*gulp*

mark your calendars: september 9, 2008. if gus has not seen fit to arrive by then, he’s being dragged out, butt-first and screaming.

on his cousin gaby’s birthday, no less.

i’m not naming my boy mavis, that’s for sure…and other gender-stereotype musings

some of mairin’s crib sheets are pink. so are more than a few items of her clothing. she’s got a handful of dresses in her closet and a gorgeous hand-knitted pink baby blanket. shannon and i both chose newborn outfits for her, one with hot pink whales on it (s’s choice) and the other (mine) a kimono-type top-and-pants set with a large oriental flower print on it. i’ve been looking forward to bringing all these things out for the new baby. but i just can’t bring myself to pass them on to … her baby brother.

i know by now, very well thank you very much, exactly what to look for on an ultrasound picture, and where to look for it, to make sure for myself that i’m having a daughter. so picture me resting on my back, goop slathered on my tummy while the probe slips and slides across my ballooning belly, staring just a few millimeters too low on the ultrasound scrren, looking and looking and looking for those three white lines, wondering if they’re just not there because it’s too early to tell, yet, the baby’s sex, when shannon lets out a WHOOP! and the tech says “um, yeah, i guess you see it, right?” and i’m thinking “see what, you damn fools?” and then i look at the spot where the tech is pointing her cursor on the screen at precisely the same moment that shannon hollers out — obviously trying to project his voice not just across the ohio river but also the the hudson, the thames, the seine and the rhine — “WE’RE HAVING A BOY!”

yes indeedy do, ladies and gents, we’re having a boy. and he’s looking kinda butch already.

and the really beautiful thing about this news is that it’s given us something new, something exciting and different, to think about and plan for. we’ve always prepared for baby girls. pondered girls’ names. worried about how to raise a girl in today’s world. we’ve never given more than passing thoughts to those questions with boys because, well, we didn’t ever need to. but now we do, and we’re both giddy with delight at having this new excitement to ocucpy our minds. i’ve been picturing our house with two girl-childs running around. life will not be the same with a girl and a boy, and it’s startling and energizing and downright pleasurable to contemplate it.

and of course the doc’s news is all good otherwise, which makes the contemplation that much more real for us. my cervix has stayed long (still >4 cm) and closed, the baby has plenty of fluid. i’m getting all the extra care that a nervous high-risk mom could ask for.

and holy urethra, batman, i have a penis growing inside me.

off the charts!

that’s right yo — my cervix is off the charts.

which is a good thing, if you discount the scary 15 minutes that the doctor and the tech spent examining, in great detail, three different cross-sections of a 3D section of the cervix, all on the screen in front of us at the same time. finally the doc had the presence of mind to say “there’s nothing wrong” and the sighs of relief that escaped our mouths nearly blew the doc and the tech right over. then the tech was summarily dismissed and a new (more experienced? more senior?) tech was called in to repeat the scan.

turns out neither tech could get my full cervix into the ultrasound picture, despite turning the magical trans-vaginal wand until it was nearly horizontal. no, the exterior end was just not going to show up. so they measured what they could see, and that part measured variously 3.99 cm and 4.17 cm, so the doc feels good about my cervix’s length (if not its lack of cooperation).

the new kid was there, too — and was about equally uncooperative. we watched the little dickens pull her hands up over her face every time the tech tried to scan her face, roll over to give us her back every time the tech tried to scan her belly, and pedal her legs like a green-jersey winner every time the tech tried to measure her femur. during the cervical non-measurement the kid was face down against the cervix, occasionally pummelling away at the funny thing poking at the door to her warm little home. i’ll tell you what, the kid’s got spunk. now we just need to see whether she’s got patience.

as for me, i’m revelling in the bi-weekly certainty that it’s okay for me to walk around, to pick things up, and bend and move in any of the other gazillions of motions that most of us get to take for granted. i even stretched yesterday, and am gearing up for (i.e., still procrastinating over) re-starting prenatal pilates or yoga.  all this “activity” is helping me come to terms with my ob’s injunction to get fat and let myself get even further out of shape, to keep my walks to two miles or less, and to let shannon do any of the really strenuous work around the house. (guess my plans to move the piano will have to wait.)

