29 Week Check-up

I am exhausted.  I left the house this morning at 9:15am, drove 1.5 hours to the doctor, was there for four appointments and then drove another 1.5 hours, arriving home at 5:30pm.  And I have to do this twice next week, once on Tuesday for several appointments for Nora, and then again on Thursday for several more appointments for me.  And all without Eric.  Ugh.  I keep telling friends I will come see them on the weekends, but I’m just too worn out.  And add to that the fact that I’m getting an average of four hours of sleep a night.  Not enough, between Nora waking due to teething and me just not being able to sleep lately.

So a recap of today…  Tomorrow I will be 29 weeks, a new milestone for me, as Nora was born on 29w0d.

  • OB Check-up – My doctor still wants to keep seeing me weekly, so another check today to see how I was doing.  We chatted a little about my gestational diabetes diagnosis, but we left most of my questions for the dietitian.  We listened to baby’s heartbeat, which was around 130-140 bpm, she moves constantly, so hard to get a good reading.  My OB measured my tummy again…  Last week I was measuring two weeks ahead, today I was measuring three weeks ahead, so she wanted to get a growth scan to make sure all was on track, especially with the GD.  Oh, and she checked my cervix also, last week I was just a fingertip dilated and cervix was 50% effaced. Today I’m just a tad bit more dilated, but still less than 1cm and still 50% effaced, so she was happy.  I’m still having lots of tightening, but baby is still inside, so we’re counting this a win for another week.
  • Growth Scan – I got lots of cute pictures of baby, posted below, and happy to report she is measuring perfectly, head and femur were 28w5d and they estimate her weight to be about 3 lbs., so just a tad larger than Nora was born weighing.  Also, fluid around baby is good, apparently GD can cause extra fluid, but not the case right now for me.
  • Nurse Teaching – This was really pointless as Eric had already walked me through how to use the glucose monitor, and really, if you can read, the directions that came with it are pretty good.  I’ve been using the monitor for the past several days, so really no need to review this.  The nurse did give me another Makena injection though.  I’m still saving the two doses we have at home, as I assume it will still take another two weeks or more to get our new insurance to approve the drug and have it shipped to me.  More on insurance below 😉
  • Diabetic Teaching w/ Dietitian – This was a really good visit, the woman I met with was super helpful and answered a ton of my questions.  She laid out a sample meal plan, went over what’s good and not so good for eating, and reviewed when I need to check blood sugar levels and what they should be.  This probably deserves its own post, so I’ll make some time tomorrow to tell you all more about that!

Our insurance still isn’t figured out, basically we just aren’t in their system yet, even though our coverage is active, therefore I can’t get the information I need to give my doctor’s office or pharmacy.  In their eyes I’m uninsured.  And OMG, my doctor’s office is having a COMPLETE FIT.  My four appointments today, you check in and out of each, and at each check-in and check-out, so eight times, I was asked about my insurance, even though all of them said they would add notes to the system, that I should have the data soon.  Oh, and my doctor’s office called me yesterday to remind me I had an appointment but no insurance listed in the system.  And then, while I was meeting with the dietitian, she got a page that I was to go see a financial counselor before I left the office.  UGH.  He was like, so you know if you don’t pay in 120 days we send the balance to a collection agency.  So I was like, can I just pay cash for whatever our balance is right now, which would only be from my appointments last week and this week.  He was like, well, there isn’t a balance yet, billing period isn’t over yet, so nothing to pay.  I wanted to scream, then why did I have to talk to you???  I seriously feel harassed…  No really.  It was that bad.

Okay, I have lots more to say, but honestly, I’m just too tired.  More tomorrow, if Nora naps!

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28 Week Check-up

I guess overall today’s check-up went well.  For the past week I’ve had such a strange feeling that this baby is going to be born as early as Nora.  I hope I’m wrong!

