Chez Perky

Ancient History: Hospitalization

I've been promising to write about my hospitalization and subsequent delivery for the last six months now. I haven't pulled together the story of the actual deliveriy yet, but here is the VERY LONGWINDED story of my hospitalization... and this is just the readers' digest version! I've been writing this since the end of February, but just in tiny little chunks, so bear with me if it's not entirely coherent!

I’m on my way out to Winchester, VA to visit with Jess and her husband and their Five Little Monkeys. Since Jess was one of my biggest supporters in the latter part of my pregnancy and through my hospitalization (even going so far as to post updates for me while I was internet-less in the hospital), I figure there is no better time than now to finally start writing my epic post about my last few days in the hospital and my subsequent delivery at 33 weeks of my 3 little miracles, Abby, Ellie and Sam.

So, to recap, I was admitted to the hospital on September 11, 2007 (which happened to be my admitting perinatologist’s birthday), because my blood pressure was creeping out of control, my liver enzymes were elevated, the contractions weren’t getting any better, home monitoring wasn’t helping, and the terbutaline, procardia, and indocin weren’t keeping things at bay any longer. While the contractions in and of themselves weren’t that worrisome (I was far enough along that they weren’t going to stop labor if it happened), the elevated liver enzymes were worrisome, as was my blood pressure. I went to my check up knowing full well that I was likely to be admitted that day. We’d been playing this dance for weeks, really. They’d been offering to admit me for a while, and I had almost taken them up on it several times. If I hadn’t had an almost-four-year-old at home, I would have been in the hospital a couple weeks before, because I was having such a hard time managing at home. What I hadn’t been expecting was to hear my doctor suggest that if they monitored me for a day or two and felt it was necessary, they’d deliver me. DELIVER ME? WHAT? As far as I was concerned, I still had at least two weeks left! And here my doctor was talking about delivering me in the next day or two. Gah!

Anywhozit, I got all checked in, and my nurse got me hooked up to the dreaded monitor because the perinatologist that admitted me had ordered non-stress tests (NSTs) qshift. That meant that at least three times a day, they strapped on three fetal monitors plus a toco monitor to my enormous belly for about an hour in order to get at least 20-30 minutes worth of readings for all three babies. Suffice it to say, that was all sorts of fun. The good news is, I was having so many contractions (at least 10 per hour) that the nurses FREAKED OUT every shift even though I tried to assure them that it was totally normal for me. So every single shift they would call my doctors to make sure that it was okay to do nothing. Needless to say, when Dr. G. came on call a day or two later, he put a stop to the NSTs real quick. He asked me if I felt like I was comfortable judging for myself if things changed significantly enough so that I could alert the nurses. If I wanted to continue with the NSTs, he was fine with it, but he thought it was probably a little silly. I agreed, particularly since they were waking me up in the middle of the night to deal with the stupid NSTs. He ordered Percocet for pain because the contractions were really painful, and they also ordered Ambien to help me sleep if I wanted it, though I don’t recall ever actually taking it while I was there.

I wrote in my notes on 9/12:

5:30am- nurse took me off the monitor finally. Now I’m wide awake, b/c it’s pretty close to normal wake up time anyway.
6:10am- Babies are kicking away, just as awake as I am. I’m still in a lot of pain fr. contractions, but I could care less, which is essentially what Percocet does for me, which is why I don’t really bother. I know it’s fantastic that I made it to 32 weeks, even though my goal was (and IS 34. Still, I’m scared about it. I did not want this. I went to my appt. yesterday completely prepared to be admitted to the hospital, but absolutely UNPREPARED to hear the word ”deliver,” let alone when grouped with “in the next day or two.” That left me completely incapable of processing anything else.
I am supposed to have a “NICU Consult” today. Hopefully that will help ease my fears, but I worry it will only solidify them. I know logically that triplets born at 32 weeks do really well. And I also know that it’s not a sure thing that I’m going to have to deliver yet. But I’m completely freaked out nonetheless. Hopefully the neonatologist will be able to help calm those fears somewhat. I know that we’ve already passed the point of serious concern re: intraventricular hemorrhage (IVH). And I got my 1st of 2 betamethasone shots yesterday, so that should help with concerns re: lung development. So we’re in good shape.
Dr. G. should be coming by this morning. I should apologize for having him woken up at 4:30 in the morning. I do hate waking doctors up- it makes them less alert during the day to do things like c-sections! (Speaking of which, I think I’ve pretty much kissed my chances of avoiding a c-section goodbye) Anyway, I’m curious what he’ll have to say about the game plan. He seems to be the most cautious and conservative of the three doctors in the practice. My guess, though, is that at this point, all three doctors would pretty much havce the same approach given what’s been going on. At any rate, it’ll be good to see him. I had thought I’d be seeing him at my appt. yesterday, but it was Dr. M.
Much Later-Dr. G. came in at 7:30am. Asked what was going on last night [I’d had tons of contractions through the night and he’d been called a couple times about me]. I told him the number of contractions was fairly consistent with my normal rate, but the intensity/pain level of each contraction was much higher than usual- except for the night my terbutaline pump hadn’t been working. Dr. G. suggested that we might re-start the pump for the sake of my comfort level. He isn’t looking to hold off labor at this point – if it happens, it happens, but there’s no good reason for me to be in that much pain. Fair enough.

