrasound, my favorite OB in the practice, I think would be. She gets my concerns.)

Maybe I'm committed. Or just stubborn. Or should be committed. No matter.


Tuesday, October 16, 2012

When Bigger is Not Better

Baby boy is nearly a man. He's estimated by ultrasound measurements to weigh >6 lbs at 35 weeks. Although this method is error-prone, it's all that's available and his extrapolated weight by 39 weeks is between 8-9 lbs. Where 9 lbs is the cut-off for converting the induction plan to a C-section, because big babies get stuck in vaginal deliveries and injuries all around can hypothetically ensue. So. I have another ultrasound in 3 weeks (the week before the scheduled induction) to recheck his estimated weight, and a decision may be made then. Or not. Nobody seems able to say. That's perhaps the worst part. Second only to the fact that the doctor on call the day of my scheduled induction is one of my least favorite in the practice -- she's not awful or anything, I just am very lukewarm toward her and vice versa (plus some info from a friend about the doctor's Catholicism and its impact on patient care leaves me unsettled as a secular person/patient) -- and my attempt to have the scheduling nurse move the induction up by one day, so I can have my absolute favorite doctor in the practice deliver my baby the day before, was met with the Great Wall of Hospital Policy. They simply won't schedule anything a minute before 39 weeks without an amniocentesis to confirm lung maturity is what I'm told. I had a meltdown on the phone with this nurse, explaining that the Great Hospital Policy is protecting their liability with regard to a procedure (induction) I don't even want and certainly don't want to have my least favorite doctor perform. This is not an elective procedure after all, it's being mandated for medical reasons. She offered to move it back, which would allow more time for baby to gain more weight and almost certainly require a C-section, another Great Policy (as I know several moms who've safely delivered 9+ lbs babies) that exposes me to increased risk in order to further minimize hospital liability. What choices am I permitted regarding my pregnant body and my baby in this actuarial calculation? Did the election happen already and the GOP (win or lose) plant a flag in my vagina? Her final offer was to leave a note on the (favorite) doctor's desk to follow up with me. Super. I expect little at this point. It seems the best way to not be massively disappointed.

My greatest aspiration now is for an early labor. I'll be full-term by Halloween, in 2 weeks, and will start doing any voodoo suggested to promote labor in the hopes that he will come spontaneously between 37-38 weeks, before he can be declared too big to birth. Bug bucks, no whammies.

Fucking diabetes. My body is spectacular at failing me and now this baby, too.


Tuesday, October 9, 2012

Three Down and Three-to-Five to Go

Or, One Down and 3.6 to Go. Find out what and why here unless you're already a music nerd like me.

Third NST was fine. Baby boy is a champ. The practice OB I saw today answered all my lingering questions about what GD means to my labor options and the L&D process itself. Here's what I know:
  • Growth scan is scheduled for next week (35 weeks) to see if the extrapolated size of the baby will be >9 lbs by 39 weeks. If so, C-section. If not, plain ol' vag delivery.
  • After the scan we'll schedule induction (or C-section if warranted) for 39 weeks. Hopefully I'll go into spontaneous labor before that, but we won't go past 39 weeks due to GD.
  • The hospital now uses wireless monitors so I will be FREE! to wander the halls and move around to deal with contractions. Except if/when I get an epidural, after which I will have to stay in bed (but I'll try to at least switch positions, sit on the side, etc. to keep labor moving).
  • I'll get my blood sugar tested frequently during active labor and if it's high, will get IV insulin to keep it in the normal range. This minimizes the risk of the baby having hypoglycemia.
  • Gloriously, all GD interventions and monitoring will cease 100% for me immediately after delivery. I will have to do another glucose tolerance test at my 6-week postpartum visit to confirm that the diabetes is cured (amen), but getting the baby out is the cure.
  • Even if the baby has low blood sugar at birth, they won't send him to the NICU for monitoring (assuming everything else is fine as well). The treatment would be to breastfeed right away (which I already plan to do) and if that doesn't work, he'd need a small amount of formula. Whatever it takes, I'm just glad to know he won't have to leave our room.
It's good to have a plan. Now I just have to keep on truckin' for 3-5 weeks. I think I can, I think I can...


Tuesday, October 2, 2012

Two for Two

The second NST went just fine today, with baby boy cooperating admirably. We also confirmed he's head-down, which I could tell mostly by the head-butting of my bladder and the butt-butting of my ribs. But good to know for certain. There will be a growth scan some time in the next several weeks.

