Tuesday, August 21, 2012

Welcome to the World, Amanda :-)

We made it! We made it through 9½ months of pregnancy with overall healthy numbers and measures for both me and the little one. What we didn't manage, though, was to convince the doctors that initiation of delivery induction at 38 + 0 was too early.

On Monday August 6th (37 + 6), I'd started my day as I liked to do with breakfast and a 14 km bike ride that I managed to get in just before the
rain started pouring. I was at my computer by 8:00 AM with a wish to finish as much as I could on the publication that I was working on. Since being at home in the last months of pregnancy, I typically would work on data analysis or paper drafting in the morning and then take a long walk with our dog after lunch. On days when I felt a need for a nap it would typically be just before or after lunch. On that particular Monday, though, the weather forecast had shown that the rain should abate around the time of lunch, so to have the entire afternoon open for the long dog walk - and because the gray and rainy weather outside was making me sleepy, - I decided to take a nap at 9:00 AM. Before lying down, my BG was 5.1 (92), having dropped just 0.7 (12) points within the past hour. I knew that I had a tendency to drop over the morning, but at that point it had been 3 hours since my breakfast bolus, and I considered it safe to take a 1 h nap. I set my alarm clock for 10:00 AM, but all I remember is that I hit snooze, then nothing until Jimmi was home with me at 13:30 PM! :-( At that time, I was able to test and had 1.6 (28) staring back at me. Jimmi was very concerned, also for our baby - at that point, my brain was still too foggy to remember how very pregnant I was. He'd called the paramedics, and even though my BG had already climbed to 4.6 (83) at their arrival, I was still very affected by the hypo, and hence we were all off to the hospital for a check-up.

At the hospital, they immediately started an IV on me - even just with saline - and initiated CTG monitoring of the baby. She was affected by the hypo as well, showing a much slower heart rate than she typically would do, so with no room for discussion I was admitted and they were practically ready to cut her out of me with minutes notice. Having both recovered for a few hours, the baby's heart rate was back to normal, my BG was cruising at much higher levels than usual, but at least the doctors backed off a bit, deciding that they probably didn't have to start delivery induction until the next day. Even though I tried, I could not convince the morning round doctors that it would be Okay to wait until Thursday for the scheduled induction to start. They wanted to start right away, so we only managed to push their schedule to start late afternoon instead of in the morning, as this would give us a chance to go home on a temporary leave to pack some things and get a bit of rest (I'd only gotten some 30-45 min of sleep that past night).

Tuesday afternoon was the initiation of a long and not very successful attempt to induce natural delivery. From the beginning, my cervix was about 2 cm long and very closed. 6 suppositories later that hadn't changed significantly and because I was not willing to agree on a c-section until there were no other
opportunities, we proceeded to insertion of a balloon catheter which should mechanically force open the cervix. The first attempt was a painful flop, as the catheter fell out during a toilet visit because the doctor had not been able to fill it as much as required because it hurt like H... The next day (now Saturday!) took a longer discussion with the doctor, who said something different from the doctor who had checked on me over night when the catheter had fallen out, but the end of the discussion was that we should be transferred to the maternity ward and I should be started on a contraction stimulating IV. The plan was that either this alone would be enough to help the baby settle in my pelvis so that she could add a bit of pressure to the cervix to make it open enough for the midwife to break my water, or if that didn't happen, then at least hope that the IV would enable insertion of a new balloon catheter for the night. It ended up being the last, this time much less painful, and the balloons were filled as they should. The doctors were encouraged by this and were almost certain that if my water didn't break by itself overnight, then at least it could be broken the next morning.

On Sunday morning (12.8.12) Jimmi and I were hopeful that the whole thing would soon come to an end and that natural delivery could finally be induced. Unfortunately, the examination after removal of the catheter revealed that induction of natural delivery was not going to happen, and because they had started that process they also wanted to finish it, so c-section was the only way out - we got just 1½ h to get used to that. I had an emotional meltdown when they announced this. It was exactly what I'd feared would be the end of it, because from the very beginning I had felt that our baby would be better off staying in my uterus for another week or two.

Fortunately, the spinal sedation wasn't as unpleasant as I'd imagined, and Amanda screamed her lungs out in protest the minute she was pulled
out. She was just 2745 grams and 47 cm, so a very lean little baby. Her blood sugars were perfect all the way, only her stomach and intestines needed a couple of days to get to work properly so we had to stay in the hospital for a few days afterwards.

Amanda, 2 days old, still with a stomach tube, but chilling peacefully with her dad :-)

Sleeping beauty, 5 days old :-)

Friday, August 03, 2012

Point of no return

Yesterday, we had the final pre-scheduled hospital appointments of my pregnancy. It was meant to just be with the midwife and a pump nurse if needed, but because we had so much that we needed to talk through with the midwife it ended up taking most of the morning anyway.

The midwife, who's followed me from the beginning was back on duty yesterday, and while doing the heart rate monitoring on the baby we expressed our concerns and frustrations with the decision of induction that we felt had been forced upon us last week. The midwife was very understanding, and ended up checking which doctors were on duty to get us into an additional consultation. Fortunately, the doctors that have been following me along this journey were back after their summer holiday, and with both of them being chief physicians they had a lot more knowledge and nerve than the ones we saw last week.

The OB took us through their main reason for sticking to the 38+0 rule, which was new to me: According to her, the function of the placenta will typically drop more or less dramatically after 38 weeks, and this drop in function seems to be more severe and with a quicker onset in PWDs. Both of the doctors were rather surprised though, when we showed them the information we had about the procedure in the two largest national hospitals. Apparently it was new to them that type 1 diabetics elsewhere in the country could be allowed to await natural induction of delivery all up to their due date, so I hope that if we change our mind about trying for a sibling for junior in a year or two, the procedures will have changed in Odense as well to allow this type of approach if there are no problems or complications.

In the end we felt like they listened to our concern, and they agreed that postponing the induction a couple of days wound hurt anybody. It's a small, but more acceptable compromise, I think. They offered us a bit of influence and we accepted it. My feeling is still that the little one is not ready to be born just yet, but now at least she may not be out until around 39 weeks. I'll still have to check in for another ctg on Tuesday, but the full examination and start of cervix maturation will not take place until Thursday the 9th of August. This will be the point of no return even if it might still take days before active labor commences.