June 30th, 2008

I went to work this morning which was a nice change of pace. A little bit of normalcy helps to take your mind off of the fact we are just waiting for something to happen. It also gave Josh a bit of a break from taking care of me and gave him some time to himself to just do what HE wanted for a bit.

We were back at 1pm for another BPP and the baby recieved an 8 out of 8 again. Dr. Wylie came in after the ultra sound tech left and looked closely at how the cord blood is flowing. She didn’t see much of a change from last week but did note that when I initially had lay down on my back for the test, the baby’s heart rate dropped a bit. Because of this, we were sent back over to Labor & Delivery Triage to have the heart rate monitored for about an hour and a half. Dr. Wylie again talked to us about the fact we really are looking at days, maybe a week or two at the most so they need to be as cautious as possible to make sure they get the baby out in time.

We were sent on our way to triage with the message that we could go home if his heart rate remained stable, and if not…we would be deliverying today. We also got an update on how delivery will most likely work…C-section seems to be the most likely. Interestingly (or not for some I guess) they will do a horizontal cut on my skin, but a vertical cut on my uterus because of the baby’s age. Another thing I didn’t know they do in the medical world…

Back at Labor & Delivery, Dr. Katz was on the floor so we met with him to read the heart rate. The rate was steady for almost two hours so we have been sent home again for today. We are due back on Thursday for another BPP and a consulatation with Dr. Wylie. We also were given “homework”…checking to see how my body is processing protein to rule out preeclampsia. So that will also be analyzed on Thursday.

My dad leaves tomm so in light of the hours spent in the hospital today, he took us out for a great dinner which helped us get our mind off of everything. We will be sad to see him go but we know he will be back as soon as the baby comes.

June 30,2008

I went to work this morning which was a nice change of pace. A little bit of normalcy helps to take your mind off of the fact we are just waiting for something to happen. It also gave Josh a bit of a break from taking care of me and gave him some time to himself to just do what HE wanted for a bit.

We were back at 1pm for another BPP and the baby recieved an 8 out of 8 again. Dr. Wylie came in after the ultra sound tech left and looked closely at how the cord blood is flowing. She didn’t see much of a change from last week but did note that when I initially had lay down on my back for the test, the baby’s heart rate dropped a bit. Because of this, we were sent back over to Labor & Delivery Triage to have the heart rate monitored for about an hour and a half. Dr. Wylie again talked to us about the fact we really are looking at days, maybe a week or two at the most so they need to be as cautious as possible to make sure they get the baby out in time.

We were sent on our way to triage with the message that we could go home if his heart rate remained stable, and if not…we would be deliverying today. We also got an update on how delivery will most likely work…C-section seems to be the most likely. Interestingly (or not for some I guess) they will do a horizontal cut on my skin, but a vertical cut on my uterus because of the baby’s age. Another thing I didn’t know they do in the medical world…

Back at Labor & Delivery, Dr. Katz was on the floor so we met with him to read the heart rate. The rate was steady for almost two hours so we have been sent home again for today. We are due back on Thursday for another BPP and a consulatation with Dr. Wylie. We also were given “homework”…checking to see how my body is processing protein to rule out preeclampsia. So that will also be analyzed on Thursday.

My dad leaves tomm so in light of the hours spent in the hospital today, he took us out for a great dinner which helped us get our mind off of everything. We will be sad to see him go but we know he will be back as soon as the baby comes.

June 28th, 2008

We went into the hospital today for another BPP at 9am. It was quiet probably because it was a Saturday morning but they got us right in and set up on monitors. The attending doctor was the chief of Maternal Fetal Medicine who did the test himself (Dr. Barth). He is a very tall, yet quiet man who told us all about our other doctors. Our main doctor is a women who is about 36 years old, Dr. Wylie. We found out last night through Google that she went to Princeton as an undergrad, went on to Columbia then got her medical degree at Harvard. Needless to say, we feel she is well qualified to be taking care of us. The other doctor that we see regularly is Dr. Katz. He is a fellow over at MGH but moonlights as a regular OBGYN at Newton-Wellesley. He has been the one to relay most of the info to us throughout all of this and tries to meet with us as much as possible so we feel we get consistent information. He has been very up front with his philosophy of being overly cautious but we appreciate that as it tends to reassure us rather than leaving us constantly wondering. Josh and I can detect Dr. Katz has a slight accent and had been debating where he was from. We worked up the nerve today to ask Dr. Barth and he confirmed we were both actually correct. He is Israeli (my guess) but his family is from Russia (Josh’s guess). We also learned Dr. Katz attained a degree in Nuclear Physics from MIT prior to deciding to become a doctor. Again, not a bad person to have on our side.

