Contractions and appointments

I am now going to my OB appointments every two weeks. Yesterday's included an ultrasound scan for growth, and all looked well. Baby is 3 pounds, 8 ounces, and the technician said baby has very long feet. Baby's head is down and on top of my bladder, with the spine running up and along the right side, with one foot down at the head (!), and a hand behind baby's head. She printed off some scans for us (the one showing foot by head is above), and videotaped a few more minutes, including baby blinking the eyes! But baby wasn't in a photogenic position, unlike two weeks ago when I got to see baby on the small screen in the exam room. The doctor came in and did a check, too. He said there are no signs of heart failure, and baby's heart is beating rhythmically, at 133 BPM. There is plenty of amniotic fluid, too.

This has been a different kind of week for me. I have been having a lot of Braxton Hicks contractions. These are sometimes called "false" or "practice" contractions, since they usually aren't painful and don't cause dilation. They started Monday night, the night of the full moon. The uterus tightens up all over for about thirty seconds. I can feel them coming on. If you have more than five in an hour, you are supposed to call the OB, however. And that happened Tuesday morning. The remedy is to lie down and drink lots of water for an hour. So that helped. After that, I just got them about once or twice an hour. But Wednesday evening, as I was preparing to shower, I got about seven in ten minutes! After the shower, I lay down, but still got another six. The doctor on call wasn't too concerned after I described everything.

I find I get them if I go to stand up, if I'm sitting at the computer, or running a quick errand like picking up milk. So basically, any time! I don't feel too good though after I get a few of them, and I think it has curbed my appetite. But baby is still moving quite a bit.

So at the OB appointment yesterday, when the nurse examined me, she asked if I had been having any contractions. I said, surprised, "Oh, haven't you heard?" So she asked me if I would want an internal exam to set my mind at ease that I am not dilating. And I was grateful, I said yes. She was very gentle with it, first saying, "And this is your pelvis" as I could feel the pressure against one spot, "and now I'm feeling baby's head" which was amazing to hear, and finally "and this is your cervix." She said it was barely indented, so pretty closed, right where it should be at 30 weeks.

My weight hasn't changed in the past three weeks, so it was good to hear that baby was growing well and is in the 50th percentile which they felt was perfect (i.e. won't be too big). And they did say baby is very symmetrical, all body parts measuring in symmetry.

Today we have our second consultation with a pediatric cardiac surgeon. I will eventually post about the first consult, too, and the tour we had at Children's.

Baby belly (and birthing plans)

This is my belly at 28 weeks (last Thursday night)! Baby is lying at an angle, head is down and to my lower right, rear end is up and under my left ribs. I mostly feel the arms thrashing about, although there is some squirming.

Tim and I have signed up for "hypnobirthing" classes. This is a fairly new birthing method that allows a woman to approach birthing without fear of pain. The majority of babies born to women who have used this method arrive calmly, without stress. We are doing this to give us a chance of having baby delivered (or "breathed out" as they say) without distress so we can have a few minutes to bond with baby.

We are also hiring a birthing doula. We have asked Lynn, my yoga instructor, to be there with us at baby's birth. As she describes it, "I draw on my knowledge and experience to provide emotional support, physical comfort and, as needed, communication with the staff to make sure that you have the information you need to make informed decisions as they arise in labor. I can provide reassurance and perspective to you and your partner, make suggestions for labor progress, and help with relaxation, massage, positioning, and other techniques for comfort."

I'm confident that with Lynn there, and having had the hypnobirthing training, I am doing all I can control to make this birth as smooth and natural a process as possible. Everything else is in God's hands.

Wallpapering done!

We hired someone to hang the wallpaper borders. She was very good, she put sizing (or primer) on the walls first, so we can remove the borders more easily when it is time. Then she hung the top 6" border, the bottom 9" border, and the matching wall accent in under three hours. She reinstalled all the outlet covers, too. I did goof, I forgot to measure the wall over the 5' wide doors, so we were short a roll of paper on the top. I reordered one, and she will come back next week to put it up, no extra charge. She didn't even want payment today, that's how nice she was! Next up, window treatments, wall hangings, and furniture!

Nursery update

I thought you might like to see the fabric my sister Amy found to use for the window treatment. It is called Dotz Mint and is by Waverly Fabrics:

She will make a little cushion for Tim's white baby rocking chair, too; I sent her a tracing to use as a pattern. And she will sew a table topper for the table we will (hopefully) have in one corner of the room, near the glider and ottoman. She ordered an extra yard and a half for these little accessories. Plan is to have white wooden blinds for privacy, and then two side panels with wooden rings hanging from a matching wooden rod that is painted white with little specks of aqua and green.

