Wednesday, April 27, 2011

A Room with a View

Never a dull moment with this baby.

Easter Sunday didn't go quite as planned. I woke up early in the morning with severe pain and frequent contractions, which didn't improve with three doses of the medication I had been taking at home to help stop them. After about 3 hours of trying all the tricks I know, we headed back to the hospital for a check. Once I got there, we were relieved to see that Asher was doing just fine, and my cervix was completely closed still. However, no sooner did we feel relief (not relief of my pain, mind you--the contractions were still coming every 3 minutes or so), when I realized that I was bleeding. Given the circumstances, we were very concerned about the possibility of a placental abruption, which is a premature separation of the placenta from the wall of the uterus and can be dangerous for both the mother and, especially, the baby. So rather than heading home as I had expected, I was admitted, and I've been here ever since.

The first few days, I was put on a different tocolytic (contraction-stopping) medication called magnesium sulfate. I am pretty sure it was concocted by the devil. After experiencing its side effects, I am truly shocked that so many of my patients say that it doesn't bother them that much. Among the effects, the most unbearable were the total body ache and inability to keep my eyelids open or focus my eyes. However, I agreed to stay on it for about 60 hours because it seemed to help the contractions initially. But by the second night, the contractions were back, and we eventually decided that it working anymore. Getting off that medication and then the next day having my IV taken out and getting to take a shower have been the major highlights of my hospitalization so far.

Fortunately, the bleeding stopped after the first day. Unfortunately, the contractions have persisted on and off since that time. Because of my high blood pressure and another risk factor (an abnormal low level of a protein called PAPP-A, which was discovered during my first trimester Down syndrome screening), the continued contractions make us more worried than usual about the possibility of abruption, which is why I have continued to be monitored in the hospital. I'm happy to say, though, that now the contractions are much more mild and more infrequent, and Asher has continued to look great.

Just like with any pregnancy, our future is somewhat mysterious. We're hoping to plan for delivery at 37 weeks--19 days from now--as long as we continue to be stable. In fact, I might even get to go home (on strict bedrest, of course) if things continue as they have been. For now we're just taking it one day at a time and trying to enjoy the little things, like my view of the magnolia tree outside my room and my daily shower. Meanwhile, I've received great care from my nurses and awesome visits from friends and family.

Room 229 is not exactly where I had planned to spend the last few weeks of this pregnancy, but all in all, I guess I can't complain.

Tuesday, April 19, 2011

Bedrest Update

It's day number five of bedrest, and not much has changed, which I guess is a good thing. The urine collection I did on Friday did not show enough protein to qualify me for preeclampsia, but it was quite a bit higher than my baseline level (231 mg vs. 84; the cut-off for preeclampsia is 300 mg), so I'm pretty sure I'm headed that direction in the next few weeks. After discussing things with my doctor/partner, Rachel, we both agree that staying off work is the safest thing. It won't prevent preeclampsia from developing (nothing will), but it keeps my blood pressures more stable, which is safer for me. It seemed like backward logic to try to control my BP with medication while continuing to work if there was an easier option that required less medical intervention. Lifestyle modification is always the first step, as far as I'm concerned (which is why my overweight patients don't like me sometimes--I refuse to prescribe diet pills!). Being off work also prevents my partners from having heart attacks worrying about me; they have all been incredibly supportive and helpful, despite the disruption I have caused to their schedules and workloads. I feel very fortunate to work with such a caring group of people.

We had a follow up appointment yesterday, the first of many in the next few weeks. At that appointment, I had a non-stress test (NST), which is a way of monitoring the baby for any signs of distress, and an ultrasound. Asher wasn't terribly cooperative with any of it. He wouldn't stay in one place long enough during the NST to get a good heart rate tracing, so it took almost an hour to do. One of his grandmothers came for the ultrasound for the first time, and he refused to show his face but instead kept finding new ways to hide it behind his hand and umbilical cord. We were able to see that he has a nice mop of hair on his head. I wonder what color it will be since the Dunns are blond babies and the Marki babies are brunettes.

