Monday, January 27, 2014

Platelet Problems

I am sad to say that last week got crazier as the days passed. Earlier on in my pregnancy I had posted about my platelets being somewhat low. Again, platelets help your blood to clot and therefore prevent you from bleeding too much. Well, in my 28th (ish) week they were at 116K which is just below the pregnancy normal low of 120K (normal person range is 150K-450K). So, at 36 weeks (last Thursday) I had to have them redrawn before delivery. They were down to 80K. My doctor called me himself that afternoon, and the minute I answered the phone I knew something with my labs was pretty off. I mean, usually he has his nurse call, but this time it was him. This call was legit. The scariest part was the seriousness and concern in his voice. I would have to go to labor and delivery on Friday for a full work up and a non-stress test.

What does it mean? Platelets are below 100K= no epidural. Or pretty much, no epidural. Some anesthesiologists will still do one down to 50K but there is risk. The risk is that you could bleed into your spinal canal and become paralyzed. Or, just bleed, and bleed, and since epidural medication makes your blood pressure low anyway, you can become very sick very fast, and not have enough blood volume pumping through your body. This is never good, but its especially not good when you are exerting yourself trying to give birth.

Why are the platelets low? There are several dangerous reasons, like pre-eclampsia or HELLP syndrome which can both be VERY dangerous and occur in pregnancy. I tested negative (thank God) for these things. It can also be an autoimmune disorder, such as lupus, that the pregnancy makes more noticeable. I also tested negative for this. My doctor contacted a hematologist (doctor that specializes in blood disorders) and because there is no good reason, they've named it "gestational thrombocytopenia." This is a fancy term for low platelets in pregnancy. It happens, not super common but it happens, and there is no good reason why. Apparently because your blood volume doubles this can make the number lower and platelets get destroyed more readily in pregnancy. These play factors.

So here we are. What are we going to do? It sounds like we are going to check the platelets weekly and if they fall to 50K or below, I will be induced and have this baby. The reason is, the lower they get the more the risk of bleeding. On Thursday my level was 80K, on Friday, it was 71K. I am not heading in the right direction. I am also doing NST's twice a week. "NST" stands for non-stress test and basically they hook me up to the fetal monitor and make sure that baby moves and when she moves, her heart rate increases at least 15 points above her usual rate. This shows that she is getting enough oxygen and tolerating being inside me for a while longer. So far, she has looked amazing.

I'm just sitting tight until my appointment tomorrow. Hopefully I will gain some more insight for what the plan will actually be. I am scared to give birth period. And now knowing that an epidural, which was my "safety net" may not be possible I am even more anxious. An epidural was certainly not my "plan" but it was something I really wanted waiting in the wings if I needed it.

We took a childbirth class this weekend which showed us the different methods of breathing, and also educated us on a few other options for pain relief, and it was really helpful. I feel more empowered to conquer this labor with no epidural. I realize it could mean nothing, and I could end up traumatized or with a c-section but for now I am more comfortable with not having the epidural option rather than just feeling terrified when I think of it. I have no idea what I'm in for. But, there have been many times in my life that I've had no idea what I'm in for, and I've made it through those things. Instead of being fearful I am going to validate the fear and jump over it. Instead of worrying I'm going to pray. God will get me through this. As long as the baby is OK and I don't bleed to death, we will have done well. Childbirth is pain with a purpose, and it has a time limit with a great prize at the end. I am going to try and focus on that, rather than the pain. I have waited too long for this to let it break me.

Wednesday, January 22, 2014

29 days!

Holy balls. I'm due to have this baby in 29 days. 29. It seems unreal. With holidays and birthdays and baby showers time has flown by over the past couple months.

It's been an eventful 35th week. On Monday, after a great weekend of a baby shower and catching up with a great friend (Hi L, I know you read this and I love that you came to stay with me) we were out running couple errands and took the kids out to lunch. When we got home I went into the bathroom and had some bleeding. Needless to say I flipped the eff out. I called my doctor, for those of you that may want to know, ****TMI ALERT*** it was a few quarter sized amounts of frank red blood. Anyway, he told me to go to labor and delivery at the hospital and he would call them to tell them I was on my way. When I got there I hadn't had anymore bleeding, so they hooked me up to the monitor and watched me for about 30 minutes to make sure baby was doing ok. She was moving all around, her heart rate was fine, and I was having contractions, but they remained painless.