My notes over the next several days are really sketchy because it was Rosh Hashana and I couldn’t write anything or use the computer. It was weird to be in the hospital on Rosh Hashana, the Jewish New Year. I couldn’t use the phone or electricity or anything. I did have some visitors, because fortunately, the hospital is walking distance to my house and my community, so it could have been a lot worse. Also the hospital arranged to have Yeshiva students come in to blow the Shofar for the Jewish patients. I was at a Catholic hospital, so it was a little surreal to have a nun come into my room to ask if I’d like to hear the Shofar, but it was great that they did that for us. Also, Pastoral Care Services made sure that apples and honey were on my dinner tray every night.

I had a sonogram on 9/14, with a BPP. They didn’t do growth measurements, but the sonographer could tell from the Doppler that Baby C was smaller than the other two. She seemed worried, but Dr. G. was running off to an emergency procedure, so I didn’t get to talk to him. I assumed that if it were anything to worry about, he would let me know after he reviewed the pictures later in the day. I didn’t hear from him, so I assumed all was well. I asked Dr. M. about it the next day (Saturday) and she said that particular sonographer is very jumpy and that she and Dr. G. talked about it and looked at the pictures and didn’t think they needed to be too alarmed just yet. They would be doing a growth ultrasound on Tuesday, when they’d know more about what was going on. And not to worry anyway, because she’d scheduled my c-section for next Friday, the 21st, so the end was in sight.

Uh. What? First of all, what c-section? I was still holding onto the thought that we were going to get me to 34 weeks. The 21st would only be 33 weeks and 2 days. Second of all, if I made it to 34 weeks, Dr. G. and Dr. P. said we could talk about a vaginal delivery and avoid the c-section. I knew Dr. M. wouldn’t do a vaginal delivery, so she and I had never discussed it, plus I nearly never saw her during my pregnancy, so it just hadn’t occurred to me to discuss this with her. But what do you MEAN it was scheduled for the 21st? Worse, the 21st was right before Yom Kippur, which was just NOT going to fly with me, unless I went into labor and just didn’t have any way around it. No way was I going to PLAN to deliver my three babies just hours before my husband would be completely unavailable to me for a full 25 hours. No possibility.

The most horrible part about it was that she told me this on a Saturday when I couldn’t call anyone, I couldn’t talk to my husband (he was sick, so he didn’t make the walk down to see me…it’s about 2 miles, so it’s completely doable, but when you’re not feeling well, it’s sucky). I was in a blind panic that they were going to make me do this on the absolute worst time. Dr. M. was convinced that the real reason I was upset about it was that there was a date on the table and that it was hard to imagine the concrete-ness of it all. While it’s true that there was probably some element of that, it’s really hard to describe how horrible it would have been for me to have delivered three babies and had them in the NICU with me recovering from major surgery after three months on bed rest and not have my husband even remotely available to me. Even if he skipped out on shul and stayed with me at the hospital (which would have been hard for him to do because remember there was still J at home to take care of), he would have been fasting, and Seth is not terribly functional when he’s fasting. Yom Kippur is a full 25-hour fast. No food, no water, no nothing, so it’s not pretty. While I would have been exempt from the fast, he would not have been. Delivering on the 21st would have been miserable and horrible at best.

I spent the entire day in tears, absolutely panicking. Two friends came to visit and I burst into tears the second they walked into the room (the first friend was the one to break the news to me that Seth wasn’t going to come visit that day, which was the last straw for my nerves that day). I had put up with an awful lot of discomfort, an awful lot of pain, an awful lot of fear and uncertainty through 7 months of pregnancy. And dammit, I’d mostly done it with a smile on my face. I had been fairly graceful about it all, looking back, but that day I absolutely hit my limit.

Finally, the sun set, and I called Jess and completely lost it. Jess had been commenting in all our conversations about how unflappable I’d been. When I was admitted and they started talking about preeclampsia and cholestasis and delivering and whatever, I’d really been okay. I was calm, I was at peace. I was just trying to hold onto my babies. But poor Jessica didn’t know what to do with me that night. She listened to me blubber and she told me it was okay to be upset and she told me she understood, even though she was probably thinking that it was a mistake to have ever given that total nutjob her phone number. I sobbed and sobbed into the phone and told her it just couldn’t be and I couldn’t let it happen and how I just felt so completely out of control and I begged her to find a way to stop it, even though I knew there was nothing she could do.

Poor Jess. Jess had never heard me so out of control. Jess had absolutely no idea what to think of me that night. She calmed me down. She told me she understood why I was upset. She told me that she would be upset too. She told me it would be okay. She told me that it was okay to tell the doctor that I was NOT okay with having a c-section the day before Yom Kippur if it was elective. Going into labor and not having a choice? Okay. Doing it on purpose? Not okay, and it's okay to tell the doctor that. And then, poor Jess had the misfortune of having to update my blog. The poor dear had no idea what to say. She didn't want to betray my state of mind and tell the whole world that I'd completely lost my shit, but she couldn't very well say that I was completely okay either. She did a pretty good job

I remember I was having horrible, uncontrollable migraines and headaches while I was in the hospital. Percocet wasn't helping them, and there wasn't much else we could do for them. The itching from the cholestasis/preeclampsia was nearly unbearable. I could hardly move, which wasn't so bad because I wasn't really allowed to move anyway. The contractions were fairly regular, but that wasn't the end of the world once they took me off the qshift monitoring. So long as the nurses weren't freaking out about it, I was okay with it. I still dream of having a pregnancy where I don't know what it's like to have 12 contractions an hour every hour for three months. I still remember having a doctor tell me he wasn't worried about me having 12 contractions an hour. "That's not what labor's like... When you're in labor, you won't have that many contractions. You'll have contractions about every 4-5 minutes." Uh, yeah, you do the math, okay? I'll wait. See my point? Yeah.