The good news is that all is well for now. He weighs about 3 lbs 12 oz, which puts him at the 27th percentile. This is a slight drop for him--he had been at 37th for the last three scans--but not particularly surprising given my size and birth weight (my brother and I were both under 6 lbs at term). We are happy with anything above the 10th percentile.

My BP continues to be quite labile, so I have decided to start medication for it. It is still well-controlled at rest, but the slightest activity raises it to worrisome levels. I don't want to have a stroke while getting up to grab a snack! This is particularly concerning to me, given how bad I am at this bedrest thing: I'm constantly finding reasons to run up and down the stairs!

From here on, I will continue to have appointments twice a week for blood pressure checks and NST's. In addition, I will need to do blood tests and a 24 hour urine collection weekly (I have that to look forward to on Thursday). The next ultrasound will be in 2 weeks. So far things are looking good, and I fully expect that Asher will get at least another couple of weeks to grow. If I do develop preeclampsia, the goal for delivery will be 37 weeks (around 5/23), as long as it stays relatively mild, though if there are signs of more severe problems, I will have to deliver sooner. In the unlikely event that I never get preeclampsia, delivery will be at 39 weeks, on 6/6 as we were originally planning.

So, 4 days down, 48 (max) to go! Oh, how I'm looking forward to getting out of the house again on Thursday!

Monday, April 18, 2011

Constructing a Shower

I was supposed to spend yesterday being pampered at the spa with some close friends and family, a substitute from a regular baby shower. Instead, since I'm under orders to be at home taking it easy, a few of my oldest friends came down from the Bay Area for a visit/"shower." After a quick lunch in town, Crockett put them to work constructing the last of the furniture for Asher's room. He wanted me to document the occasion so that Asher would know how many people care about him already.

You might notice that Asher's older "siblings" had to get in on the action, making furniture construction particularly challenging for our guests!

All in all, it was a great afternoon. We are so thankful to have such wonderful friends who took so much time to visit and are always willing to lend a hand.

(For others of you who might want to visit, don't worry--all the furniture is built, so we're out of jobs...for now!)

Saturday, April 16, 2011

An Asher by Any Other Name

Not surprisingly, we have already gotten a lot of questions about Asher's name. I don't think it would surprise anyone, either, to find out that a lot of thought went into choosing it. Probably too much thought, in fact. As an OB, I sign birth certificates all the time, so I guess I'm particularly opinionated about the names people give their kids, which meant a lot of "rules" guiding our choice.

The basic rules:
  1. The top 100 names for the last couple of years are off-limits. Crockett and I enjoy having uncommon names and felt that it would be a bit weird for our child to have a common one. This was hard because there are a lot of great names on those lists. However, it also helped ensure that we wouldn't chose the same name as one of our friends.
  2. Careful selection of initials to make sure they didn't spell anything uncouth (either in their usual order, or as a monogram)
  3. Awareness of potential nicknames/teasing
  4. No two people in the house should use the same name. I grew up with 2 Chrises; Crockett and his dad have the same first name. All of this can cause confusion.
  5. The name that is used should be the FIRST name. Crockett and a lot of his friends go by their middle names, and while there is nothing inherently wrong with this, we do find it a little complicated when dealing with legal documents, etc.
  6. The name should be relatively easy to spell and pronounce.
  7. The name's meaning, if it has one, should be something positive.
  8. No made-up names (my rule, which I stand by firmly after a patient recently gave her child a name that sounds a lot like the brand name of a popular prescription sedative)
  9. The name should be appropriate for all phases of life--babyhood, childhood, and adulthood.
These rules established, the next step was what was quite possibly the most inefficient research ever conducted: I read/skimmed the entire boy section of a book of 100,001 baby names. Seriously. Fortunately, most names could be discarded at first glance. Eventually, I compiled a list of names, as did Crockett through his own research (which, as you might guess, was conducted online, though I have to say that his method was about as efficient as mine). We also found a wonderful website with surveys of people regarding their names, so we were able to read first-hand reports about what is like to live with a particular name. Months later, we were finally able to compare notes, and through a process of elimination, we had a name: Asher Brighton Dunn.