Highlights from the visit

  • This isn’t really a highlight, more a pain in the behind…  Since Eric’s work changed a bit on August 1st, so did our health insurance.  We shouldn’t have a gap in coverage, but since I don’t have the information for our new insurance, and our old expired at the end of July, it’s making things difficult.  Apparently Eric’s new HR department is not exactly, with it.  Yesterday morning I got three phone calls, one from the specialty pharmacy who supplies me with my Makena injections telling me that the refill claim was rejected, one from my doctor’s office alerting me that I had an appointment tomorrow (today) and my coverage was expired, and another from the nurse at my doctor’s office who worked seriously three weeks to get our previous insurance to pay for Makena saying she was asked to start the approval process over…  Ugh.  And of course I had to tell each of them I was pretty much clueless, that we have retroactive coverage, but I have no idea who it’s through or what it covers.  The approval process for the Makena is just more than I really want to deal with again, and I even considered just paying cash for it, but it’s $3,000.00 per injection, so per week, and that will add up quickly.  I had my doctor’s office give me an injection today so that I could save the two doses I still have at home, hoping the insurance mess would be resolved before I run out.  I’m not holding my breath.
  • Right when I arrived the nurse had me drink the orange glucose ‘beverage’, for lack of a better term.  I honestly don’t think it’s bad, but then again I love Starbuck’s flavored lattes which I assume have about as much sugar.  They told me I didn’t have to fast this morning, but to limit sugars…  I had a piece of peanut butter toast and a banana.  No clue if that was a good or bad choice.  I just received my results online, 163, which I’m pretty sure means I have to do the three hour fasting test.  Does anyone know for sure?  With Nora my result was 137 and I remember them telling me I just passed.  Great.  One more thing to worry about.  I’ll wait to hear what my doctor has to say…
  • The nurse also told me that it’s at your 28 week check that they like to give a tdap booster, so of course I was willing.  Already my arm is killing me though!  Picking up Nora tomorrow should be fun!
  • My doctor came in next and we chatted for quite a while about all my symptoms.  Even tonight I’m still experiencing all the same, lots of pressure very low in my abdomen, off and on tightening of my belly, very low, some mild cramping, etc.  I basically feel like baby is just way too low already, sitting is uncomfortable, how can that be at only 28 weeks tomorrow?  And forget bending over!  My belly just aches all the time.  Is that how others feel when they’re pregnant?  I didn’t have this until last week… around the same time I started having these feelings with Nora’s pregnancy.  I just can’t imagine feeling this crappy for another 12 weeks.  I mean, I know women go through worse, but… this isn’t fun.  Although neither is having a baby in the NICU for months…  And I wouldn’t say the tightening is painful, more uncomfortable, like I find myself moving to try to get the feeling to stop.
  • My doctor listened to baby girl’s heartbeat, which was in the 140s I think, which she said was good.  Then she measured my belly with the tape measure, and it measured 30cm, so two weeks ahead of where I should be.  She said she wasn’t concerned, that measuring bellies is more an estimate.  My doctor doubts whether this baby is actually the size of the average 30 week baby… probably more just how she is laying currently.  Oh, which is feet down right now.  So perfect if she’s born in the next week, maybe we can have a repeat breech delivery!  Kidding, let’s hope not.  Does anyone reading have experience with not measuring to the week you actually are?  Just curious how common this is and what it means.  With Nora they never measured my belly, I guess we never got far enough!
  • Next my doctor checked my cervix (which I thought they weren’t supposed to do, but she’s the doctor) and she was happy to report that the length is still around 2cm and I’m dilated to just a fingertip, which she said is okay with her, given my history.  She said usually the cervix will completely shorten (efface) before it truly starts to dilate, so being it’s still 2cm long is great.  I mean, it’s shorter than it should be by about 50%, but at least I still have some length!  The fact that I’m not dilated further than a tiny bit tells my doctor that my tightening is not true labor, not yet anyway.
  • Given all my symptoms, and the fact that I am dilated just a tiny bit, my doctor wants to start seeing me weekly.  Ugh.  That’s a lot of driving, but probably a good idea.  Her main concern is, if I am going to have this baby early, the more notice we have for steroids the better.  She said that steroids are most effective the later and closer they are given to delivery, preferably 48 and 24 hours before delivery.  Giving too early can waste their effectiveness so to speak…  Nora’s were given almost exactly at 48 and 24 hours as I was given magnesium to stop labor until we completed those doses, and thankfully, breathing was never her primary issue.