Anywhozit, the days passed and blurred one to the next. Sunday, the 16th, was J's 4th birthday. Seth brought him to the hospital to open presents and have cupcakes in my room. I broke the rules and curled up on the couch with Seth while J played with the adjustable bed (it goes up! AND down!) and watched cartoon network (seriously! there are NO kid-appropriate shows on that channel!) It was quite possibly the best birthday J has ever had. He loved that adjustable bed! :) The nurse was pretty amused by his jumping around, which I was pretty happy about, because it distracted her from scolding me about being out of bed. But, eventually it was bed time for J and I was alone again.

The lack of internet at the hospital was definitely getting to me, and when Seth and J left that day, I felt more alone than I did on most days. For some reason, the emptiness of the room resonated more than ever, perhaps because J's exuberance at turning four was so clear... He was so excited to turn four, because, you see, now it meant that at his NEXT birthday he'll be FIVE and five is his VERY FAVORITE number. So now he's even closer to his very favoritest birthday EVER. What more could a boy ask for? But when they left... oh it was beyond quiet in the room. The silence was deafening. Even the TV didn't help. Monday was even worse. I looked forward to Tuesday because I was scheduled for ultrasounds on Tuesdays and Fridays.

And so, Tuesday came and they brought me down for an ultrasound...

There was a student nurse at the ultrasound and she asked permission to stay for the ultrasound and I said, sure what the hell. I mean, everyone else and their sister has seen my insides, why not someone else? And really, how many sets of triplets was this student going to get to see while she's in school? How cool am I? I remember I freaked out the nurse because my legs and feet were really swollen and I guess my hands must have been too. I might have been more freaked out about it myself had the ultrasound itself not have been cause for so much activity the rest of the day. Baby C hadn't grown at all. Again. Baby C was a very small baby. They estimated the baby to be about 2 pounds, 14 ounces at best, compared to baby A, who they thought was 4 pounds, 4 ounces (in retrospect, they were a little optimistic on both counts, but really not that far off, actually. I can't remember what they estimated Baby B at, but I think it was 3 pounds 14 or 15 ounces, which was the closest to accurate). The sonographer disappeared to talk to the doctor, but it was clear that she was worried. I chatted with the student nurse for a long, long, long, long time. Eventually she got pretty nervous and she disappeared to figure out what was going on with the doctor and sonographer and they all came back to talk to me.

Dr. M. came in, took a look at the pictures, poked around at the babies, and said, "I want to deliver you. Today or tomrorow at the latest." And yeah, a vaginal delivery was out of the question. Baby C (who I now know is Abby) would not have done well with a vaginal delivery. While she might have survived the delivery, she probably would have ended up with a prolonged NICU stay as a result. It wasn't worth the risk of course. I was despondent, but I obviously wasn't going to put my baby's life in danger.

I went back to my room and called Seth and told him he needed to take the next day off of work. And I called my dad and gave him the news. And I called a couple other folks, including Jess and my mom of course. And then I quietly freaked out. Remember how I wanted NOTHING TO DO WITH A C-SECTION? I still wanted NOTHING to do with a c-section. I was still utterly terrified of having an epidural. I was still utterly terrified of not being able to feel my lower half. I still didn't want to have my babies whisked away from me without the joy of a normal delivery. I was angry. And worried that something would get forgotten or overlooked or whatever.

AND OH CRAP.

WE HAD NO NAMES! Well, clearly we could NOT have these babies! Seth was given directions to get a babysitter (my mother) for after J went to sleep that night so that he could come to the hospital to go through the baby name books AGAIN to look for names (AGAIN) to see if THIS time we could come up with SOMETHING that seemed like a reasonable list of names that MAYBE would work for our babies when they arrived. As it turned out, we weren't terribly successful, and this was probably largely due to the fact that we didn't know what we were having. It's amazing how hard it is to make a list of names when you know you've got three babies coming, but you don't know what flavor of babies you've got. Impossible, really.

I was convinced that I couldn't possibly deliver the babies if I didn't at least have a list of possible names, so we did make a list of possible girl names, but we never did come up with a list of boy names. For this reason, I was absolutely certain that we were having three boys. I was also convinced, by the way, that I could not deliver my babies until I was done knitting my three hats for them... but I finished the three hats I was knitting and needed to sew one last seam, but Seth accidentally threw out my needle... so I said I would NOT deliver those three babies until he found me another needle. Suffice it to say, he didn't find me another needle, I didn't finish the hat before I delivered, the doctor wouldn't delay the surgery for something that dumb, but the hat got finished when they were a few days old. Sigh.

But I digress...

Seth and I did NOT come up with three perfect names that night. Seth and I came up with a list of about 15 girl names that I didn't hate, but nothing in combination (in other words, they were just random names, not first-middle complete names) and ZERO boy names. I had NOTHING, and I mean NOTHING for the possibility of having a boy. Eventually, my poor, weary husband had to go home, knowing that he had to be back at the hospital early the next morning so as not to miss the main event, names or no names.

This post is long enough, so you'll just have to wait for the story of the birth itself! But rest assured, I AM actually working on it.