Wallpapering is being done on Wednesday; we hired someone to put up the two borders and the wall accent. (See 5/30/08 blog post "Nursery planning.") All the painting is complete, including scraping of the glass and touch-ups along the edges. After the borders are up, we will rehang the French doors and move the office furniture into final position. (We will leave the couch in there until we get nursery furniture, so I can have a comfy place to nap!!) Tim will then hang the ceramic rabbit chandelier. After fabrication, the window treatments will be installed.

We still need to purchase the furniture. We would like a standard crib, an armoire with a hanging rod, and a dresser, all in white or off-white. We would also like a reclining glider and ottoman. The office desk will remain in the room, along with the matching file cabinet, which we can use as a changing table since it is the perfect height. There is going to be a lot of stuff so we have to figure out how it can all be arranged. Lastly, we plan to make a 3- or 4-panel screen which will be wallpapered in a matching trellis pattern. This will hide the office furniture from view when you first walk towards the nursery.

We are getting there! It is pretty exciting!

Baby Shower in Michigan

My mother-in-law, Mary Anne, sent out seventy of these invitations to our first baby shower, and we had forty-two attend:


The party was held at a church hall, where the Ladies League did all the work of setting up the tables, preparing and serving the lunch, pouring drinks (water, lemonade or ice tea), and cleaning up. The lunch started with a molded cranberry salad, and then a delicious chicken salad croissant sandwich served with fresh fruit, with bowls of potato chips and relish trays (i.e. pickels and olives) on each table. The centerpieces were white daisies in decorative galvanized buckets with an attached white stuffed animal. At each place setting was the party favor, homemade raspberry jelly made by Mary Anne and her sister Fran, and a blank envelope (to go with the thank you cards) for each guest to write out their own name and address.

This (unfortunately blurry) photograph at right [click on images to enlarge] was taken before any of the guests arrived. The hostesses are from left to right: Annemarie, Jenni, Mary Anne, and Karen. Then I am next, in green, with nieces Hannah and Kirsten.

We posed in front of the gift table. To the left of the table, as a party decoration, Mary Anne placed her original baby bassinet from when she was a baby. All of her siblings slept in that bassinet, as did nearly all of their children and grandchildren! Inside the bassinet is Tim's baby picture. Hanging from it is an old satin stork, which has been hung up on numerous front doors announcing the arrival of the latest family member. After the shower was over, we packed up the bassinet and stork and shipped them to Missouri, where they await the latest delivery!

After we ate lunch, I went back and sat in front of the gift table to open up our baby shower gifts. Hannah handed wrapped packages and gift bags to me while Kirsten wrote down the names of the guests and their presents. Our guests were very generous. We got many items from our registry and plenty of beautiful surprises, too. An amazing thing also occurred: we did not receive a single duplicate gift! While I opened the gifts, the rest of the party got to enjoy a piece of the shower cake, which was a white cake with raspberry filling, very much like our wedding cake (and made by the same bakery!). The cake was served with an ice cream or sherbert. (I eventually got some after the last card was opened! And they saved a piece for me to bring to Tim later.) After the opening of several gifts, Hannah would draw out an envelope with one of the guests' names on it to annouce who won a centerpiece to bring home.

So after the gifts and cards were all opened, I suddenly stood up as if to say something, and had to laugh as everyone turned my way. I had prepared nothing. But I went ahead and told everyone how blessed Tim and I were, that we had tried to have a baby for five years, and thanks to medical intervention, we were where we were today. I also told them our baby had a heart defect and that things will be tough, but that we knew there were a lot of people praying for baby, and we appreciated it. A lot of people came up to me afterwards and told us positive stories they knew about. Very sweet.

Some of the shower gift highlights were the homemade items. At left are my personal favorites, a pair of crocheted baby booties, complete with tiny buttons, and a matching bib. They are so tiny and so adorable! These were made by the mother of one of Tim's good friends. She also made embroidered burp cloths with funny sayings like, "If I'm not sleeping, nobody's sleeping!" and "2 a.m. Party. My Crib. Bring your own bottle." An eagerly awaited gift was a homemade quilt by Marilyn Adams. Apparently Marilyn has made many newborns' quilts, but I didn't realize that. In just a few days before the shower, she pieced together a quilt with the Beatrix Potter fabric. It is quite warm, large, and beautiful. Other handmade items included washable cloth books sewn by Hannah and her other grandmother Barb, and a play quilt to lay on the floor.

Before leaving for Missouri, we put all the soft items (clothing, blankets, stuffed animals) into an extra golf travel bag that we had brought to check in as airplane luggage. We packed the hard items (books, albums, knick knacks, first aid kit) into a small box for shipping home. (Tim's good friend Leo works for DHL, so was kind enough to ship the boxes for us at discount.) We did return the very large or electronic items to the local Babies 'R Us so that we could purchase them at home and not have to worry about shipping them or damaging them in transit.