My blood glucose values have been mostly fine, with a few excursions above normal (but not by much). The more common issue has been low values, necessitating a bigger and more urgent snack when I feel crappy (I can tell before even checking that it's going to be too low). I have to do a better job of planning morning snacks especially, to avoid the hypoglycemic response that can in turn prompt a surge in blood sugar afterward. So damn complicated. But only for a few more (4? 5?) weeks.

I finally worked out the details of Operation Toddler Watch, for when we have to go to the hospital to wrap up Operation Get This Baby Outta Me. One of Jackson's teachers is available on any weekday to pick him up in my car (because of the carseat) and feed him dinner and put him to bed, then wait patiently for KB to come relieve her of her duties. She can stay overnight the first night if needed. Score. We have another babysitter who can come over on a weekend, and can also stay the night if needed. (Our plan, assuming an uneventful delivery, is for KB to spend evenings/nights/early mornings at home after the first night to keep Jackson in his routine as much as possible). And a neighbor offered to come over if we have to scoot in the middle of night. So. Whew. I was having a mini-freak-out earlier this week about the nuclear option, which would be KB staying with Jackson during all non-school hours and possibly leaving me to birth a baby BY MYSELF. It's been our misfortune thus far that KB has not been able to attend a single OB appointment (even the anatomy scan), so the prospect of L&D being a solo visit just walloped me. Plus, what if something goes wrong? What if it turns into emergency surgery? Or would I labor all alone in the L&D room while the nurses are out chit-chatting at the nurses' station? If the baby has to spend time in the NICU for low blood sugar who would go with him and then follow him to my room? Gah. Mindfuck. But we seem to have it worked out now, so hopefully this plan sticks and everything goes according to it.

My maternity leave starts in 4 weeks. Hell yeah.


Tuesday, September 25, 2012

Non-Stress Stress Relief

The NST was no biggie and the little man passed with flying colors. It still sucks donkey nuts that I have to do this weekly until the baby is born (so, 5-8 more weeks....that's both incredibly CLOSE and impossible FAR away). We'll do a growth scan in about 4 weeks or so to see if he's normal size or mutant. If mutant, then we'll schedule an induction or C-section (I guess that depends on just how mutant, and/or his position) at 39 weeks. I asked if we could move it up one week, if it's required at all, in consideration of the one and only silver lining: convenience in scheduling. See, I went into labor with Jackson in the 38th week. And we're all fairly well convinced that is likely to happen again. But if the C-section in particular is deemed necessary, I would prefer to know the day and time to make arranging childcare for Jackson much simpler. Otherwise, if I go into labor spontaneously before 39 weeks, we'd have an unscheduled C-section and lose that one and only benefit. Plus, who the hell wants an unscheduled C-section if a scheduled one can be arranged (when medically necessary, mind you). But alas, our hospital does not permit scheduling such procedures prior to 39 weeks as a matter of policy. Boo. I'm not trying to pull a celebrity trick here, just trying to make the best of a potential, undesirable situation. But there is a reasonably good chance that the wombfruit will not grow too big or ripen too fast, and we can just wait for natural labor to kick in and be on our merry, unscheduled way. So I'm working on devising Plans A, B, and C for lining up minders for Jackson when it's go-time. Fun.


Monday, September 24, 2012

So Now You Are Two

Both KB and I were a little sentimental when we got up with Jackson Sunday morning. He woke up not too early (for once) and in good spirits (not always true) and when we reminded him it was his birthday, he answered back that he was "two!" *one pointer finger on each hand held up* and clapped and we melted a little. He helped around the house and at the grocery store all day long, and was hysterically happy (in an adorable, involuntarily-make-you-laugh kind of way) when his friends showed up for his party. He shared his toys and ate his taco and chowed on cake and it was good.

I ate cake and ice cream and still had normal blood sugars. (So go fuck yourself, diabetes!)

Here is his cake, y'all:
And some cookies I made (bear paws! acorns!):
And cookies I bought as back-ups in case my cookies sucked (which they didn't, so more cookies!):
And party decorations (the crappier the thing, the more likely I made it; everything else was from Etsy):
And homemade play-dough for the kiddies:
A good day.


Saturday, September 22, 2012

I Win at Diabetes

The doubled dose of glyburide did the trick. In fact, my blood sugars have bordered on low after breakfast and dinner, which just means I have to eat more snacks. Eat more snacks! So problem solved, for now. Knock on wood. Praise the lawd. Etc. Etc.

