27 Weeks, 5 Days

We are rounding the bases and about to slide into 28 weeks. That will be a day to celebrate. Reaching 28 weeks was our long term goal from the beginning but we didn't dare verbalize it. My favorite perinatologist congratulated me no less than 3 times today. She was the attending on call the first weekend we arrived and she has been a source of comfort ever since. It is hard to believe that I've been hospitalized for 34 days now (but who's counting?).

I am sorry for the lack of updates lately. The past two weeks have been difficult and the last thing I wanted was to dump some of that Debbie Downer funk onto all of you. I can manage to talk myself into being positive about 80% of the time but sometimes I just like to wallow in sadness and self pity that remaining 20%.

Last Friday was our 6 year wedding anniversary. We celebrated with breakfast from Bagels Forever and my extremely generous gift to JD was to order him two Diet Mountain Dews from the cafeteria. The OB did a double take when she saw that tray delivered and she was relieved to learn that the milk, not the soda, was my beverage.

We were supposed to be celebrating with a trip to Minneapolis to go to a U2 concert so you can imagine the soda didn't quite cut it. For months I was trying to come up with a clever, attention getting saying to put on a maternity tank top but all I could come up with was "Baby loves Bono." I'm pretty sure that BD#2 is a bigger fan of The Edge, like his dad, so at least the pressure was off for that. Apparently astronaut Mark Kelly made a virtual appearance from the space shuttle; that was probably a more entertaining and noble choice than selecting this bed-ridden prego. All the reviews from the concert were glowing so it sounds like we missed a fantastic show - despite some heavy rain (Thanks for the pics TL!).

The Edge, cool as ever

Bono, singing in the rain

However, a highlight from our unplanned staycation, was a visit from my brother, sister-in-law, niece, and nephew. They left the fridge stocked with food for JD and KD and my brother made me my favorite indulgence - chocolate scotcheroo bars. Being the mechanical engiNERD that he is, he decided to increase the Rice Krispie® volume by 50% to allow adequate surface area for maximum chocolate coverage. This was the first time he had ever made the bars and I give them two chocolate-smeared thumbs up.

For the past few weeks, my OB has been talking about scheduling a growth ultrasound for July 25 so you can imagine that I was pretty excited and anxious to reach that milestone on Monday. Well, sometimes being a stable and relatively low maintenance patient has its drawbacks because somewhere along the way, that little order was never processed. I feel bad for the medical resident who was sent to tell me that it wouldn't make a difference, clinically speaking, if the ultrasound was delayed for two days until an appointment opened up. My tears of disappointment quickly showed her that, from a clinical standpoint, it may not have been a big deal but from an extremely personal standpoint, it was a huge deal for this patient whose happiness depends on reaching major milestones like that. Ultimately, it was rescheduled for this morning at 9:45. We received great news...the AFI is 7 and the estimated weight is 2 lbs, 12 ounces. The measurements estimate that the gestational age is closer to 28 weeks and 1 day instead of the actual 27 weeks and 5 days so it looks like BD#2 is following in his sister's footsteps and measuring a little bigger than expected. They tried to take some pictures of him but, also like his sister, he is most comfortable with his hands up by his face. Here is one that is pretty clear. You can see two little eyes, a nose and mouth towards the right of the image. They can't do those cool 3-D images because there isn't enough fluid to allow for that.

That's all the news for now. Thanks for your continued support and prayers. A social worker stopped in today and she was amazed with the social support network we have, something we are very thankful for.

25 weeks, 6 days

The week started on a happy note. JD brought Summit up to the hospital. Amazingly, the hospital has a policy that allows well-behaved dogs to visit their owners. Describing Summit as well-behaved might be a stretch but she seemed to fool security personnel who actually requested that she stay with them instead of come visit me. The first thing she did was jump on my bed and curl up to snuggle. I was surprised she missed me given the love/hate relationship we've had over the past year. She is a wonderful dog but when she barks during nap time, we don't get along very well. The nurses loved changing those sheets saturated with dog hair that night.

On Monday, the medical resident checked the AFI and there was only a single pocket of fluid with less than 3 cm of volume. The first time she measured it, it was 2.99 and the second time it was 2.63. It was very hard to hear those results. My first question was whether they would decide to deliver the baby with levels that low but she explained that BD#2 is still better off staying inside for now. She reminded me that the problem isn't producing enough fluid, it is retaining it. She then reviewed the risks of low AFI and promised to return with reading materials before I could enter a search into Google.

She returned with a printed review from a trusted online medical resource called UpToDate and a yellow highlighter. I had been researching on that site earlier but the topic she provided was much more specific to our situation. I thought I would share some of the statistics with you in this blog post.

• I am considered a midtrimester preterm premature rupture of the fetal membrane (PPROM) which is the spontaneous rupture of membranes between 16 and 26 weeks of gestation.
• You might remember that the complication with KD was also due to PPROM only we were past that midtrimester window. Only 3% of pregnancies lead to PPROM. The chance of being a midtrimester PPROM is 0.4 to 0.7 % but the overall risk of being a PPROM again in a recurring pregnancy is higher, up to 30%. Because we were never able to identify the cause of the rupture with KD, my OB referred to it as a fluke and encouraged us to not worry about it happening again with a second pregnancy.
• The risk factors for PPROM are the same as those for any preterm birth and are listed in Table 1.

