I can't believe I am going to say this, but the reason you didn't hear from me via blog yesterday is because I was so busy I had absolutely no time!!! This is a major blessing in the hospital. I thought I was going to go crazy on Thursday morning because at that point few people knew I was in the hospital and I felt pretty lonely and uncertain about what was going on. Since then, the outpouring of love and support has been almost overwhelming. It is so nice to know that there are so many people out there thinking about and praying for us and who are willing to take time out of their busy schedules to check in and help out. So, first of all, thank you all.
Now onto the update! Unfortunately, the main gist of things is that I am going to be confined to this hospital room/bed for quite some time. The only standing privileges that I have are to go to the bathroom and to shower (however, it has been specified to me that the showers are to be short). Thankfully, I have retained these privileges and have not had the misfortune of being seen by another doctor who notoriously kept one pregnant woman here for 179 days with 100% bed rest (sponge baths and bed pans).
The reason for my bed rest and extended hospital stay are that I have dilated more since I entered the hospital. I am currently 3-4 cm dilated and 80% effaced. The doctors wanted to do a test on me yesterday called fetal fibronectin. Fetal fibronectin is the protein glue that holds your amniotic sac to your uterine wall. When this protein glue starts to break down, the amniotic sac is less supported and you are more likely to have your water break and go into labor. If the test is negative (no FFN is detected breaking down and leaking out) there is a less than 2% chance of going into labor in the next two weeks. If the test is positive it doesn't really mean anything - the glue is breaking down, but you could go into labor tomorrow if it is breaking down quickly, or you could go into labor in 5 weeks if it is breaking down slowly. I was really hoping, of course, for a negative test result yesterday. When I woke up yesterday morning they did the swab and then checked my cervix. Unfortunately since I had dilated beyond 3 cm they didn't send the sample to the lab because after you are greater than 3 cm dilated it is almost certain that the test results will come back positive.
I spoke with the high risk maternity attending yesterday after finding out that I had progressed and that we were unable to do the FFN test. He said that his plan is to keep me here until early next week and to see if things calm down a bit and if the progression has stopped. I asked him about taking other tocolytics (meds that stop/slow down contractions/labor), but he said that they probably wouldn't change my meds. The problem with tocolytics is that we really don't know enough about pre-term labor. We know that there are several causes, but we don't know what all of the causes are. We have a lot of tocolytics, but we don't know which tocolytic will work on which pregnant woman since each one targets a different cause of pre-term labor. Furthermore, we don't have any real good ways of testing what is causing the pre-term labor, so the general approach is to throw a bunch of tocolytics against the wall and see what sticks. As my attending described it, "There are several hammers and several nails, and we would have to find the right hammer to hit the right nail on the head or it won't slow things down."
If I were much earlier in my pregnancy, let's say 25 weeks, they would try a plethora of tocolytics on me to stop things since the outcomes on 25 week old fetuses are much worse than for 32 week fetuses. However, tocolytics are not risk free. At this point, my baby would be born healthy enough that the risks of many of the tocolytics outweigh the benefits. If baby were born today there would be three reasons to be in the NICU: 1.) they don't develop the suck, swallow, breathe reflex until around 34 weeks, so they have to be tube fed; 2.) they sometimes get tired breathing because, even with the steroid injections, their lungs haven't quite developed all of the way; and 3.) they are teensy and sometimes have temperature control issues. None of these are devastating long-term problems, they are just discouraging inconveniences that would last for 2-3 weeks until baby is able to grow enough to not need the extra help. The doctors have me on one tocolytic, procardia (a calcium channel blocker that calms down the uterus), that has very minor side effects. Essentially, it can make my blood pressure go a bit too low. However, I am in the hospital and am stressed out somewhat - I don't think there is a risk of my blood pressure dropping too low. Additionally, they check my blood pressure before each and every dose of procardia to make sure that it is safe to give it to me.
I spoke with my primary OB after speaking with the high risk team. He agreed with their assessment, however is a bit more conservative in his approach. He has adopted the "wait-and-see" attitude for me and said "I would like you to stay in here at least until Tuesday since you will be 33 weeks at that time. On Tuesday we can reevaluate things and develop a new plan." From interacting with my doctor over the past 32 weeks, I know that this really means, "We are going to keep you here until Tuesday. On Tuesday you will be 33 weeks. After you are 33 weeks we will reevaluate things and keep you here one more week until you are 34 weeks. At 34 weeks we will reevaluate things and keep you here one more week until you are 35 weeks." I know that the best outcomes occur after passing the 34-35 week mark, so we are keeping our fingers crossed and keeping our prayers going that baby will be willing to stay in for at least 2 more weeks. I have a feeling that I will not make it to term and that they will keep me here until baby is born. But it is better to be in the hospital with baby in my belly than to be in the hospital with baby in an incubator being fed through a tube.