On the Plus Side, Now I Know the Terbutaline Works...

Yesterday for hours I was having pretty uncomfortable contractions spaced exactly 5 minutes apart. Eventually they shifted to exactly 4 minutes apart. I wasn't loving this development, but having a lot of contractions wasn't the end of the world. After all, that's what I DO, right? Yes, they were more uncomfortable than usual, but they weren't alarmingly so, so I wasn't sure whether it really mattered. I decided that I'd see if I could sleep through the night to decide how alarmed I should be. And that's when the fun began. The contractions didn't get better through the night, and I never did get more than about 20 minutes of sleep at a time, but there were only 2 stretches in the night where I even got that many. I spent the whole night trying to figure out when it was appropriate to call the doctor or at least call Matria. Calling at 2:30 seemed silly, I rationalized, since I'd be getting a bolus at 3am. At about 3:15, I fell asleep for 20 minutes, which seemed to me to suggest some improvement, so I figured calling wasn't strictly necessary. By 4:30 I was in agony, so I considered calling and asking for an additional bolus, except that the auto-doses really weren't doing much good, so why would I think another bolus would? By 5:30 I was in tears from the pain (as I had been intermittently through the night), but again, only half an hour away from a bolus, so calling seemed premature.

All night the contractions themselves were not only stronger and more regular than usual, but I had cramping so severe I expected to see blood every time I went to pee and pain into my back along with the cramping so strong that I would have sworn I had a kidney stone had it not been so definitely in sync with the contractions. Once I dragged myself out of bed at 6:30ish (with less than an hour total sleep to show for myself), I couldn't quite figure out WHAT to do with myself. I still felt crappy, but at that point, I wasn't feeling any worse than I'd felt all night, so I decided to wait to call Matria until it turned over from After-hours to the local center, so that I had a higher likelihood of talking with a nurse who knew me. At 8:30 I called over there and spoke with a nurse who, as it happened, I'd never spoken with before. She suggested giving myself an extra bolus, but also said that she'd recommend contacting the doctor, since this was a change from the norm for me. So she paged the doctor for me.

Dr. P. was on call, which surprised me, since he's going to be away all this coming week, but that was good since I saw him twice this past week, so he knew what was going on with my medications, etc. He called me directly, rather than trying to relay everything through Matria, which I appreciated. He first told me to raise my basal rate on the terbutaline, and then said he could bring me into the hospital and get me onto a monitor and possibly mag sulfate if I wanted. Alternatively, this is about the last opportunity I've got to use Indocin (they won't use it after 32 weeks), so since I haven't been on it for a few weeks, and since historically it works well for me, that was my other choice. So I decided to try the Indocin again and he said if I wasn't feeling better in several hours, I can always come in to the hospital. Fine and dandy, except today is my foster son's 4th birthday party, so I'd like to avoid that if possible. Obviously, if I need to go, I need to go, and that's all there is to it. However, if there's any way to avoid it today, I'd like to. I do want at least my husband to be at the party, and I'd rather not go to the hospital alone (I'm not going to be at the party regardless).

So that's what we agreed upon. And then... shortly after I talked to Dr. P., I pulled out my pump to give myself the extra dose that my nurse had suggested and I realized that the pouch that holds the pump was a little damp, as was the area around the pump where the tubing attaches to the syringe in the pump. How odd... And I peered closely at the tubing and watched it for a good long while. And I realized that absolutely NO medicine was going through that tubing. In fact, probasbly no medicine had been going through that tubing all night. And in retrospect, when I changed the syringe last night, I vaguely remember that ther was a subtle "crack" sound as I put the tubing on, and I DID check to see if anything looked cracked but didn't see anything, so I'd sort of forgotten about it. Obviously, I didn't look closely enough. Whoops. In the two months that I've had the pump, this is a first. Still, I feel foolish.

However, at least now I know that the terbutaline really IS serving a very important purpose. Because if that was just a tiny glimpse of 12 hours without terbutaline (bearing in mind that the half-life of terbutaline is, I think, 4-5 hours, so I theoretically still had terbutaline in my system that whole time, just less and less of it through the night, then boy, do I not want to know what life woud have been like without it all together. So as many contractions as I feel with the terbutaline... at least I now know that the Terbutaline DOES work. Really well. Sheesh!

followup appointment

First of all, my Pajama Gram arrived today! Go me! I'm very happy about this.

I saw the doctor again this morning. As compared to Wednesday, I'm relatively stable... my cervix is still about 1.5cm at its longest, which is what it was on Wednesday, so that's good. Dr. P. gave me a prescription for some extra Nifedipine so that I can take it twice a day, in hopes that it will help my blood pressure (today's was totally normal, but yesterday was 136/111...I didn't know BP numbers WENT that high). Other than that, I get to wait for test results to come back (labs that were ordered from Wed's appt. plus the fetal fibronectin they checked today).

Dr. P. didn't want to make any final decisions on admitting me to the hospital next week until they see me next week, so he had me change my appointment from Wednesday to Tuesday. His preference would be to keep me at home and have me in the office Tuesday and Friday, but a Friday appointment would be complicated at best, since that's the 2nd day of Rosh Hashana. By Tuesday all the labwork will be back, and they'll also have a better idea of how carefully I'll need to be monitored through the week, so it makes sense to wait to make a decision, and I'm comfortable with that. I'm totally happy being ABLE to stay home for Rosh Hashana, provided that he thinks it's prudent to do so. His feeling is that he doesn't have all the information today to be able to make a real determination about whether it's prudent to do so, but will know more on Tuesday. That's completely reasonable. He (Dr. P.) will actually be out all of next week (*gasp!* He can't abandon me!!), but I'm seeing Dr. G. on Tuesday and I love Dr. G. so I have no concerns.