Table 1. Risk factors for preterm labor

Risk Factor Category	Examples
Stress	§ Single women § Low socioeconomic status § Life events
Occupational Fatigue	§ Use of industrial machines § Physical exertion § Mental or environmental stress
Cervical Factors	§ History of abortion § History of cervical surgery § Premature cervical dilation
Infection	§ Periodontal disease § Systemic infection § Bacteriuria
Placental Pathology	§ Placenta previa § Abruption § Bleeding
Excessive or Impaired Uterine Distension	§ Multiple gestation § Uterine anomaly (?) § Polyhydramnios (excessive fluid)
Fetal Factors	§ Congenital anomaly § Growth restriction
Miscellaneous	§ Substance abuse § Smoking § Maternal age (<18 and >40) § Previous preterm delivery

• I bolded the two that might apply to our situation. At the 13 week ultrasound for BD#2, the sonographer asked if I had ever been told that I have a heart-shaped uterus. My initial thought was how that must mean there is even more love in the uterus than usual. Unfortunately, that is not the case and having a septum like that prevents the uterus from being able to expand enough for a growing baby. It can be fixed surgically if identified before becoming pregnant. Unfortunately, we didn't learn about this until after pregnancy #2 and my OB still isn't confident in those ultrasound images to make a definitive diagnosis.
• The average amount of time from rupture to delivery is 17 days (we are on day 21) and by 28 days post-rupture, 73-88% of pregnancies have delivered.

There are two things that will haunt me for the rest of my life. The first is that my body is to blame for putting our two miracles in this situation. The second is having to hear survival and disability percentages presented to you multiple times a week as decisions are being made or results are being explained. I will not write or talk about what those percentages have been because I refuse to put validity to them and I refuse to believe anything but that BD#2 is a very strong and stubborn little boy. We recently bought a wall sticker to place by BD#2's crib that says "For One So Small, You Seem So Strong."

It seems for each low point of the day, there is a bright spot. Today the low point was being moved from a single room into a double room with a roommate (I am on the side without the window). She is a very nice person but having to share a room makes the situation that much more difficult. The best part of the day was the repeat AFI. After the low value on Monday, they started a continuous IV. I think I've received about 8000 mL or 8 Liters of lactated ringers solution. I am thrilled to tell you that the AFI today was 4.5. This news couldn't have come at a better time.

This is a very long post so I will sign off for now. I hope you are all having a very nice week.

25 weeks, 1 day

Happy weekend to all of you. We have reached the 25-week mark. One more week and we will be close to getting out of the micro preemie stage. There are less 24- and 48-hour goals to break up the week so it takes more effort to mentally take it one day at a time. The on call OB hinted that they typically won't let ruptured patients go longer than 34 weeks before inducing so it started to form a little bit more of a time frame for us. They've told us that based on our history of maintaing pregnancy for 4.5 weeks after rupturing with KD that making it to 27 or 28 weeks is a realistic goal. We've also been told not to count on the chance of being discharged home for any period of this bed rest. I haven't left this room since Tuesday, June 28; there are no wheelchair privileges like we enjoyed in Phoenix.

Rumor in the halls is that the unit is full again so there is a chance I might be put back into double room. The next inhabitant of this room might be disappointed since JD, in all his strength, accidentally broke the window shade last night before he left. A friend propped it up today using the ceiling and some strings (Thanks SW!) but I hope we don't lose our room deposit. I guess that cost to our insurance would be minor compared to what the cumulative bill will be once we all finally vacate this place.

Surprisingly, the days pass by quickly. The day starts at 6:15 am with Medical Resident rounds and ends at 12:30 am after the overnight nurse does a vital sign check. Last Tuesday, it seemed that there were specialists visiting constantly from 6:30 am to 6:30 pm so that day flew by. The parts of the day that I dread the most include the twice daily heparin shots and the highlights are hearing BD #2's heart tones every 8 hours. I don't nap during the day so that nighttime sleep isn't disrupted. In between visits from MDs, nurses, friends, pastors, and coworkers, I spend the time working and trying to help with those home-related things that can be handled remotely (i.e. shopping online for sandals for KD's growing feet).

I keep TV watching to a minimum. I figure nothing good can come from the 24-hour news cycle or daytime soaps. I had a little hope for Jeopady last week since it was Kid's Week but sadly, I still knew very few of the questions (answers?). There was a little validation in not knowing anything in the tween-related celebrity category (read: "What is Twilight, Alex?" when I am thinking "yah, what is Twilight?"). The first week here there was a category called "On Wisconsin" and I am proud to say that I knew four of the six answers...or is it questions?