best of all, i’m feeling like it’s ok to think about the possibility of a living babe coming to stay with us late this summer. there are no guarantees, of course, but we’re checking everything that can be checked and coddling everything that can be coddled and anti-oxidating everything that might need strengthening. my body is going to do what it’s going to do, and we’ll never understand it (no matter what it ends up doing), but at least we know we’re helping it do its best. and there’s no small measure of comfort in that.

things take a turn for the, um, normal

on monday the new kid and the perinatologist met each other for the first time. they seemed to hit it off: said kid proved to be quite photogenic

(see?)

and the doc pronounced everything just fine. normal. which is great.

the new kid has (despite shannon’s worries) four limbs and no tail. a beating heart, a working bladder, and a big ol’ abdomen. and possibly a bit of a shy streak — during the 4D part of the photoshoot ultrasound, the kid actually brought her hands around to cover her otherwise not-so-private parts. (not that they’re visible yet — the kid is still too young — but this cuts a striking contrast to mairin, who had no problems giving good old doctor hallman what he used to call “the money shot.”)

the photos have sent the nicknaming in a whole new (but still fruitless) direction. is the kid an eddie munster look-alike or what?

the new kid also has what appears, so far, to be a good looking and healthy placenta. it’s either anterior or fundal, or perhaps both, or somewhere between, but it is a) present and accounted for and b) not blocking the cervix. these are good things. (we’ll have to wait to pass judgment on the question of fibrin deposits, but we’re taking the good while the good comes our way.)

the new kid is also being kept company by the not-yet-vanished twin sac, which seemed to fascinate both the ultrasound tech and the doctor. so much so, in fact, that the doc took extra special 4D shots of a cross-section of the sac just to make sure it “was not in communication” with the new kid. (no communication my patootie. who’s to say the new kid isn’t going to come out speaking her own private amnio-language?) anyway — that’s the sac, down in the bottom left corner. trippy, ‘eh?

the new kid’s mama has a beautifully long and still-quite-obviously-closed cervix. this was the first time i’ve ever had an official u/s cervical check; i marked the occasion by panicking the whole time — is that funneling i see? holy cow! it’s only 2.5 cm? since i had no idea what i was seeing and even less of an idea how to interpret what i was seeing, i was wrong on both counts. no funneling. and it measures >4cm (closer to 4.5), which the doctor calls “upper normal.” he explained that over the next ten weeks (and 5 visits for peeks at it) we would likely see it shorten to somewhere around 3.5 cm as the baby adds pressure and weight. but everything’s ok, he said, until we hit 1.5. i know we’re only talking a few centimeters, but i feel like that’s a long way to go. and that makes me — dare i say it? — happy.

and speaking of having a long way to go: as i lay sleepless in bed this morning i realized that we are more than halfway to probable viability, and exactly halfway to viability with a pretty decent chance for good, maybe even normal, health. obviously we hope this kid gestates longer than 28 weeks, but just knowing that we are halfway to having a child who should be able to breathe on her own feels huge.

huge.

positively gigantic.

(that’s right, sing it with me: gigantic! GIGANTIC! a big big love! a big big love!)

a medical update, most of which we are trying to find not alarming

we find that we are alarmed easily now — gun-shy, you might call us — but really, there is no cause for alarm. well, there is little cause for alarm. well, honestly, we can’t gauge the appropriate level of alarm. somewhere between green and red, i guess.

first, the heparin thing.

those of you who follow medical news when it’s not related to you may already know that heparin has been having some PR problems. manufactured from pig guts, the basic components of the drug are procured predominantly from china, and not infrequently from small family-run operations that are not fda approved or even, if pictures tell the truth, even remotely sanitary. well, last fall patients in hospitals who were given heparin started having “adverse reactions” (anything from nausea to low blood pressure to, um, death), and now above-mentioned yucky & unclean practices are being publicized and investigated, and lo and behold, the primary pharmaceutical distributor of heparin — which provides, i’m told, roughly 75% of the heparin supply in the u.s. — recalled ALL its heparin. (somewhere in there i’m pretty sure the alert level started rising to orange.)