Meanwhile, I'm exhausted, so I'm going to take a nap. I have a terrible headache, so I'm hoping it will go away by sleeping some more. I'm not counting on it. It's astounding how much energy growing three babies can take out of a girl. Maybe I'll go put on my new snuggly pajamas. Probably not. That would take a lot of energy. *yawn*

Well, I know what I'll be doing tonight...

Tonight I will be packing a hospital bag. Because, you know, it seems like there's a possibility that I might need it at some point. I probably wasn't clear enough in my last post. In fact, I was downright misleading when I said, "So I'm just going to sit around waiting to see if it's a trend." What I'd been told yesterday by my Matria nurse was that one day of high blood pressure wasn't really a good data point and that if I had two days, then they'd decide what to do. So at the time I wrote my post this morning, I was waiting for my Matria nurse to call (since I'm not doing contraction monitoring anymore, she calls me in the afternoon, rather than in the morning after morning monitoring).

Anywhozit, my nurse called me around 12:30 and told me to take my BP again around 1:30 and see if it was still high. It was (125/94), so she called my doctor's office. They promptly had me come into the office to be seen and the nurse at my doctor's office suggested that IF I already have a bag together I might want to bring it with me, but if I didn't already have it together, not to worry about it. Well, phooey. That wasn't entirely what I wanted to hear. Suffice it to say, I didn't have a bag packed anyway, so it was a moot point. And so... off to the doctor's office. Dr. P. was in the office I went to, which made me happy (he's a very calming influence). My BP was, annoyingly, elevated but not high while I was there (130/84). High for me, but not high enough to be problematic. My cervix has shortened by about half a centimeter. That's not fabulous, but Dr. P. pointed out that at this point we want to get these babies another three weeks, not another three months, so it's manageable (at its shortest, it was 1cm, it's longest was 1.6 which used to be about as short as it would get).

Anyway, Dr. P. ordered some labs and a 24-hour urine collection. He said that obviously they've been doing their best to manage me as an outpatient for as long as possible, and that now they've kind of got a choice, which he left with me. Did I feel more comfortable being admitted now so I can be monitored 24/7 or would I be more comfortable and less stressed at home? I told him that honestly if he'd asked me last week I would have told him to admit me, but I really, really wanted to go home today. Next week, I said, I'm all yours. You can take me. In fact, I said, it's probably best to admit me next week, so that I'm not trying to navigate the issues of dealing with getting to the hospital or doctor's office if I need to in the midst of the Jewish holidays. He said that was a good point, and we'll talk about it again before we get there. He wanted me to still come in for my already-scheduled appointment on Friday and we'll see how it goes. At this point we're just taking things one day at a time, and that's okay.

Right now I'm really uncomfortable. The contractions are really getting intense. I gave myself an extra dose of terbutaline, which I normally try to avoid, particularly at night, but that's the way it goes. But it's okay. Not far now, right?

Miscellaneous Jibber Jabber

Since I'm not monitoring contractions anymore (except mentally) and I'm not checking my blood sugar four times a day, I almost have nothing to say anymore. I have no reason to be awake at regular intervals anymore, so I haven't been, if I can help it. I feel so crappy that I just sort of lay around drifting in and out of consciousness. That's only partly true, but it's what it feels like these days. I've lost any sense of structure to my day, and I'm really okay with that. I do still get up every morning and get dressed, which makes me feel somewhat human, but that's my one nod to actual humanity. The rest of my day is devoid of useful activity, for the most part, which is fine, because I really don't have the brainpower for much more.

I am less and less able to move about without assistance. Getting out of bed is a chore. Just getting to the bathroom takes serious motivation (but since a really full bladder triggers contractions, that's usually motivation enough). The babies are all kinds of squirmy, sometimes in fun ways, sometimes in uncomfortable or painful ways. I'm trying to enjoy it, because I know that I'll miss the fun ways at least once they're on the outside. I'm not ready for them to come out, but I'm very uncomfortable, so I know once they're out, I'll be grateful to have my body at least partially back to myself. I had to increase my terbutaline dose again last week because the contractions were just getting too painful. It's done the trick for controlling the contractions, but makes my muscles even weaker than they were (this is a common side effect) and makes me a little shaky, so don't trust me with anything that requires good fine motor skills!

One great milestone of the week was that our soon-to-be-four year old felt the babies kicking for the first time. He got a HUGE grin on his face when he felt it and seemed to really understand what was happening. It was terrific. My husband has also been able to feel them more than usual... normally he gets near them and they suddenly fall asleep. But he's been able to feel AND see them move more than he had been able to even just a couple weeks ago, which is great. Now at least he doesn't think I'm just making it all up. It definitely feels different from the outside than from the inside, but I still appreciate that they can share a teeney bit of the experience.