So what's in a name? Asher is on Old Testament name. Asher was one of Jacob's sons. The name means "happy" or "blessed." In general, Asher was a decent guy, and his descendents, the Tribe of Asher, were a group of amazingly fertile people who were blessed with good fortune and prosperity. They were also known for their wisdom.

Crockett liked the concept of the name "Bright," in the sense of "intelligent," but it was not in any books or websites, meaning it broke rule #8. "Brighton" is a legitimate name, though, and seemed to pass all other tests. It didn't make the top of my list but was Crockett's favorite, so it is a compromise.

To answer the other question we are always asked: no, neither of these is a family name. We liked the idea of using a family name, but we feared that if we had a second child, we would have to have an "equal" name for that kid to make sure (s)he didn't develop an inferiority complex. It seemed safer to give each child a unique name.

In the end, I leave you with what we told the family when we announced our decision: Asher Brighton is our baby's name. We hope you like it. If you don't, feel free to keep that opinion to yourself.

Friday, April 15, 2011

And So It Begins

Little Asher Brighton Dunn is due June 13, 2011. We are quite sure he won't be waiting that long to meet us. One of my medical assistants commented that she thinks he's just impatient...and then said that he must get that trait from his mother. Apparently, I am not an intimidating enough boss.

As of today, we are 31 weeks and 4 days along. It has been a long 31 weeks and 4 days, complete with just about every annoying pregnancy problem known besides morning sickness. Thankfully, none of it has been serious at this point, just a drag to deal with. I've managed to get over my needle phobia (believe me, doctors like needles going into them about as much as you do--it's different when you're the one wielding the needle), as I have been stuck in more places than you can imagine...and I haven't even gotten my epidural yet! As much as I would like to be done with it all, more than anything, I really, really want him to stay inside to grow a little longer. The longer he is in, the less time he spends in the NICU.

Last night I was put on bedrest by my partner Dr. W. Here's how we got to this point:
I have underlying high blood pressure, which has been very well controlled without medication since the first trimester (BP often drops during pregnancy). Though I have never had any visible swelling, yesterday my fingers felt a little tight, so I checked my blood pressure and found it was all over the map--definitely higher than it had been running for all these months. The first reading was 180/120, which definitely got my attention! Fortunately, I think that was a spurious reading. After that it settled down to 140-150/100 and then was actually completely normal after I'd been at bedrest for a little while. It's unclear right now if this represents the normal rise in blood pressure that occurs in the last couple of months of pregnancy, or if I'm starting to develop preeclampsia. Part of the way to tease this out is for me to collect my urine for 24 hours to see how much protein is leaking from my kidneys. If it falls above a certain level, then it's preeclampsia. Either way, it looks like I'm in for a lot of close observation, repeat testing, and, probably, bedrest until the little guy has to come. If it's not preeclampsia, medication to control my pressures might be sufficient, but I'm having to think long and hard about whether going back to work is really the best thing for us at this point. I'm thinking the answer is no.

For those of you unfamiliar with bedrest, it is pretty much exactly what it says it is--resting in bed, on the couch, etc. No going walking, shopping, or doing the dishes. For someone who is used to doing a very active job full time, running miles a day, and doing construction projects around the house, this is bit of a shock to the system. Crockett has been a major help the last few weeks (I had to stop a lot of this stuff a few weeks ago because of frequent contractions, though I had managed to continue working through it). He's learning to cook and does a great job--any failures have been the fault of a bad recipe! We also have had a wonderful meals-on-wheels service provided by various members of the Marki family (Mom is the cook, Dad and Robin, my sister-in-law-to-be, the delivery people). We are also fortunate to have the world's best cleaning lady, Susana, who keeps the house and our laundry in check. I'm also glad that I got the manual labor in the nursery done a few weeks ago (we still need the crib, but I've been assured that it should be here momentarily).

I am hoping that this time off gets me into the habit of blogging so that this is not yet another blog that gets abandoned after a few posts. I'm sure that Asher will continue to amuse with all the mischief he gets into.