Patients have a decent menu to select meals from. Imagine Perkins minus the bread bowls and mammoth muffins (thinking of our love of the double chocolate chip muffins, JFK). Those of us who are here for the long haul are given a secret code to be able to order food from the exquisite Meriter Cafe (Trademark pending, I am sure) which offers slightly different options. As you can imagine, nothing is very exciting after two weeks. It is, however, an improvement from our dining experience in Phoenix. While we were initially impressed with their waiter-style approach, we quickly realized that it was all a cover up for their tour de chicken. Every Monday night it started as a breast of some sort, on Tuesday morning it was served diced in an omelet, on Wednesday it was incorporated into the chicken salad sandwich, and by Thursday, whatever remained was shredded into chicken noodle soup. I shudder to think of how it might have been used as a filler in Friday's menu.

My mom leaves on Monday and then JD's mom and babysitters will help fill in the non-daycare days. KD's vocabulary has grown exponentially since I was first admitted and her main words were Mama, Dada, and uh-oh. Now her favorites include cheese, wa-wa (water), puppy, and bye-bye. She is especially good at that last one when it is time to leave this hospital room. She does great when she is up here but is very ready to leave after an hour or so. Given the choice, I'd rather her be happy to leave than sad. The nurses tell stories of older children crying for their moms who are hospitalized and that would make things much harder. Glad to see we have an independent little girl in the making. There is a video below of KD dancing last weekend in the spirit of the 4th. It has been edited slightly so that Grandma L isn't humiliated by the broadcasting of her dancing skills.

(How about those jazz hands SZ?)

JD probably won't be posting much since he is so busy managing everything else. By the end of his long days that include working, child rearing, and dog walking, he doesn't have much creative energy. He is doing a great job with all of this and I continue to be amazed by him.

Thanks again for all the support and encouragement. We really appreciate all of you. Thanks to our neighbors who have offered to mow or do anything we need around the house and to friends and family ready to help in a moment's notice. It is really hard to accept all the generous offers but we are sincerely grateful for everything.

Happy 4th of July

Happy 4th of July to all of you. My mom surprised us and had some 18-month pictures taken of KD. Here is one where she is dressed like a little firecracker.

Thank you sincerely for all the emails, calls, and texts over the past week. We are reminded again of how incredibly fortunate we are to have such supportive family and friends. This is partially why we are having a hard time sending out updates or accepting your generous offers of support. We still feel indebted to all of you for the support you poured over us during our stint in Arizona with KD.

We are are thankful to be in somewhat of a holding pattern. Things are stable and each day that we cross off means another day for BD#2 to get stronger in utero. Right now we are at 24 weeks, 3 days and after visiting with my OB this morning, the next goal is 28 weeks.

As soon as the calendar flipped to 24 weeks a few days ago, we were officially on the intervention algorithm. BD#2 received the recommended regimen of steroid injections and IV antibiotics were started. If contractions should occur, IV magnesium sulfate will be used to try to prevent labor. They also started monitoring BD#2's heart rate and activity. The nurse very hesitantly told me today that she is seeing "accelerations" in his heart rate which usually doesn't occur until week 32. The accelerations are fun to watch; when his activity increases, his heart rate increases (a little response us cardiac nerds refer to as chronotropic competence).

They will check the amniotic fluid index (AFI) once a week and BD#2's growth every 4 weeks. Last Monday the AFI was 7.7, today it was 7.5. I am trying to be satisfied with that value but it is hard to hear that after a week of laying flat on either side and drinking fluids nonstop, the value decreased. Instead of using the term "decreased," the MDs choose to explain it in terms of the AFI being "maintained." This homeostasis of sorts is a success to them considering how much was lost and that I continue to lose small amounts each day. Last Monday they referred to the AFI as "adequate." I don't think there is one person on our email distribution list that finds much satisfaction in terms like "maintained" or "adequate." In fact, almost immediately after hearing the "A" word, we thought of the following clip from a favorite News Radio episode where the late Phil Hartman receives a peer review of his work as a news reporter:

(Right after that last line, Phil Hartman's reply is "ah, you miss Wisconsin don't you?")

So, we, rather I, learn to adjust expectations and accept that results close to the norm or slightly below in this situation are a good, if not great, outcome.

JD has been amazing as always. He has been taking care of everything outside of this hospital room and still maintains that consistent positive outlook that makes him such a wonderful person. He brought KD up to the hospital three times this weekend so it was great to see her after not seeing her since that dreadful night on June 24th. Thankfully, she doesn't seem to notice any difference in our family dynamic. My mom and JD's mom have been helping a ton.

I'll sign off for now. If any of you were wondering where the "creative" blog title came from, I stole it. A good friend of mine writes a fantastic blog, "Mission Decorate," (www.missiondecorate.com) with great home DIY project ideas. I've had more time to catch up on her posts so when it came time to come up with something, this was all I could think of...(sorry for the intellectual plagiarism JiD).

I hope you all had a fantastic Holiday weekend. If you are starting to wonder why time goes so fast, particularly in the summer, I have a theory. It is because of people like us who are trying our best to follow instructions to do nothing but "wait and see."