One less positive milestone of the week is that yesterday suddenly my rings were too tight to remove (I did get them off eventually), and my blood pressure shot up. It's still not alarmingly high by normal person's standards, but my BP normally runs a bit on the low side, so it's a pretty huge shift upward for me. The diastolic (the bottom number) was averaging around 90 all day, and seems to be doing the same thing today. One day of high blood pressure is not alarming, so the only thing to do is wait and see if it's a trend. But I still don't like it. Swelling in the hands, elevated blood pressure and sudden weight gain (oh, did I forget to mention that I seem to have gained back last week's four pound loss overnight??) are all signs that point to, well, they're not great signs, let's put it that way. So I'm just going to sit around waiting to see if it's a trend. Because really, I'm so close to the end of this pregnancy, I see no good reason why it SHOULD be a trend. I feel like I should catch a break already.

Oh, and I still have this cold. Which is probably not helping the BP issue. Colds are supposed to run their course in about 7 days. Today is day 8. It is time for it to go now. My throat hurts and it's hard to breathe (which makes it hard to distinguish whether the terbutaline side effects are problematic or if the cold is annoying). I'm stuffy and gross. Sudafed and other products don't seem to help. I would like for it to stop now, please. Not far now, my little smurfs. Not far now.

In other news, I sent myself a Pajama Gram for when the babies are born. I decided I was entitled to some nifty nursing pajamas. I had trouble deciding what size to buy, though... My pre-pregnancy size? That's what I've been wearing throughout my pregnancy... for the most part, I haven't been wearing maternity sizes. So what to do? Well, I went ahead and bought my pre-pregnancy size, on the theory that I'm 99% sure I'm having a c-section, so it can't hurt to be a little too lose on me, right? Besides, who knows how long it will take for some of this triplet belly to go away. Maybe it won't ever. Anywhozit, I will soon own some snuggly jammies.

Now what I really want to know is why didn't my husband ever buy me this super cute Vermont Teddy Bear?? (Besides the fact that I would have strangled him for tempting fate and for putting more clutter in my house?) And furthermore, why does Vermont Teddy Bear sell twin teddy bears, but not triplets? Okay, admittedly, I'm sure if I called them, they'd make it happen, and it's not terribly surprising that it's not available as a standard on their website selection. And it's not like I actually want them, because seriously, what am I going to DO with them? But still. I'm just saying!

And that, I believe, is enough jibber jabbering. I have to go back for my morning nap. I've been up for two and a half hours. I think that's long enough, don't you?

30 week appt. (UPDATED)

Appointment today went okay. They did the fetal fibronectin check again. I should have the results of that tomorrow. Since it came back negative last week, I'm guessing it will come back negative today as well. If it doesn't, that's when they'll talk about bringing me in for hospital bed-rest. Fair enough.

My cervix was 1.5cm. It's short, but it's been that short before. So is it worrisome? Sort of, but not much more worrisome than its been for the last 7-8 weeks. So all I can do is hang in there and hope it holds up for another four weeks. In other news, my blood pressure is still great and I've lost another four pounds. Babies all have good heart rates, as per usual.

Dr. R's last day was today as she's moving back to Boston tomorrow, so she and I chatted for a bit while the sonographer did the growth measurements after Dr. R. had measured my cervix. This meant I missed much of the growth ultrasound, which I normally would have watched really carefully. Babies A and B are just about 3 pounds. Baby C is smaller, and its growth curve has slowed from the last growth ultrasound. There's really no telling at this point whether that's something to worry about yet, but they'll check again in a couple weeks to make sure Baby C is still growing, but at this point, there's really no way to tell whether it's worrisome. It probably isn't. And if it is, we'll deal with it when the time comes.

Also, the doctors are taking me off of home monitoring. It's clear that I have a good handle on what's normal for me. The last straw was essentially that last night I monitored, had to remonitor and still had 13 contractions. They wanted me to remonitor again, and I said I wasn't inclined to do so because this was normal for me and nothing unusual was going on, so I recommended they call the doctor. As it happened, Dr. R. was on call and she said, "She doesn't want to remonitor? Okay. Karen's pretty smart, I'm sure she'd know if something was any different. Let her go to bed." And that's how that worked. Honestly, that's mostly how it usually works. So the doctors pretty much feel like there's not much point in continuing with it. They've pretty much gotten the data they need from the monitoring: I contract a lot. They know that now. I know that now. The key now is that I know to call them if there's any significant change in the intensity or pattern. I noted to Dr. R. that I've been noting a bunch of subtle changes in my contractions in the last few days, but I wasn't sure if that mattered and she said no... they're looking for major changes in intensity. "You're not going to miss when you're in labor, I promise you." I do believe her. The contractions I had with my miscarriage last fall were DECIDEDLY different than the contractions I'm having now. I couldn't talk through them, they forced me instinctively into different positions in hopes of relief. So I'm pretty sure I'll know the difference.

I told Dr. R. what a hard time I was having walking/moving around and she wasn't surprised or alarmed. There's not a lot to be done about it, and it's just the way it's going to be and it's only going to get worse. I also told her I still don't think I need a stinkin' c-section and she did acknowledge that a triplet vaginal delivery ISN'T impossible. She cautioned that one of the things that makes it difficult in my case is that I've never delivered a baby before, which means I'd probably be facing a long, prolonged labor, which can present too much stress for the babies, or could leave me having to deliver one or two vaginally and STILL needing the c-section for the rest, and that's the last thing anyone wants, because recovering from BOTH a vaginal and caesarean delivery at the same time isn't pleasant... better to recover from one or the other. She said if I went into labor this week, it would absolutely not be an option, but if I make it to 34 weeks, I can probably talk about it with the remaining members of the practice, but of course, the first consideration will always be what is safest for me and for the babies. Understood and agreed.