Now to throw a 2-year-old's birthday party tomorrow and then pass the first NST on Tuesday. The fun never stops. (And dare I say, the low-ish blood sugars bode well for my unabashed plans to eat CAKE.) I shall will myself into a happy place this week. I think I can, I think I can.


Thursday, September 20, 2012

Double, Double, Toil and Trouble

Glyburide once-daily hasn't done jack shit to consistently lower my blood sugar. So we are doubling the dose (same 2.5-mg dose but taken twice-daily instead of once). What it has done is make me feel sick every morning, despite the disappointing effect on insulin production. It's like first (and second) trimester all over again. If the new dose/regimen doesn't work over the next few days then I will have to start seeing a fetal/maternal specialist (yay! double the appointments! officially high-risk!) and would be started on insulin. Oh for shit's sake. (At least my IVF veteran status makes me a pro at self-injection, so no classes or instruction required. And good thing I kept a sharps container under the sink, how's that for fucked up serendipity?) So fingers crossed the double-dose of oral meds is good enough. Here's hoping the universe can throw this dog a bone.

I'm still eating birthday cake this Sunday. Because fuck it. Two layers, Tahitian vanilla bean cake with honey and green tea meringue buttercream filling vs. salted caramel. Right?


Tuesday, September 18, 2012

When Life Gives You Lemons...

...forget about making lemonade because that's a sugary drink and you are diabetic now, moron.

I start glyburide 2.5 mg once daily today and we'll monitor sugars to adjust the dosage and timing as needed. And I start weekly NSTs next week at my 32-week appointment. I argued (gently) against doing these, since it only tells you how baby is doing right now. But I was countered with some flimsy suggestion that the data provide predictive information for a week out. (I suspect the only predictive info one would obtain from a less than stellar NST is "we're going to do more frequent NSTs.") What am I going to do, tell my OB that I'm okay with putting the baby at some immeasurable risk?

The two main things I feel right now are 1) anger, that my body can't give me or this baby a break and 2) defeat, that there's nothing I can do about any of this but play along and cross my fingers. If I don't go into spontaneous labor by 40 weeks they will induce. If he measures too big (I don't know how growth scans factor into this yet, but it seems inevitable I will get one or more) at any point then we will plan for either an induction or C-section by 39 weeks. Anger and defeat. The dynamic duo.

For grins, here's a gratuitously cute video of the child I did not endanger in utero with diabetes.


Monday, September 17, 2012

Whatever and Ever Amen

My blood sugars have been erratic over the past week despite cutting out processed sugars and adhering to a meal schedule. I get one normal value per day, plus three abnormal values that range from a few "points" above normal (say, 130 mg/dL, just over the 2-hr postprandial cutoff of 120 mg/dL) to occasionally way out of range (over 200 mg/dL). And the variance can occur from eating the same food at the same mealtime. Huh. So basically, pregnancy hormones have fucked my pancreas hard and my beta islet cells are just curled up in a ball whimpering, but definitely not cranking out enough insulin. My follow-up appointment is tomorrow and I will just walk in with my hand outstretched for an oral antidiabetic med script and ask a bunch of questions about where we go from here. I don't really want to know the answers, but I need data, people. Knowledge is power or whatever.

In much better news, Jackson's birthday is this coming Sunday and I have next to no (paid consulting) work to do this week so I am spending my time making decorations and treats for our family and friends. It will be a super small party, just immediate family and a couple of Jackson's friends and their parents. I wish we do could something a little bigger, maybe invite more kids, since he's about to take a backseat to a newborn who will rock all of our worlds, but we're just physically wiped and need to keep this low-key. I don't think a 2-year-old will care too much. Wait. Is he going to be a TWO-YEAR-OLD? Shit. When did that happen?

I completely stole another blogger's idea from her munchkin's first birthday theme (thanks, R) and went with "woodland creatures." Doesn't that sound enchanted? Nicer than "baby wild feral animals." I ordered a cake from the same bakery that made his sock monkey cake last year and can't wait to see what they've made for us this time. (I gave them some basics, like flavors -- one layer each of green tea/vanilla and salted caramel -- and told them go nuts with the artsy stuffs and surprise me). And I made a little pennant and door hanger with woodsy fabric. And I just got home from buying ingredients to make acorn cookies and bear paw cookies. (I feel like I have to put in some kind of effort to make something, since we're leaning toward ordering pizzas for the party). If I had known when I picked this theme how obsessed Jackson would be right now with Elmo and Cookie Monster, I would have gone that route -- I just found an awesome youtube tutorial for making Cookie Monster or Elmo cupcakes -- but there's always next year. Unless he's moved on to something else by then. Likely.

