The latest... but not so greatest....

I figured I better update somewhat properly since I am a) for the brief moment feeling decent (which has become a rare moment yet again sadly) and b) because things can change really fast any time now and you wouldn't know what happened to us.

Where to begin??? Well after my last blog post - around weeks 13-14 pregnant things started to change for the better. I got to where I could eat again and could function and things were pretty decent and "normal"ish for several several weeks. I would be lying if I said they were perfect or that all days were good but I had more better days than worse ones which was a nice change.

Flash backwards to a month ago (mid to end July)... I had an ultrasound and all looked well and healthy. They told us we were having a girl which we were surprised because this pregnancy has been so different but she said she checked three times and was very sure - we just laughed because Dave had already picked out his boy name (which I didn't necessarily agree with) which now he wouldn't get to use - har har har - but he was a good sport and really didn't "care" that it was another girl - his fault anyways and secretly I think he likes having girls. Anyways at this ultrasound which was supposed to be our main "20 week/anatomy scan" they said she was measuring in the 27th percentile which was smaller but still within normal ranges. We left and I made more appointments for a month later (we meet with both my regular OB and my high risk OB MFM doctors every month).
 
Flash forward to this month - this last Monday and Tuesday (Aug 15-16th to be precise). I had my regular OB appointment first on Monday and they asked about the baby and I said that I was told she was 27th percentile and the OB said that was "small but normal" and then she told me I had a bladder infection (fun stuff) and gave me paperwork for my gestational diabetes testing and for kick counting since we were basically at 24 weeks pregnant at that point and I would have the diabetes test next appointment. Nothing more was said or discussed really and this was the first time I had ever met this particular OB. This OB office I see has like six Obstetricians and some nurse practitioners and basically you see whoever has an appointment. You never have just one doctor and when you deliver, its whoever is on call that delivers you. I hate this but its just how their office runs and doctors are limited in the area I live in so you take what you can get. I basically chose this office based on the hospital they delivered at and the fact that hospital had a NICU (little did I know it was a NICU for babies only 35+ weeks along or I might have chosen differently at the time).

Almost every time I see the regular OBs they have no idea what's going on with me (they have to flip through their notes right in front of me) and ask a lot of old questions about outdated lab work and usually I know more what's going on than they do - I HATE THIS - its particularly annoying when you are "high risk" and have been since your first appointment with them.... anyways it just makes me extra glad I see the MFM high risk doctor too. I love her and she more than makes up for the inadequacies of the regular OB practice. It does make me laugh though because she (my high risk doc) always says she will discuss my latest results or findings with "Dr. XXXX" from the regular OB and I just laugh and say "sure go for it" because they are clueless over there.

Tuesday was the second of my appointments and this one was with my lovely MFM doctor and included another ultrasound to which I brought my mom (she has never seen an ultrasound for a baby so I dragged her along in addition to Dave and of course Everly). The ultrasound was supposed to be a "growth" ultrasound which is shorter and to the point but hey an ultrasound is an ultrasound so I thought it would be fun. The plan was to have my mom for the ultrasound while leaving Dave and Everly in the waiting room and then swap Dave for my mom for the actual appointment / consult afterwards. It all went to "plan" as far as the swap but the end of the ultrasound the Doctor came in (as she usually does) and it was obvious there were things needing to be discussed in the consult so off to the consult room we went and thus ended the ultrasound.

The first words out of her mouth as we sat down for the consult were that things were going to change and that we were changing action or course plans. After this she told us instead of meeting monthly it would now be weekly and we would be having ultrasounds every appointment and consults afterwards. You should have seen Dave's eyes when she said "weekly appointments". He always is up over 24 hours when we go to these appointments (because of working graveyard shifts) and he knew eventually they would turn weekly or bi-weekly but he was hoping or didn't think that would happen this early.

IUGR stands for Intrauterine Growth Restriction which is kind of a "blanket" term to mean a baby that grows or more accurately doesn't grow enough and ends up under the 10th percentile. Not quite the same as small or low birth-weight baby or "small for gestational age" but very close. Sometimes women know the cause or know they are at risk for it (like me) but some women are surprised or don't find out until they are 30+ weeks or until they actually deliver. I was warned up front I was at risk and thought it was more from having a kidney disease but the MFM doctor says that its more likely the "auto-immune diseases" or a faulty immune system in general that usually causes the IUGR at least in my case. Sometimes the cause turns out to be a slight knot in the umbilical cord or a genetic issue but usually its means a faulty placenta in some way. Whether that be a placenta that is too small, ages too fast, calcifies or just deteriorates or fails in some way before its time. The worst thing it could do is fail completely without you knowing and your baby dies in utero. This is why they deliver you sometimes way early just to give the baby a chance.

IUGR is what my, or more aptly the baby's, diagnosis is right now. Usually they wait until you hit the 5th percentile to give you the "offficial" diagnosis but since I was 6th, she said I was "right there" so they were calling it. Plus that and the fact I am high risk for it (IUGR amongst other issues). She said they tend to see people who get it develop a sudden drop in size at the end of the second trimester and basically that was exactly what was happened with us.

Its kind of "funny" in a way because when Dave and I left the regular OB appointment on Monday we were joking how smooth things had gotten and that I might actually end up with a December baby or a baby that goes past my due date but at this point that will almost for sure not be the case. The MFM doctor was telling us that there were a few things that would cause soon or immediate delivery. Those are the amniotic fluid levels change or more aptly - drop - which means the baby's kidneys have or are shutting down to preserve the brain and heart or if the umbilical cord blood flow changes. What that means is the placenta is malfunctioning and instead of the blood flow going freely to the baby through the cord there is either resistance or the blood flow actually reverses. That means immediate delivery. Also I am high risk for preeclampsia and the extra bad version of preeclampsia called HELLP where your liver begins to fail because of the kidney disease I have and the fact I started getting a tad preelamptic back at the very end when I was pregnant with Everly. One of the symptoms of preeclampisa is high blood pressure. I have never had high blood pressure when not pregnant but if I develop it during this pregnancy I may have the baby early as well because if you have placenta problems the last thing you need is blood pressure problems because it can effect blood flow to the placenta. It's all really kind of a tangled intertwined mess actually.

What this means for now? Well the MFM doctor was talking delivery options at 32 weeks, 28 weeks or in a dream world 34 or 35+ weeks. She was ready to admit me to the hospital Tuesday if any lab work came back bad but thankfully it didn't and I bought myself another week. I go in every Tuesday now so if anything changes, that will be the day I know unless something drastic happens and I get into the ER before an appointment. We talked delivery possibilities: c-section or vaginal and steroids and viability etc. Almost anything that happens before 35 weeks means I deliver up in Tacoma at Tacoma General Hospital or that I would be observed there or admitted on hospital bed rest there which is stressful because that's about 75 miles from home or 1.5 hours away with NO traffic (and there is ALWAYS traffic, this is WA of course).

Basically at this point its a crap shoot. No magic ball can tell me what will happen and the goal is to limp along as long or as far as I can get for the baby's sake. She said if I went a month and stayed the same/stable that they would decrease my appointment frequency. I then asked what she thought the chances of that happening were and she said about 30% so the chances of something changing is 70% and thus more likely. I secretly hope when we go back Tuesday that I have gained ground on growth but in only a week's time and with a baby so small that might be kind of a big wish. Either way we try to be "prepared" but it's still VERY surreal to think about having or seeing our baby this early.