I admit that part of why I don't want a c-section is that I'm afraid this will be my last pregnancy and therefore my last opportunity to experience a vaginal delivery. I also admit that part of why I don't want a c-section is because I hope this WON'T be my last pregnancy (as crazy as that sounds for a chick who's about to have four kids in her life) and I don't love the idea of having to convince a doctor to let me attempt a VBAC. But mostly... I just really don't want drugs running through that epidural if I can help it. I hate the idea of losing that physical control. I just hate it and it terrifies me, even though I know I'll get over it if it comes to that.

Edit: Two points of clarification: First, whether I have a c-section or a vaginal delivery, the doctor will make me have an epidural in place. The difference is whether there are actual drugs running through it. If I have a vaginal delivery, they won't have to run drugs through it unless I want them to, they just need it in place in case they have to suddenly switch to a c-section. And either way, I'd deliver in an operating room, again, just in case.

Second, my objection to a c-section has far less to do with having surgery, being cut open. or "losing out" on a vaginal delivery." It's actually having the epidural. I have two issues with the epidural, the first of which I clearly have to get over regardless and that's having a needle inserted into my spinal column. It's not a rational fear, so rational explanations and comments really don't help, and like I said, I obviously have to get over it regardless, so please don't try to talk me out of this one, because it won't work and will likely just cause me more anxiety. The other issue I have with the epidural is the actual drug going through the epidural, and this relates specifically to the loss of physical control of my lower half. I had a TIA (trans-ischemic attack, sort of a mini-stroke) when I was 23, so I've experienced the whole "you can't move your limbs no matter how hard you try" sensation before, and it's excruciating for me. I don't relish the idea of doing it on purpose. Again, if I have a c-section this is just something I'll take a deep breath and get over, so there's no need to try and talk me out of it.. most attempts to try and soothe my fears about such a thing only make me more anxious about it, so trust me when I say that I really will just get past it, but I really do have a pretty straight-forward reason for not wanting an epidural, and therefore not wanting a c-section. (This, by the way, makes me even MORE opposed to having a spinal, which can't just be turned off, so I'm REALLY hoping that's not what happens)

As for pain relief, I really am not that concerned about it. I'm fully aware that my only real pain relief option is an epidural even with a vaginal delivery. But pain doesn't worry me. I have a lot of chronic pain in my life. I know how to handle pain. I have a lot of techniques in my arsenal (so to speak) to handle pain. I have chronic migraines. I have chronic kidney stones, many of which I've gotten through without any pain relief (kidney stones are often likened to the pain of labor, and often women who have had both labor pains and kidney stone pain say that kidney stones are actually worse). Believe me, I'd much rather have to deal with pain, which is finite, than an epidural (which, admittedly, is also finite).

There is also the minor fact that I'm not loving the idea of taking care of triplets while recovering from a c-section, but I don't imagine it'll be all that fun to recover from delivery of triplets no matter what, so that's a pretty minor issue. End of Edit

30 weeks, Dr. R. emphasized, is a big milestone. And 32 weeks will be a bigger milestone. And 34 weeks will be huge if I can get there. I'm definitely getting there. Not far now and I know I can get there. Back for another appointment next week.

hangin' in

A couple people have emailed to ask why I've been so quiet (and I got at least one comment on the blog about it as well). I'm mostly quiet because I'm exhausted. I have little energy for anything. I wrote last Friday that I don't feel nearly as horrible as I would have expected to feel, and that's still true, but I had imagined feeling truly, utterly, unbearably horrible, so it's all relative.

I've gotten to a point that walking the 20 feet from my bed to my bathroom is excruciating not only for the time it takes, but the physical pain and exhaustion that it causes as a result. It's worse in the morning than afternoon, but it's not pleasant no matter what. I don't sleep well, but I can't keep my eyes open half the time anyway. I know I'm in the home stretch, and I'm grateful for that. In a lot of ways, I think I'll miss having my little parasites inside me in a few weeks, but otherwise, I'm also looking forward to a time when getting up out of bed is no longer a two-person, five-minute effort.

I'm not complaining. I'm really not. Heaven knows I never thought this would be easy. And I certainly can't say I didn't ask for this (well, yes I can... I was pretty specific that I wanted a singleton, but that's another story). But I knew the risks. And as cheesy as it sounds, I love these babies even though they're not even here yet. So it's not a complaint. Just an explanation for why I've been quiet. That, and I've been spending a fair bit of time on and off the stupid monitor because the contractions haven't quit. Made some more changes to my medications today, though, so hopefully that will help in the next couple days.

Tomorrow I will be 30 weeks. I'll have my growth ultrasound to see how the babies are growing, and they'll check my cervix to make sure it's stable. And hopefully, I'll be told that I've got another four weeks of growing to do. Maybe I'll even have the energy after the appointment to post about it. Right now, I really have to go to bed and snuggle with my snoogle.

29 weeks, 2 days - Appointment

Guess who doesn't have gestational diabetes? Yep. That would be me. Apparently one of my levels was slightly high, but he said that isn't diagnostic and when he heard what my fasting levels were (this morning's was 75, yesterday's was 65... usually it's around 68-70), he said, "Yeah, you don't have it." So yay!