I'm super annoyed that my sister, who is not working nor actively looking for work at present, isn't coming. And I had to ask her; she didn't bother volunteering this info to RSVP even out of basic respect and manners. If she had an interview lined up Monday morning or something, or was concerned about the cost of driving from Chicago, I would understand. But no. She has random plans with friends and that's more important than her only nephew's birthday. On the one hand, it's a relief because she is a pain in the ass. Especially about food. She asked me a few questions when she was here last week about what we would have for dinner and cake flavors and such and wrinkled her nose at it (she claims to be allergic to tomatoes, vinegar [but not wine, mind you], soy, citrus, wheat, and other random things, and makes a huge stink out of it in public. Exhibit A: at Qdoba, when ordering nachos, she began her order with, "This is going to be a VERY complicated order due to my food allergies..." and her order was nachos, meat, and cheese.) I also tire of biting my tongue as she talks about, most recently, how she's planning to live on unemployment for a while and potentially cash in her 401K to avoid taking anything but the "perfect" job. I doubt she realizes that the unemployment offices in Illinois are not going to be impressed nor moved by her soul-searching plan and will kick her off the rolls if she doesn't take some sort of job within a reasonable amount of time. She also thinks COBRA insurance will only cost her around $200/month. (BWAHAHAHAHA.) I don't know where she got this info, but when I left my full-time job last year, my COBRA packet indicated that continuing my same policy would be around $1000/month. There goes the unemployment check. (And keep in mind, she's a hypochondriac who ends up in the ER at least once a month and spends hundreds of dollars per month on various prescription and OTC meds and even more on alternative therapies since, as she sees it, traditional medicine has "turned its back on her" for failing to recognize her totally legitimate and not at all made up ailments that no test can seem to diagnose and no proven therapy can seem to mend). My disappointment and concern is more of a big picture issue, since dealing with this brand of Crazy™ is exhausting and that's precisely why I don't do it anymore with other family members. If they can't make an effort to pull their act together when they're around me and my family (KB and my kids [HOLY SHIT, PLURAL!]) then why should I keep bending over backwards to validate, even if only passively (by not calling them out on their bullshit), this unhealthy behavior? It's a fine question I am asking myself more seriously these days, since my attention and energy is going to be fully devoted to the raising of 2 (TWO!) small children soon. I don't have the time or inclination to try and raise batshit crazy adults who should know better. She says she wants to visit in November, after her vacation (a super wise idea when you're out of work!) and presumably after the baby is born, but I find myself not caring if she does or not. And if so, I hope it's a brief visit. I pretty much have no family left at this point. They are all so royally fucked up I can barely stand to joke about it anymore. My sister seemed to be aimed toward Normal® for a while, but is now doubling down on Crazy™. Oh well.

And back to happy news again, my paid work is slowly trailing off into nearly nothing as clients keep pushing back their project timelines, meaning that I will have little to do in the coming 4-6 weeks and instead will just hand it over to someone else at the end of October. Sweet. Of course, I don't get paid for what I don't end up doing, but I don't care at this point. I'm happy to have the time to wash baby clothes and help assemble the crib and re-sterilize all my pump parts and find a part-time nanny and all that. (I have this plan that I'll write about another time to keep the baby home with me until around 6 months or so, since I'm only working part-time and from home, so I don't have to pump much and to soak up my last ever dose of newbornness. Just need to find a nanny. Zoiks.) I am finally hitting a tipping point at which, despite my physical misery, I am feeling excited for the baby to come. I wonder if he'll look like his brother or if he'll take after the more swarthy Italians in KB's family. I wonder if he'll be gigantic (thank you, gestational diabetes) or small. I wonder how Jackson will react to meeting him. (I'm trying to teach Jackson how to hold a baby by making a game of it, and asking him questions like, "Would you like to help cover the baby with a blanket? Will you help change the baby's diaper?" which are all met with a curious, "Okay?!?"). It's starting to sink in that I will soon be the mother of TWO children. Well. Who'd have thunk it.

More Diabetes News You Can Use after tomorrow's appointment (as you wait on the edge of your seat) and then birthday party pictures....because a little dose of happy is in order.