So all in all, I guess okay for now, except for hopefully I pass the three-hour glucose, if that’s where I’m headed next.  I know this sounds selfish, that I should put baby girl’s needs first, but honestly, I just don’t feel right and can’t picture feeling this way for 12 more weeks.  I know inside is better than a NICU though, just trying to wrap my head about feeling this way for an extended period of time.  I remember in the hospital, when I was in active labor with Nora, the nurse kept telling me that this was my new normal, that I wasn’t in labor, and I wanted to punch her.  I was actually relieved when she was born, that all that awful pain was over.  I guess a part of me feels that way now.  So again, lots of guilt.  I don’t wish this baby early, but just this feeling in the back of my mind that my body isn’t acting as it should…

I think I had more I wanted to write about, but I only slept two hours last night, thanks to my pregnancy insomnia.  So I’m off to bed now that Nora is sleeping.  Good night!

High Risk Appointment Details

For those of you who sent me text messages asking how my appointment went, thank you.  And I’m sorry I didn’t respond.  This felt too long to type out in a text.  Overall though, the appointment was frustrating and disappointing.

First, some details about two providers at the University…

  1. Dr. Greiner – A female high-risk OB specialist known to be ‘by the book’ and rather conservative with treatment options.  She places very few cerclages and prefers to watch patients closely.
  2. Dr. Hunter – A male high-risk OB specialist, head of the high-risk OB department.  He’s known to be more aggressive with treatment and places many cerclages with good outcomes.

During my regular OB appointment last Thursday my doctor called the high risk team for a consult (while I was sitting in the exam room FOREVER) and just happen to get Dr. Greiner, who basically said, send the patient to us and we’ll follow-up.  Knowing the above details about two providers at the University my OB specifically referred me to Dr. Hunter instead, as it was her wish for a cerclage to be placed as soon as possible, preferably before I’m 17 weeks, which is this Friday.

So Mondays appointment.  I check-in and the receptionist tells me Dr. Hunter is sick and Dr. Greiner is seeing his clinic patients.  Great.

My ultrasound was first and my cervix measured 2.57 cm compared to 2.1 cm last Thursday.  Not surprising the ultrasound tech told me, as baby was head down last Thursday and breach Monday.  Apparently the head puts a lot of pressure on the cervix, which is a muscle which can change in length from minute to minute.  Usually during my ultrasounds they take several measurements, all different, over the course of maybe ten minutes.

So next, my visit with Dr. Greiner, who I hated from the first minute she walked into my exam room.  She was overly bubbly, acted like she was all that.  I hate that in people, especially doctors.  She said a lot, and I wish I had just recorded the conversation…  I felt like her and I were arguing, it was a strange interaction…  I’ll try to high-light the major points, hopefully I’m not missing anything.

  • In her high-risk world they consider a cervix over 2.5 cm in length to be normal.  Which was odd to me as I’m told it’s supposed to be closer to 5 cm by my regular OB…
  • Nothing they do will guarantee a full-term delivery for, and from my history she truly doubts I’ll get to full term, with or without intervention.
  • Since my cervix measured over 2.5 cm, I’m not a candidate for a cerclage.  She basically ended that conversation there, even though I had lots of questions about the procedure itself, recovery, and what happens after.
  • Makena injections are best for women who have already had a pre-term delivery, while progesterone suppositories are best for women with a short cervix.  Since I fall into both categories, it’s a toss-up which I want to use, she’ll leave that up to my regular OB.  Overall though, she did not speak highly of Makena.
  • The plan for now is to monitor my cervix with weekly ultrasounds, with her high-risk team, and once it gets to 2 cm or less we will talk cerclage.