As for the rest of the appointment, it went well. My cervix is stable. The doctor basically said I'm just going to contract. It's what I do. He's not concerned with the quantity at this point, so much as the quality and the effect on my cervix. So we're on the same page on that one, which is good. Contractions are definitely getting stronger and more uncomfortable. He assured me that if I were in labor, I'd be in enough pain that I would know it. I'm not so convinced, since kidney stones barely make me flinch, but I do think I'd recognize it. We'll see.

He was concerned that all the monitoring was more trouble than it's worth. He wanted to make sure that with all the contractions they weren't making me re-monitor so much in the evening that it was keeping me from sleeping, and I promised him that I knew enough to tell them to just call the doctor if I wanted to sleep instead of re-monitoring and he said that was fine. The important thing is that he wants to make sure that I understand that I have to be assertive about letting Matria know if there's a significant change in quality and that I'm not concerned about quantity alone. So if they're pushing me to re-monitor, and I don't want to or feel that it's unnecessary, I shouldn't feel guilty about having them call the doctor. That's fair. And, he said, if we get a little further down the line and decide that the monitoring is just a bigger pain in the ass than it needs to be, then I won't do it anymore. Mostly, he thinks I have a good enough handle on things that he thinks that I know when to call myself, but he doesn't think the extra data point from the monitoring can hurt.

They want to keep a close eye on me, because things have been a bit dicey, but mostly, I'm doing great, all things considered. I'm astounded that I don't feel crappier than I do... I'm a whale, but not as whalish as I thought I would be... I fit into most of my pre-pregnancy clothes despite the enormous pregnancy belly (that's how much weight I've lost). I'm uncomfortable, but not NEARLY as uncomfortable as I'd imagined I would be. I have trouble walking, but the bed rest probably contributes to that, and I'm not allowed to walk much anyway (I only know how difficult -and painful- walking is because I had to walk down a long hallway to get to my doctor's office today). I have difficulty breathing, but that's not shocking. There are three babies in my very, very short torso. I'm tired all the time, but DUH! I'm still throwing up, but who cares at this point? I really expected MUCH worse. Or maybe I'm just handling it gracefully. Either way, I'm in the home stretch. I'm not there yet, but bit by bit, I'm getting there.

I go back for a growth ultrasound on Wednesday. I'll be exactly 30 weeks. If you're REALLY good, I might post another whale picture that day. We'll see.

feeling good

Shocking, I know. What an odd kind of post to see coming from me, Mrs. Negativity herself. But here I am. Perky, even. For the first time in over a week, I woke up this morning not feeling sick, with no pounding migraine, and without feeling like I'd been run over by a truck. I feel.... dare I say it? ... human! I don't expect it to last, but golly jeepers this is awesome while it sticks around. I'm being productive. I'm motivated. I have a little (tiny) bit of energy. Finally I don't feel like an ugly, lazy troll. I hardly know what to think, but I'm definitely not complaining!

Yesterday in the ultrasound, one of the babies was hiccuping while we were watching. It was really disturbingly cute. :) Another baby kept doing flips which made it hard to get the heart rate, but s/he eventually calmed down.

I'm still a big chicken, by the way. I haven't left my OB's office, even though I know that's what I should do and it's what I want to do. I'm not good with change, is really the problem. I guess I'll have to get over that long before the triplets get here, because boy will my life be full of changes then!

So yeah. Feeling good. Seriously! No caveats or anything! Go me!

Random notes

Holy cow. I'm pregnant. With triplets. Seriously! I keep thinking this is someone else's life I'm dreaming about or writing about or apparently completely obsessing about. Then I remember that I already woke up and this really is MY life, not some bizarre story someone told me about once. It's me. I'm the pregnant person. With triplets. For the moment. Parts of me have absoultely no doubt that come the fall, I'm going to have three little monsters to chase after (as much as one chases after newborns who don't move much, which is a good thing, since I'll also be recovering from a c-section). The rest of me can't imagine I'll ever make it that far.

But I digress.

I talked to my husband last night and reiterated my frustration about the MFM doctor, but then got smart and asked him if he came away with the same impressions I had. Yeah, um, no. He didn't. He, in fact, came away with almost the exact opposite impressions that I came away with. He didn't feel like the MFM doc was pushing an agenda. He felt like she was very clear that reduction was only one of my options, and while she believe it was probably my best option, she never indicated that it was my only option (I agree with his assessment on that point). Yes, she put the reduction on the schedule, but told me several times that just because it was on the schedule didn't mean I couldn't cancel it (now that he reminds me, I remember her saying that, but I guess the impact of the words didn't leave enough of an impression on me). Essentially the one complaint that I have that he agrees with is that no one has said, "While we still believe reduction is your best option, you should know that there are a few associated risks. And here's what we'll do to control those risks."

I don't think there's any real likelihood that I'm going to have a reduction. I don't think the evidence, even given my medical issues, is compelling enough to change my mind on this. So maybe it's just not all that relevant that no one has tried to address the risks, and maybe I should stop being all uppity about that point, since it may just be completely irrelevant. I don't feel uncomfortable with the care this practice would give me should I choose not to reduce. Maybe I'm just blowing things out of proportion. I hear that happens when you're pregnant. Could it be that this is just another of a myriad of pregnancy symptoms?

And is it really true? Am I seriously pregnant? With triplets???????? How could this be!? When will I wake up?

P.S. I think I'm brewing a new kidney stone and I am definitely not appreciating this, since there's not a darned thing that a pregnant lady can do about a kidney stone.