For now, all the baby items are collecting in our bar area downstairs while we prepare the nursery. Around the beginning of November (by when we hopefully have nursery furniture!) I will start washing the clothes, blankets, sheets, etc. to put away. Can't wait to start setting up the room with all the lovely gifts.

Three more months?!

Look at the size I am now!

My belly is really sticking out now! When I lie on my back, the top of my uterus is flowing over my bottom ribs. Things are starting to get very tight in there! Baby is now 14 inches long and weighs 2.25 pounds.

The belly is starting to be "in the way" of things now: When I greeted Tim at the door one night after work, with a kiss, my belly bumped us apart! That was good for a laugh. When I try to lean across a counter, I can't lean as far as before. Sometimes I hoist my belly up on to the counter so I can get close to the mirror over our bathroom sinks. It is hard to put on socks; I can't really bend over. I mostly have to sit or lean on something. I can't see my toes if I stand up straight and look down!

Baby still seems to have plenty of room to move around in, though. I feel movement in the morning when I'm lying in bed, and at night when I go to bed to read or sleep. The movements shift constantly, sometimes left and soft, other times high and hard. I cannot tell what position baby is in, but fortunately, it is not down low and wanting to come out!

And the best news is I have started my third trimester; I am in the middle of my 27th week. Babies can survive well enough outside the uterus at this point, in an emergency. I'm hoping baby will stay put until the middle of November and not a moment longer!! But if I'm already this big, I just can't even imagine how huge my belly will be in three more months!

Fetal echo cardiogram results

Well, after spending ten minutes or so crying in bed tonight, I decided to get up and write about our ultrasound appointment today. Warning: it gets very technical, but I wanted to get it all out there. Hopefully you can follow it. For those who hate to read, I've summarized it all at the end.

The ultrasound technician, who specializes in fetal echo cardiograms, spent twenty minutes scanning the baby's heart, recording everything she did to a videotape. She did different views, measured velocities for different arteries, examined the red and blue flows of blood in and around the heart, and told us baby's heart rate (141 bpm, normal). Since we were still waiting for the pediatric cardiologist, Dr. Rajan, to arrive from Children's Mercy Hospital, she then taped some ultrasound views of the baby for our videotape collection. She printed off three scans for us, two of the baby's profile (right), and one of the face (left). It was hard to do the profile since baby was facing down and away from us.

Then Dr. Rajan arrived. He and the technician spent the next twenty minutes reviewing the entire tape she made for him. Halfway through, Dr. Scott, one of the OBs on the team, arrived to watch. They discussed things that they saw, reassuring us that they would discuss it all with us after they were finished. Then Dr. Rajan took control of the ultrasound machine, and spent another twenty minutes scanning the heart from all sides. He seemed to be pleased with the view he got coming through the baby's back. But he continually dug the wand deep into my belly, and it began to really hurt.

When he was satisfied, he and the technician stepped to one side of the room to quietly go over the findings. Dr. Scott then took control of the wand and indicated he wanted to do more anatomy scanning. He was looking for the organs of the torso cavity. He showed us the diaphragm and after some searching, finally found the baby's stomach below the diaphragm, as it should be. He was pleased that the cavity was properly positioned and told us so. He said everything about the baby, other than the heart, was in good shape and normal.

All told, we were in the ultrasound room for an hour and twenty minutes. As Tim said, the longer it took, the worse we feared the results.

So then Tim and I left the room to wait for Dr. Rajan in the conference room (where we had last met with Dr. Lu). First to arrive was a young woman who was to be our coordinator between St. Luke's (the hospital I would deliver in) and Children's Mercy (the hospital where the heart surgeries would be performed). She explained her role to us, then sat quietly after Dr. Rajan arrived.


The doctor sketched for us what a normal baby's heart would look like (at left), and what our baby's heart looks like (at right). As you can see from the difference, our baby's heart is missing quite a few things, has holes in places it shouldn't, and is missing holes where it needs them. The diagnosis he gave us was no longer hypoplastic left heart syndrome (HLS), which we had previously been told.

First, an explanation of terms and how the heart works: The top two quadrants of the heart are called atrium and the bottom two are called ventricle. The right side of the heart is drawn on the left above, and the left side is drawn on the right. The "blue" blood, or oxygen depleted blood enters in the right side of the heart, passes through and out to the lungs via the pulmonary artery, then returns rich with oxygen to the left side of the heart which pumps the "red" blood out via the aorta. [FYI: Wikipedia is very helpful in understanding the terms mentioned below.]