Our little monkey cooperated today and got himself an 8 out of 8 within five minutes of testing so we were cleared to not come back again until Monday. Same orders as every day though, if we don’t feel him kick as often as usual, we are to call/come in immediately.

The rest of the day today was filled with little errands getting boxes for packing and then packing up the kitchen with dads help. Josh also got another coat of paint on the dresser that is intended to be the baby’s so at least we have one more thing taken care of before he comes.

We also picked up books on Premature babies per the NICU doctors suggestion (Dr. Cronin) and have started reading that to prepare ourselves. Of course, we have to ask Dr. Barth our favorite question…when is the baby going to come? He said we are hoping for 30-32 weeks if we can make it that long. Decipher as you will but seems we are still in the range of less than a month until arrival.

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Kate & Josh

June 28th, 2008

We went into the hospital today for another BPP at 9am. It was quiet probably because it was a Saturday morning but they got us right in and set up on monitors. The attending doctor was the chief of Maternal Fetal Medicine who did the test himself (Dr. Barth). He is a very tall, yet quiet man who told us all about our other doctors. Our main doctor is a women who is about 36 years old, Dr. Wylie. We found out last night through Google that she went to Princeton as an undergrad, went on to Columbia then got her medical degree at Harvard. Needless to say, we feel she is well qualified to be taking care of us. The other doctor that we see regularly is Dr. Katz. He is a fellow over at MGH but moonlights as a regular OBGYN at Newton-Wellesley. He has been the one to relay most of the info to us throughout all of this and tries to meet with us as much as possible so we feel we get consistent information. He has been very up front with his philosophy of being overly cautious but we appreciate that as it tends to reassure us rather than leaving us constantly wondering. Josh and I can detect Dr. Katz has a slight accent and had been debating where he was from. We worked up the nerve today to ask Dr. Barth and he confirmed we were both actually correct. He is Israeli (my guess) but his family is from Russia (Josh’s guess). We also learned Dr. Katz attained a degree in Nuclear Physics from MIT prior to deciding to become a doctor. Again, not a bad person to have on our side.

Our little monkey cooperated today and got himself an 8 out of 8 within five minutes of testing so we were cleared to not come back again until Monday. Same orders as every day though, if we don’t feel him kick as often as usual, we are to call/come in immediately.

The rest of the day today was filled with little errands getting boxes for packing and then packing up the kitchen with dads help. Josh also got another coat of paint on the dresser that is intended to be the baby’s so at least we have one more thing taken care of before he comes.

We also picked up books on Premature babies per the NICU doctors suggestion (Dr. Cronin) and have started reading that to prepare ourselves. Of course, we have to ask Dr. Barth our favorite question…when is the baby going to come? He said we are hoping for 30-32 weeks if we can make it that long. Decipher as you will but seems we are still in the range of less than a month until arrival.

<
Kate & Josh

June 27th, 2008

We went back to the doctors this afternoon for a BPP (Biophysical Profile). Its like an ultrasound but rather than take the usual measurements, they look for 4 key findings and score them up to 2 points. 1) Baby;s activity level 2) amniotic fluid level 3) muscle tone and 4) baby’s ability to practice breathing. On Wed and Thurs we received an 8 out of 8. Today they were unable to view the baby take practice breathes so they decided to send us for a “non-stress test”.

For the non-stress test we were hooked up to a fetal heart monitor and instructed to press a button every time we felt the baby move. Unfortunately, he was a bit lethargic for this test so we only felt movement once over the twenty minute test. The doctors were hoping to to see his responsiveness level which basically is whenever he makes a major movement, his heart rate should go up fro approx 15-20 seconds along with that movement. Even though his heart rate today was steady and strong (which is good!) he wasn’t responsive so in the end, he was given a 6 out of 10 points which gets us another appointment tomm.