Wednesday, September 12, 2012

Pour Some Sugar on Me

My blood glucose (and normal reference cutoff values) yesterday:
  • 8am, morning fasting: 126 mg/dL (95)
  • 11am, 2 hrs post breakfast (oatmeal): 183 mg/dL (120)
  • 2pm, 2 hrs post lunch (PB&J on wheat): 130 (120)
  • 8pm, 2 hrs post dinner (chicken burrito): 99 (120)
Not looking too good. (And for those of you with experience, yes, I ate morning and afternoon snacks and everything was complex carb-no processed sugar and as much protein as I could work in). Rather than jumping straight to insulin, my OB suggested we can try oral meds first (glyburide and metformin have been shown to be as effective as insulin at lowering and stabilizing blood sugar, and actually present lower risk to the baby for hypoglycemia at L&D vs insulin). I have to keep up with the dietary control (for what it's apparently worth) and record blood sugar values until next week, and then we'll go over the results and decide how to proceed. I am really hoping we don't need to escalate the OB visit schedule and/or add a bunch of NSTs or ultrasounds. I don't need more to worry about. I'm also bummed by the prospect of me having to be closely monitored for blood sugar during delivery (read: more intervention) and the baby being poked numerous times after birth (they all get tested, so hopefully his first result will be good). I explained all this to my OB and she gets it. She told me what I already know: one step at a time. Sure.


Monday, September 10, 2012

(Epic) Fail

I took the 3-hr glucose tolerance test last week and it was torture. I laid on a cot in the clinic for over 3 hrs fighting the urge to vomit up the horrendous 100-g glucose orange sludge. And then this morning I got word that I failed spectacularly. Only my fasting and 3-hr levels were normal; it only takes 2 out of 4 abnormal values to declare gestational diabetes. And my 2 abnormals were out-of-the-park abnormal. So the kind nurse instructed me to sign up for some all-day class on how to eat whole grains and how to poke your finger to test blood sugars and what diabetes is or whatever and the thought of sweating through such a thing that is beneath even my first-year biology course education made me stabby. So I pulled rank and informed her that I hold a biomedical doctorate from a top-10 medical school and worked my way through college as a nurse aide drawing blood and doing finger sticks (in addition to taking blood pressures and emptying bed pans) and now consult for a major pharma company on, among other things, diabetes therapy protocols and health outcomes. Therefore I will be taking no such class and instead just want to know if there's a specific glucometer they want me to use, how many hours postprandial they want me to test, what reference values they want me to use, and when/whom to call for abnormal results. I also politely reminded her that we drew thyroid labs weeks ago and if they indicate that the synthroid my RE put me on during IVF cycling is still suppressing my TSH, then I can stop taking that annoying little pill every day. I want a paycheck for my own advocacy 'cause it appears I'm the only one working hard at it.

So I'm depressed about this, since it means mandatory OCD over every meal and every snack (when nausea is STILL a goddamned problem for me, not to mention the chronic bowel obstruction I have to contend with every day -- thanks, progresterone! hcg! estrogen!). It means stabbing my fingers a minimum of three times daily to check blood glucose levels. It means higher risk of induction and/or C-section. Fuck me sideways, y'all. Just when I thought the universe was done laughing at me, here we are. I also need to plan for rapid weight loss after I'm cleared at my 6-wk postpartum check since GD increases risk (through correlation, not necessarily mechanism of action) for a later diagnosis of type 2 diabetes. I will probably have to go through rounds of postpartum testing to rule this out. Fucking YAY!

And KB has been gone on his man-trip to Vegas since Friday, so all this great news comes when I am already on edge. My sister is here but being a colossal pain the ass. It's just crushing to her to not be the center of attention or to win the Who Has the Worst Ailments game, so she has suddenly developed some kind of generalized malaise and just can't be bothered to help much these last couple of days. Like, back of the hand to the forehead, damsel-in-distress, in need of smelling salts, Oscar-worthy acting. She lays in bed (which is an air mattress in the family room) awake, listening to me struggle to get Jackson up and ready in the morning with him crying and me doubled over. And just lays there. Because she's so ill, everybody. Woe. So I've been contending with a cranky toddler who's asking where Daddy is every day and wants to be held all the time and I'm not sleeping more than 2-3 hrs per night and just wishing this week was over. The end.

Although, I do have a therapy appointment Wednesday that should help. Sometimes it's refreshing to cry your fucking eyes out to a sympathetic person, even if you're paying them. And I booked a day of haircut and pedicure and in-room dining at a downtown hotel for Thursday night and Friday morning, because fuck it. I probably won't get any better sleep but at least I can have solitude. And some low-carb bullshit meal from the menu.