First, baby has "AV Canal Defect with Small Left Ventricle." This diagnosis is made up of the four following issues: (a) "primum ASD" which is atrial septal defect, meaning the interatrial septum (the tissue that divides the right and left atria) has a defect. In the diagram above, the portion missing is the one below the normal "hole in the heart" (or foramen ovale). (b) "common AV valve" which means instead of two sets of atrioventricular (AV) valves, there is just one half on the right side and one half on the left side, working together; in our baby's case, most of the valve is committed to the right ventricle. (c) "VSD" which means ventricular septal defect, a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart. (d) "small left ventricle" which, as you can see in the diagram above, is just a tiny area of the heart that is doing nothing.

Second, baby has been diagnosed with "Double Outlet Right Ventricle." Although not drawn above, the aortic artery does connect to the pulmonary artery, which means both of the great arteries connect to the right ventricle, the definition of DORV.

Third, the diagnosis concludes with "Pulmonary Valve Atresia." The valve that would normally open and close with each beat of baby's heart has been permanently sealed off. In the diagram above, you see that the pulmonary artery does exist, is attached to the heart, but there is no access to it, as the valve has sealed.

So when baby is born, they will need to keep the "ductus arteriosis" open, which allows the body to receive some of the oxygenated blood from the lungs. They will give the baby a prostaglandin by IV as soon as the baby is born. (This ductus otherwise closes within the first ten days, it exists to allow the flow of oxygenated blood which baby receives via the placenta instead of the lungs, which of course don't breathe in oxygen while in utero.)

So how do they fix baby's heart? Dr. Rajan showed us three diagrams. In the first week of life, they will perform surgery on the baby. The first operation is called the "Blalock-Taussig Shunt" or BT shunt. This is a manmade "ductus arteriosis" to allow the mix of red and blue blood, so baby can get at least 50% oxygenated blood through its system. In the diagram on the right, the yellow shunt is the BT shunt. This operation is done through the baby's side, and is not open heart surgery. Baby will require about ten days of recovery time, and another week or so to assist with feeding. So baby will be in the hospital for about three weeks following the surgery.

The second surgery to be performed, when baby is about five or six months old, is the "Glenn Shunt." What this surgery does is take the superior vena cava (the artery carrying the blue blood from the top half of the body), which normally returns to the right atrium, and attach it to the pulmonary artery instead, bypassing the heart and going directly to the lungs. This will now help to bring the oxygen level in the bloodstream to about 75%.

The third operation is called the "Fontan Procedure." In this surgery, the inferior vena cava (the artery carrying the blue blood from the bottom half of the body) will now be attached to the pulmonary artery. When this procedure is complete, all systemic venous (oxygen depleted) blood flows directly into the pulmonary arteries, completely bypassing what was the right side of the heart. The heart becomes, in effect, a pump simply to take blood from the lungs and pass it to the rest of the body. This surgery might be scheduled any time when the baby is three or four years old, depending on how well he/she is doing. If the baby is suffering from lack of oxygen, the surgery can be performed even sooner.

The doctor said that at any point, things can go wrong. Baby can get fluid build up, infections, or who knows what else. They don't know the long term outlook for this. A child can suffer from heart failure in their teens, or perhaps when they are older. Our child will require cardiatric care for the rest of his or her life.

He asked us to come in again in six weeks for another fetal echo cardiogram. He said they will perform another one of those after baby is born just to confirm the current findings.

After the doctor answered our questions and left the conference room, the coordinator continued to tell us what to expect. When baby is born, they will in all likelihood whisk baby away from me, bring them to the NICU to stabilize the baby, then transport the baby at three hours old to Children's Mercy Hospital. I will not get to hold my baby. I will not see my baby while I am recovering for the first 24 hours after birth. This is what makes me cry. Tim will go to Children's Mercy to complete the paperwork there, and then after they stabilize baby, he will be allowed to visit and touch the baby. If I am doing well, St. Luke's might give me "a pass" that allows me to leave a bit earlier and travel the ten minutes to the other hospital to visit with our newborn.

In a few weeks, Tim and I will tour Children's Mercy and see how it is set up and how they handle this whole thing from a parent's perspective. We will also consult with the pediatric cardiac surgeons (they have two). St. Luke's assures us that we can choose to change hospitals and use other surgeons; they will send our records elsewhere. But that is for us to think about later.

I'm sure I missed something, it is now 1 AM, and I've been writing for two hours. We did learn some good things like baby's weight (1 lb 2 oz?) and baby is measuring two weeks ahead.

Summary
The fetal echo cardiogram lasted over an hour. They diagnosed missing valves, sealed over valve openings, and extra holes in the heart. Baby will require three surgeries: the BT shunt in first week, the Glenn Shunt at 5-6 months, and the Fontan Procedure at 3 years old. Baby will be sent to the other hospital within hours of birth, and we will likely not be able to hold baby at all.