We certainly cannot complain about the level of care we are receiving but we will be heading back into Labor & Delivery Triage tomm morning at 9am for our 4th day of testing in a row. We are hoping our little monkey moves a bit more tomm and practices his breathing like a good boy.

My dad was there through all the testing with Josh and I today and he chatted it up with the doctors about all the structures in the baby and umbilical cord. My dad always amazes me with his ability to know a lot about everything…he just retains everything. But it was nice to have another set of ears to hear all the info that they keep giving us.

We also again asked today about “best case scenario” for how long they thought this would go on for. The doctor told us that if we could get two more weeks inside and possibly see the baby grow another 100 grams they would be happy. We are figuring this means there may not be much more time so we are trying to relax and get as much rest as possible. They also mentioned I might want to be on “modified bed rest” which may drive me crazy but I will do the best I can. Josh has been taking great care of me though and making sure I get enough ice cream which always seems to make everything better.

Thank you for all your well wishes on both email and text. I’ve gotten all of them and are keeping them in mind s we go in for every test.

June 27, 2008

We went back to the doctors this afternoon for a BPP (Biophysical Profile). Its like an ultrasound but rather than take the usual measurements, they look for 4 key findings and score them up to 2 points. 1) Baby;s activity level 2) amniotic fluid level 3) muscle tone and 4) baby’s ability to practice breathing. On Wed and Thurs we received an 8 out of 8. Today they were unable to view the baby take practice breathes so they decided to send us for a “non-stress test”.

For the non-stress test we were hooked up to a fetal heart monitor and instructed to press a button every time we felt the baby move. Unfortunately, he was a bit lethargic for this test so we only felt movement once over the twenty minute test. The doctors were hoping to to see his responsiveness level which basically is whenever he makes a major movement, his heart rate should go up fro approx 15-20 seconds along with that movement. Even though his heart rate today was steady and strong (which is good!) he wasn’t responsive so in the end, he was given a 6 out of 10 points which gets us another appointment tomm.

We certainly cannot complain about the level of care we are receiving but we will be heading back into Labor & Delivery Triage tomm morning at 9am for our 4th day of testing in a row. We are hoping our little monkey moves a bit more tomm and practices his breathing like a good boy.

My dad was there through all the testing with Josh and I today and he chatted it up with the doctors about all the structures in the baby and umbilical cord. My dad always amazes me with his ability to know a lot about everything…he just retains everything. But it was nice to have another set of ears to hear all the info that they keep giving us.

We also again asked today about “best case scenario” for how long they thought this would go on for. The doctor told us that if we could get two more weeks inside and possibly see the baby grow another 100 grams they would be happy. We are figuring this means there may not be much more time so we are trying to relax and get as much rest as possible. They also mentioned I might want to be on “modified bed rest” which may drive me crazy but I will do the best I can. Josh has been taking great care of me though and making sure I get enough ice cream which always seems to make everything better.

Thank you for all your well wishes on both email and text. I’ve gotten all of them and are keeping them in mind s we go in for every test.

Be prepared to go into labor…week 27, day 2

While neither Josh nor I would consider ourselves “bloggers”, we realize that since we are entering into a period of uncertainty, with changes occurring day to day, we simply will not be able to update everyone individually as regularly as we would like. Thus gave birth to our blog.

Our adventure began approx. 14 weeks ago when during a routine Ultrasound the doctors detected the baby was lagging in growth. At that point, the baby was approx. 1 week behind its gestational age which was something we would watch but did not raise huge red flags. At approx 17 weeks, we received test results that indicated an elevated risk of a chromosomal disorder called Trisomy 18. The doctors immediately referred us to a fetal cardiologist who would look at the babies heart to detect any abnormality that is very common with this chromosomal problem. We had a very small window to decide if we would have an amnio and the cardiologists report would help steer our decision. We ended up seeing the cardiologist twice and in the end she gave us positive findings meaning she felt the heart was structurally sound. After consulting with genetic counselors, we decided against amnio.

At this point, we were told we were basically out of the woods, we would continue to watch the baby’s size but mostly we were relieved and moved forward with our plans to move to New York. We found a new apartment, scheduled a move, secured logistics for our new jobs/job locations and were as prepared as we possible could be.