After I got all checked out, he sent me home and scheduled me an appointment for the following day (yesterday). At my appointment he tried to figure out what caused the bleeding. We did an ultrasound and everything looked fine. He even amused me and printed some 3D shots of the baby's face which was so cool. What it looked like happened was that up until this day the baby had not been head down. She had been "transverse" which means she was laying horizontally across my belly. If she would have stayed here I would have likely had to have a c-section. But, as of yesterday she was head down. And she is very head down, her head is already engaged in my pelvis. So, he thinks that when she turned it irritated my cervix and caused the bleeding. My cervix has barely begun the thinning out process (called effacement) that happens before you start dilating. So, I'm not going into labor at this point. But, if I did, he would not stop me. I'm 36 weeks tomorrow so I am close enough.

Of course, I don't want her to come out yet. Last year, the standard for "full term" changed from 37 weeks to 39 weeks. It used to be that doctors allowed for scheduled c-sections and inducements anytime between 37-42 weeks. That five week block was considered "full term." Now, because they've discovered that fetal outcomes are improved if they "cook" til 39 weeks, 39-41 weeks is considered "full term," 37-39 weeks is "early term" and 41-42 weeks is "late term." They no longer will schedule a c-section or a labor induction until 39 weeks unless there is a risk to the mom or baby (for example high blood pressure, etc).

So, she can just hold tight. My doctor told me that the only "bad news" is that I am going to be pretty uncomfortable now that she is head down in my pelvis. And he is right. I get pelvic pain a lot, it's tough to get comfortable at this point anyway. But, I'm OK with it. As long as she is growing healthy I can deal with a little discomfort. Just like as long as she is content once she's born I'll deal with the fact that my arm is numb because she is resting on it, or that I'm so exhausted I cannot see straight because she kept me awake all night. This is motherhood. It is uncomfortable at times. Especially when the little nugget is crowning and I'm trying to push her out! Ha :)

Thursday, January 9, 2014

34 week milestone

At 34 weeks my baby is 4 3/4 lbs and is about 18 inches long. Her main goal from this point forward is to continue developing her lungs, and gaining weight. Most of the work is done. The milestone of 34 weeks is that most babies born between 34-37 weeks have a fairly easy time and are healthy. They will only require a short stay (if any) in a NICU. I wanted to make it to this point because at 34 weeks she can be born at my hospital with my Dr delivering her.

As of yesterday I am officially on maternity leave. My original goal was to make it to 36 weeks. However, my job is busy and I am on my feet a lot, so I started having contractions during work at 32 weeks and they got more persistent, so Dr told me to be done. I didn't argue. It was getting tough hopping around our unit with this big belly. Its funny though, I feel huge but everyone else keeps telling me how little I look. Who knows. The weight gain (almost 50 lbs) suggests hugeness, and since I'm supposed to gain a pound a week from this point forward and have usually gone over, I'll likely hit a 60lb gain before I deliver her. Super. Bring on the pilates.

She is still VERY active in my belly, after dinner and 2-4am are her favorite times. I can tell she is continuing to get big. If I turn to one side, and she wants to be on the other side she definitely lets me know. This and next weekend are my baby showers. I am very excited to celebrate this little one, and start putting together her nursery. In fact, that will likely start today.

The main "symptom" is fatigue. I'm just sleepy all the time. I alternate doing things I need to do with putting my feet up. Oh, and the feet, they look like sausage links at the end of the day. I HAVE CANKLES. Holy swelling. I hear the final month the swelling really gets serious….can't wait.

I took advice from a fellow mom and bought a few items from the Earth Mama Website for my post partum healing. It's mainly like ….um…. spray to relieve your vag after the baby comes out. I got some nipple salve for breastfeeding too. I like that the products are all natural, and I really want to avoid taking any pain medication after the delivery.

I don't know why, but I feel rushed to get all of these things done because since I was about 18 weeks I have always felt like this baby will be early. I have no reason to believe she actually will be, my OB thinks I'm just impatient I'm sure, but I just have this FEEEEEEELING. She is carrying really low, so I think as she puts on weight she's just going to cause me to go into labor. Granted, scientifically I have no idea that this would even matter, but the thought is there.

Here is what I hope to get accomplished:
1. baby's room and gear washed, assembled, and ready for action
2. 6-7 meals in the freezer so that our first week or so home we can just throw stuff in the oven
3. clean out girls toys
4. organize my office and get taxes done
5. organize hall closets
6. have a few lunch dates with friends since I will be on breast arrest for a while after delivery
7. Finish reading "Nursing mothers companion" and "baby wise" books  so I know what the hell I'm doing (ha)
8. continue to walk and stretch 3-5 times a week

We shall see how it goes :)