Most of my arguing with her was my fear of basically waiting until my situation gets worse, until something bad happens, to actually take any precautions.  Plus, I know there is a window where cerclages can be placed, and I think I’m getting to the end of it.  Also, she said it’s easier to place a cerclage the longer the cervix is, which makes me wonder again why we are waiting for it to shorten.  Dr. Greiner just kept repeating all the risks to the procedure…  Which I do understand, but at this point I feel like it’s a better option that having another baby really early.  I’m not sure if Dr. Greiner doesn’t believe my cervix is going to keep shortening, or if she just really does stick by the book of research studies.

I did email my regular OB regarding my visit, I’m anxious to see her response, hopefully she emails me back today.  I also need to call Makena as I need another injection Thursday and I’m still not sure if my insurance will pay, or if Makena will allow the injections to be given at home.  I really don’t want to drive to Iowa City twice each week, once for an injection, and once for an ultrasound.

In the meantime, I wait, feeling like a ticking time bomb.

Where from here…

I’ve been struggling on where to take this blog…  It started as a way for me to get my feelings out regarding our IVF journey.  Well clearly we are past that.  Then our NICU days, and more recently the life of a stay-at-home mom.  I’m not sure many of my posts have been all that entertaining!  Although I guess I don’t really write for all of you, but more for me, and for the advice all of you wonderful ladies, (and men?) offer me.  All that said, do all of you really care to follow as I document my life?  I mean really, I’m not all that exciting!  Honest yes, and I LOVE everyone I’ve met through writing, but entertaining I am not.

So the password protected posts…  If you haven’t already guessed, those were to conceal my pregnancy.  Yes, I’m pregnant, again, on our own.  (If you remember back to October when we got pregnant on our own but lost it very early.)  This pregnancy I was the annoying lady who kept bothering her doctor to do something.  So not to rehash too much, for those of you who know all this…  I’ve been on progesterone suppositories, 200 mg each, twice a day, since we found out we were pregnant.  I hate them, but ya know, what we do for the sake of our children!

Side note, I decided to write openly on here, as we are now into our 11th week of pregnancy and have heard the heartbeat twice already.  I know it’s still early, and thus we haven’t announced anything more publicly, so if you know us in real life, please keep this private for now.

So do you all really want to go through another pregnancy with me, reading the details that are really, probably, only important to me?  For now, I guess that is what I’ll be writing about.  Unless I can dream up something far more interesting!

For those of you reading the password protected posts, I’m sorry I didn’t update sooner with details from my appointment last Wednesday with my OB in Iowa City.  I meant to, but time got away from me.  Or rather, I was lazy and tired and laid around all weekend.

So last Wednesday.  I was scared to talk to my OB in Iowa City, as I had a lot of questions, mainly centering around how to keep this baby in past 29 weeks.  Side note, I decided to stick with my doctor in Iowa City, as she knows my history, and any doctor here would send me to Iowa City at the first sign of a shortening cervix.  So I figured skip all the hassle here and make the drive for my appointments.