It looks like this anticipated Christmas baby may now turn into a Thanksgiving baby.
Now onto the update! Unfortunately, the main gist of things is that I am going to be confined to this hospital room/bed for quite some time. The only standing privileges that I have are to go to the bathroom and to shower (however, it has been specified to me that the showers are to be short). Thankfully, I have retained these privileges and have not had the misfortune of being seen by another doctor who notoriously kept one pregnant woman here for 179 days with 100% bed rest (sponge baths and bed pans).
The reason for my bed rest and extended hospital stay are that I have dilated more since I entered the hospital. I am currently 3-4 cm dilated and 80% effaced. The doctors wanted to do a test on me yesterday called fetal fibronectin. Fetal fibronectin is the protein glue that holds your amniotic sac to your uterine wall. When this protein glue starts to break down, the amniotic sac is less supported and you are more likely to have your water break and go into labor. If the test is negative (no FFN is detected breaking down and leaking out) there is a less than 2% chance of going into labor in the next two weeks. If the test is positive it doesn't really mean anything - the glue is breaking down, but you could go into labor tomorrow if it is breaking down quickly, or you could go into labor in 5 weeks if it is breaking down slowly. I was really hoping, of course, for a negative test result yesterday. When I woke up yesterday morning they did the swab and then checked my cervix. Unfortunately since I had dilated beyond 3 cm they didn't send the sample to the lab because after you are greater than 3 cm dilated it is almost certain that the test results will come back positive.
I spoke with the high risk maternity attending yesterday after finding out that I had progressed and that we were unable to do the FFN test. He said that his plan is to keep me here until early next week and to see if things calm down a bit and if the progression has stopped. I asked him about taking other tocolytics (meds that stop/slow down contractions/labor), but he said that they probably wouldn't change my meds. The problem with tocolytics is that we really don't know enough about pre-term labor. We know that there are several causes, but we don't know what all of the causes are. We have a lot of tocolytics, but we don't know which tocolytic will work on which pregnant woman since each one targets a different cause of pre-term labor. Furthermore, we don't have any real good ways of testing what is causing the pre-term labor, so the general approach is to throw a bunch of tocolytics against the wall and see what sticks. As my attending described it, "There are several hammers and several nails, and we would have to find the right hammer to hit the right nail on the head or it won't slow things down."
If I were much earlier in my pregnancy, let's say 25 weeks, they would try a plethora of tocolytics on me to stop things since the outcomes on 25 week old fetuses are much worse than for 32 week fetuses. However, tocolytics are not risk free. At this point, my baby would be born healthy enough that the risks of many of the tocolytics outweigh the benefits. If baby were born today there would be three reasons to be in the NICU: 1.) they don't develop the suck, swallow, breathe reflex until around 34 weeks, so they have to be tube fed; 2.) they sometimes get tired breathing because, even with the steroid injections, their lungs haven't quite developed all of the way; and 3.) they are teensy and sometimes have temperature control issues. None of these are devastating long-term problems, they are just discouraging inconveniences that would last for 2-3 weeks until baby is able to grow enough to not need the extra help. The doctors have me on one tocolytic, procardia (a calcium channel blocker that calms down the uterus), that has very minor side effects. Essentially, it can make my blood pressure go a bit too low. However, I am in the hospital and am stressed out somewhat - I don't think there is a risk of my blood pressure dropping too low. Additionally, they check my blood pressure before each and every dose of procardia to make sure that it is safe to give it to me.
I spoke with my primary OB after speaking with the high risk team. He agreed with their assessment, however is a bit more conservative in his approach. He has adopted the "wait-and-see" attitude for me and said "I would like you to stay in here at least until Tuesday since you will be 33 weeks at that time. On Tuesday we can reevaluate things and develop a new plan." From interacting with my doctor over the past 32 weeks, I know that this really means, "We are going to keep you here until Tuesday. On Tuesday you will be 33 weeks. After you are 33 weeks we will reevaluate things and keep you here one more week until you are 34 weeks. At 34 weeks we will reevaluate things and keep you here one more week until you are 35 weeks." I know that the best outcomes occur after passing the 34-35 week mark, so we are keeping our fingers crossed and keeping our prayers going that baby will be willing to stay in for at least 2 more weeks. I have a feeling that I will not make it to term and that they will keep me here until baby is born. But it is better to be in the hospital with baby in my belly than to be in the hospital with baby in an incubator being fed through a tube.
It looks like this anticipated Christmas baby may now turn into a Thanksgiving baby.
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