Pregnancy is so beautiful. *snort* But thankfully almost over. Just 7 weeks until I'm full-term. Please let spontaneous labor and a non-giant baby come through in the clutch.


Thursday, August 30, 2012

Testing, Testing

So I failed my goddamned 1-hr glucose test. They want me to go sit in the fucking hospital for over 3 hrs to do the 3-hr test there and go on a preemptive diabetic diet. I think I am not going to. Here's why.
  1. My failing score was 165 mg/dL. The American Diabetic Association cutoff is 180 mg/dL* to diagnose gestational diabetes. Therefore, the national authority on diabetes says I passed.
  2. A baseline glucose was not drawn, only after 1 hr post-orange drink. So we don't know if the oatmeal I had for lunch prior to my 1PM appointment might have already spiked my glucose level. It might be a baseline issue more than a metabolism issue. (I was told to eat normally.)
  3. Even if blood sugars are lowered -- through testing, diet, exercise, even with insulin or oral antidiabetic medications -- the risk of having a larger birth weight baby remains if I do, in fact, have gestational diabetes. So the intervention is useless for the biggest concern to the baby.
  4. The major risk factors for me are poorly supported by research: increased risk of preeclampsia (conflicting data) and increased 5-year incidence of type 2 diabetes (even experts concede that the gestational diabetes diagnosed for this subset of women likely just uncovered latent undiagnosed type 2 diabetes, and pre- and post-pregnancy obesity is a strong correlate).
  5. Some experts think that gestational diabetes, considering it's estimated to occur in up to 10% of pregnant women depending on the source, may actually be a normal condition of pregnancy that simply bears routine monitoring as with blood pressure (for preeclampsia), fundal measurements (for intrauterine growth restriction), etc. 
  6. My blood pressure remains perfect, my urine shows no spilled protein or glucose or ketones, and my weight gain and fundal measurements are on track (exactly the same as with Jackson).
So as far as I can tell, the lower threshold (set by many OB clinics) is really a catch-all for false-positives and probably leads to lots of pointless intervention. I can agree to proactively reduce carbs in my diet and add more exercise, which is pretty much the entry level approach to management, anyway. The difference is I do not want to do finger sticks four times a day and obsessively record the blood glucose values which will undoubtedly be scrutinized by defensively conservative clinical standards and then end up fending off further intervention. I also don't want to be labeled as high risk come delivery, since I have a fighting shot at an intervention-free labor this time (as my doctor thinks it will go pretty fast and smooth given my first labor). (I opted pretty early on for an epidural with Jackson because I presented to L&D with high blood pressure -- although only around 150/90, which is not that high, and it resolved during labor -- and the work-up protocol for preeclampsia that this triggered made me concerned about emergent inventions. Having the epidural gave me peace of mind that an emergency C-section would not require general anesthesia and that frequent internal exams wouldn't keep making me want to crane-kick the nearest nurse.)

Fuckity-fuck-fuck. Just when I thought I was in the home stretch (3rd trimester!) with single-digit weeks until full-term, and then this bullshit. They are mailing the info to me with the diet (which I'll do my best to follow) and a lab order to schedule the 3-hr test. I might just not do it and then talk it over at my next monthly appointment in 3.5 weeks. And if they call in the mean time, I'll explain my reasons and see what they have to say. I'm not psyched about the prospect of being flagged as noncompliant, so I want to be sure to lay out a clear case for them. I also don't want for the compromise to come down to frequent non-stress tests or whatever, because that's just more intervention of another kind. I feel like the level and nature of monitoring already built in to the OB practice is sufficient to look out for me and the baby. I hope they agree. They are generally a low-intervention practice (which is partly why I chose them) so perhaps I will prevail. Dare to dream.

Of course, none of this can stop the paranoia that I should just give in to the testing and intervention for the sake of safety. I might pass the 3-hr test anyway. I just don't know. I'm not inherently high risk, so I want to proceed like a normal pregnant person. Anyone here know how the hell that even works?

*So I looked into it more and the test should have been done fasting per ADA recommendations, and the 180 mg/dL cutoff is for a fasting test. So maybe I will suggest we simply repeat following the ADA guidelines and then go from there.**

**Okay, after looking into it even further, the routine OB test is non-ADA and is a "challenge" versus a tolerance test, and I roundly failed. So I appear to be screwed and should probably take the 3-hr test and cross my fingers. Fuck me.