Appointment last Wednesday was good.  I’ll try to summarize…

  • My doctor found the heart beat with the doppler, it was in the 160s which she said is fantastic.
  • Because I’m over 35, we scheduled an ultrasound for next week (11 weeks) to check the nuchal fold, then I’ll meet with a genetics counselor to review, and then I’ll have my blood drawn for the Materniti21 test.  Should have results in roughly three weeks.  Per their website “The MaterniT21 PLUS test is a noninvasive prenatal test (or NIPT) that detects fetal chromosomal abnormalities; from common (trisomies 21, 18 and 13) to the more rare (fetal sex aneuploidies, trisomies 16 and 22, and select microdeletions), all of the information reported is clinically relevant.”  This test will also disclose the gender.  I’m pretty sure they check the nuchal fold at this appointment because the blood test does not address related issues.
  • We scheduled an ultrasound for 16 weeks to check my cervical length and at that appointment I’ll also have a blood draw related to the nuchal fold, I forgot the name of that test…
  • At 16 weeks or as soon as my insurance approves our request I’ll start Makena injections.  My understanding of these are they are meant only for women who have already delivered a pre-term baby.  Supposedly they are a long-acting type of progesterone, given in weekly injections.  I should be able to do them at home, pending insurance approval.  I assume we will do them either if they deny our request, but apparently they are $1,500 a shot.  Ouch!  Lots of interesting data about these….  If I remember correctly, 12% of women delivered before 32 weeks on the injections, compared to 20% on the control.  So they clearly don’t help everyone.  And there are risks, with 2% of women on the shots delivering stillbirth, compared to 1% on the control.
  • We scheduled my 20 week anatomy scan which will also be an ultrasound to check my cervical length.  Depending on the measurements from 16 and 20 weeks we will discuss placement of a cervical cerclage.  The stitch would need to be placed before viability, so at the latest 22 weeks according to my doctor.  We did not yet discuss the benefits and risks, although she did mention the risk of breaking your water during the procedure.
  • Ultimately my doctor expects this baby to be born early.  But how early, who knows…

Honestly, that’s all I really know for now.  I’m so sick of feeling sick.  And so exhausted, but I know it’s a good sign and comes with the territory.  And above all, I know some reading this would give an arm or leg to be pregnant.  I do remember that feeling.  And I know I am blessed to be pregnant again, and on our own this time.

I had a few other topics I wanted to touch on, but out of time as I only have a sitter until 5 today.  I’ll try to write more later in the week 🙂

Indeed pregnant, for now

When did I write last?  I feel like a lot has happened since…

I called a doctor here in Cedar Falls Tuesday afternoon and they scheduled HCG blood tests.  The first was done Wednesday at I think 22DPO.  Hard to tell this time since it not being IVF and my cycles a little all over the place.  I’m assuming ovulation was cycle day 14 and estimating my last period started on September 16th.  So at 22DPO my level was 499, and today, at 24DPO it was 614.  In comparison, with Nora my level was 189 at 14DPO and 448 48 hours later at 16DPO.  The HCG value should double to indicate a viable pregnancy, and since it didn’t, I’m guessing the end is in sight.  The office here in Cedar Falls wants me to come in Monday for another blood test.  I’m not thinking too positive at this point though.

Yesterday while I was in Iowa City for Nora’s appointments I had a chance to meet with my OB there and they did an ultrasound.  They estimated me at 5 weeks and therefore we saw what we expected on ultrasound, basically a black circle, as it’s too early to see anything else.  They scheduled a repeat ultrasound for 10 days out to check for a heartbeat.

My main reason in meeting with my Iowa City OB though was to decide where I would seek care should this pregnancy proceed.  Or future pregnancies for that matter.  I was a little discouraged by my OB’s advice.  Basically she said she could not recommend any providers in Cedar Falls who she would trust to follow a high risk pregnancy of mine given my history.  Some of her main points include:

  • No providers in CF (Cedar Falls) are accustomed to checking cervical length, which I’ll need weekly beginning at 16 weeks or maybe even earlier.
  • No providers in CF have enough experience, in her opinion, in placing a cervical cerclage.  In fact, only two providers in Iowa City place them.
  • The providers in CF will only deliver at 37 weeks or later, otherwise patients are flown to Iowa City.  Same goes for the babies, the flight team comes to pick them up a birth and transport to Iowa City’s NICU.  Just not equipped here to handle such small babies.

Shared care was mentioned, meaning perhaps some visits could be handled in CF.  I would definitely be put on weekly Makena injections, and perhaps those could be given in Cedar Falls at an office here.  Most visits though would need to be in Iowa City, including the delivery.

For now though, I’m guessing there isn’t much to consider for care…  I’m not hopeful this pregnancy is viable.  Easy come easy go?  I’ll update on Monday and let you know my HCG level and plan going forward.