We went in yesterday 6/25, for a routine appointment which included another ultrasound. We didn’t detect a problem until we had waited almost two hours to get in to see the doctor post ultrasound for routine blood pressure tests and weighing in (my favorite part!). When a doctor we had never seen before came to get us we realized something was wrong. The baby was now classified as severely growth restricted and they had identified the cause: ABSENT-END-DIASTOLIC FLOW VELOCITY IN THE UMBILICAL ARTERY.

In easy terms, it means that the blood flow between the baby and me is being compromised.

In complicated terms it means this: Fetal growth restriction (FGR) as a consequence of uteroplacental insufficiency is an important contributor to perinatal death, neonatal morbidity and long-term health problems. Progressive uteroplacental dysfunction leads to placental respiratory failure and fetal hypoxaemia, which triggers compensatory fetal haemodynamic changes including blood flow redistribution towards essential fetal organs (brain, heart and adrenal glands) at the expense of the other body systems. The duration of the compensatory phase is variable, sometimes lasting weeks, and appears not to have deleterious short-term consequences. With further disease progression, the compensatory mechanisms reach their limit and myocardial dysfunction occurs. Once the disease enters this decompensatory phase, the fetus is at high risk of multisystem organ failure and in-utero demise. There is no effective in-utero therapeutic intervention. The main aim of management is to deliver the baby when the risks of antenatal demise and irreversible end-organ dysfunction associated with further prolongation of the pregnancy are greater than the risks from delivery.

This is not something that will correct itself nor can be treated in utero. We were immediately rushed to labor and delivery triage when I was given my first dose of steroids to begin to pump up the baby’s lungs. The second dose would be given in 24 hours and 24 hours after that the baby would have all the effects it could derive from this treatment. The wanted to admit me for 48 hours for observation but the babies heartbeat was strong enough for them to let us go home for the night. We went back today for our second dose and then had another ultrasound. There has been no change since yesterday which is a good thing because no change is the best we can hope for. As soon as they detect a downhill change in blood flow to the baby., the will deliver immediately. What we are trying to do is balance the risk inside the womb vs. the risk outside of the womb. Every week/day/hour we can can keep the baby inside helps its chances of survival without problem on the outside. But they will not take any chances and will deliver as soon as they have to. That is why it was key to get the steroids administered immediately so they could try and take effect before we had to deliver.

As of now, we are okay. We are dealing with this one day at a time as its simply too complicated to plan any further out. We will go in for another ultrasound tomm, then another on Monday, then Thursday of next week. We are canceling our trip to the Cayman Islands in two weeks but hope we can reschedule again. I think we will definitely need it!

We met with the chief of the NICU today and he explained to us what happens to babies born at 27 weeks. Medical advancements have been huge and 85-90% of babies born at this gestational age survive. He said they generally fall into categories of 1/3, 1/3, 1/3. Some babies have no long lasting effects of being born early whatsoever. Some have mild problems and some have moderate problems. He said obviously severe problems can also present but the fact we have had the steroids administered, will deliver at MGH and not have to transfer the baby in and are aware already there is a problem all work in our favor.

This is obviously not what we hoped for not prepared for but what in life really is? My dad flew into town today (for a previously planned visit) so will be around to help us with packing and getting stuff taken care of as we will still need to move our stuff next weekend. We won’t stay in NY but rather come back up to MA and stay with my mom until we have a conclusion to our birth story. The doctors told us they will not let us go past 34 weeks (which is a lofty goal as is) so we feel it is best to remain up here with the care we have had from the beginning.

I will keep updating as we go, and we will talk to every individually as we can but we didn’t want everyone to constantly be waiting for our latest phone call. Thanks for all of your support, we both appreciate it more than you could understand.

Kate & Josh

26 weeks pregnant (week before we learned we would deliver early)

Be prepared to go into labor…week 27, day 2

While neither Josh nor I would consider ourselves “bloggers”, we realize that since we are entering into a period of uncertainty, with changes occurring day to day, we simply will not be able to update everyone individually as regularly as we would like. Thus gave birth to our blog.

Our adventure began approx. 14 weeks ago when during a routine Ultrasound the doctors detected the baby was lagging in growth. At that point, the baby was approx. 1 week behind its gestational age which was something we would watch but did not raise huge red flags. At approx 17 weeks, we received test results that indicated an elevated risk of a chromosomal disorder called Trisomy 18. The doctors immediately referred us to a fetal cardiologist who would look at the babies heart to detect any abnormality that is very common with this chromosomal problem. We had a very small window to decide if we would have an amnio and the cardiologists report would help steer our decision. We ended up seeing the cardiologist twice and in the end she gave us positive findings meaning she felt the heart was structurally sound. After consulting with genetic counselors, we decided against amnio.

At this point, we were told we were basically out of the woods, we would continue to watch the baby’s size but mostly we were relieved and moved forward with our plans to move to New York. We found a new apartment, scheduled a move, secured logistics for our new jobs/job locations and were as prepared as we possible could be.

We went in yesterday 6/25, for a routine appointment which included another ultrasound. We didn’t detect a problem until we had waited almost two hours to get in to see the doctor post ultrasound for routine blood pressure tests and weighing in (my favorite part!). When a doctor we had never seen before came to get us we realized something was wrong. The baby was now classified as severely growth restricted and they had identified the cause: ABSENT-END-DIASTOLIC FLOW VELOCITY IN THE UMBILICAL ARTERY.

In easy terms, it means that the blood flow between the baby and me is being compromised.

In complicated terms it means this: Fetal growth restriction (FGR) as a consequence of uteroplacental insufficiency is an important contributor to perinatal death, neonatal morbidity and long-term health problems. Progressive uteroplacental dysfunction leads to placental respiratory failure and fetal hypoxaemia, which triggers compensatory fetal haemodynamic changes including blood flow redistribution towards essential fetal organs (brain, heart and adrenal glands) at the expense of the other body systems. The duration of the compensatory phase is variable, sometimes lasting weeks, and appears not to have deleterious short-term consequences. With further disease progression, the compensatory mechanisms reach their limit and myocardial dysfunction occurs. Once the disease enters this decompensatory phase, the fetus is at high risk of multisystem organ failure and in-utero demise. There is no effective in-utero therapeutic intervention. The main aim of management is to deliver the baby when the risks of antenatal demise and irreversible end-organ dysfunction associated with further prolongation of the pregnancy are greater than the risks from delivery.

This is not something that will correct itself nor can be treated in utero. We were immediately rushed to labor and delivery triage when I was given my first dose of steroids to begin to pump up the baby’s lungs. The second dose would be given in 24 hours and 24 hours after that the baby would have all the effects it could derive from this treatment. The wanted to admit me for 48 hours for observation but the babies heartbeat was strong enough for them to let us go home for the night. We went back today for our second dose and then had another ultrasound. There has been no change since yesterday which is a good thing because no change is the best we can hope for. As soon as they detect a downhill change in blood flow to the baby., the will deliver immediately. What we are trying to do is balance the risk inside the womb vs. the risk outside of the womb. Every week/day/hour we can can keep the baby inside helps its chances of survival without problem on the outside. But they will not take any chances and will deliver as soon as they have to. That is why it was key to get the steroids administered immediately so they could try and take effect before we had to deliver.

As of now, we are okay. We are dealing with this one day at a time as its simply too complicated to plan any further out. We will go in for another ultrasound tomm, then another on Monday, then Thursday of next week. We are canceling our trip to the Cayman Islands in two weeks but hope we can reschedule again. I think we will definitely need it!

We met with the chief of the NICU today and he explained to us what happens to babies born at 27 weeks. Medical advancements have been huge and 85-90% of babies born at this gestational age survive. He said they generally fall into categories of 1/3, 1/3, 1/3. Some babies have no long lasting effects of being born early whatsoever. Some have mild problems and some have moderate problems. He said obviously severe problems can also present but the fact we have had the steroids administered, will deliver at MGH and not have to transfer the baby in and are aware already there is a problem all work in our favor.

This is obviously not what we hoped for not prepared for but what in life really is? My dad flew into town today (for a previously planned visit) so will be around to help us with packing and getting stuff taken care of as we will still need to move our stuff next weekend. We won’t stay in NY but rather come back up to MA and stay with my mom until we have a conclusion to our birth story. The doctors told us they will not let us go past 34 weeks (which is a lofty goal as is) so we feel it is best to remain up here with the care we have had from the beginning.

I will keep updating as we go, and we will talk to every individually as we can but we didn’t want everyone to constantly be waiting for our latest phone call. Thanks for all of your support, we both appreciate it more than you could understand.

Kate & Josh