so?

well, i take heparin during pregnancies and it’s supposed to do two things that i have only an overly-anxious maternal undertanding of: 1) clear the blood clots out of my system (which apparently arrive daily, thanks to a fun acquired auto-immune disorder of indeterminate origin), and 2), prevent the sinister-sounding “perivillous fibrin deposition” — which is a naturally occurring deposit of fibrous-y type stuff (all you medical doctors out there quit laughing at me, i’m a humanities girl) that eventually clogs the placenta but not really very noticeably and not really until it’s so late in the pregnancy that it doesn’t matter — but which in MY case happens early on and can cause, oh, um, let’s see, PRETERM PREMATURE RUPTURE OF MEMBRANES (abbreviated hereafter as pPROM).

so as you can gather from all this, heparin is supposed to be my friend. it prevents two things that can cause the baby to die. (green!) well, it was not my friend in 2005, when it hadn’t been prescribed to me and my membranes broke at 17 weeks and earl died. it was my friend in 2006, and we can thank its efficacy for our lovely li’l budgie. once again, it appears it was not my friend in 2007, when i took it but somehow still had heavy fibrin deposits and my membranes still broke and ruby still died. (rising past orange to some rich sunset-y color….)

and then we find out that heparin has been wreaking havoc in hospitals, and that batches of it were at best ineffective and at worst contaminated. (red. definitely red.)

so i’m off heparin and on its sister-drug, lovenox — which i’m told a) is synthetic and b) comes from pig guts, so i don’t really get it. (are the pigs themselves synthetic?)  anyway, it should work. (ahhh. green.) never mind that it costs FIVE TIMES AS MUCH because i have insurance that will accept, for my monthly supply, a manageable $50 copay.

but all this is only good only up until a few weeks before delivery, when i have to quit taking lovenox (it can cause spinal hematomas in women who are given certain pain relieving drugs in labor, and those hematomas can cause temporary or permanent paralysis) and go BACK on heparin. (shit, maybe turning orange. paralysis? not what i asked for. maybe by then there will be some clean heparin in the country?)

but really, we’re cool. what’s to do except take the drug that’s supposed to work and hope for the best?

second, the whole doctor thing.

 my OB wants me to see the perintalogist at week 17. hello…? i’ve already had pPROM at 17 weeks once in my life. since the whole point of seeing the perinatologist is to do extra-special exams that help screen for possible problems that could cause pPROM again, shouldn’t i be seen earlier? like, now? OB says no. (red! definitely red!) so being the pushy broad i am, i went over his head and called the perinatologist directly. i’m not happy that i’m waiting for answer, three business days later. grrr. but i’m a great nag, so i’m confident i can expect an answer soon.

it is just possible that i have the best ob in the universe

the doctor’s office called me this morning. one of the nurses was reviewing my chart and realized that she needed more information and she actually called me. amazing.

at first, i’ll admit, it was terrible. they had an lmp (last menstrual period — i warned you about tmi) of november 9, which makes my stats, um, worrisome, and means i need to get in there now. but no, no, i assured her (heart in throat) that my lmp was december 8. i could almost hear her sigh of relief.

well, since i have you on the phone, she says, why don’t i set up your next two appointments?

february 5: first ultrasound. we should see a tadpole-like embryo, and if the new kid is still living, we should see and hear a heartbeat.

february 19: first ob appointment. a silly name for a woman’s fourth visit to the doctor for the same pregnancy, but it’s where they get serious: check my history, blood pressure, weight, mental stability, and so on. dr. lum likes to make sure i still have a sense of humor — he’s been checking on this since ruby died – so i’m sure he’ll tell a few jokes to check my funnybone.

i know some of you think i don’t have a sense of humor. you’re wrong. my humorlessness around you is a choice. i’m actually quite funny. dammit.

a little bit of math, a little bit of chemistry

pregnant women who have suffered multiple losses generally CRAVE information. and early in the pregnancy there is little to no information to be had. the baby won’t show up on an ultrasound, the heartbeat can’t be detected yet, and those tummy-flutterings are generally only gas.

but we can get bloodwork done. and it can be a beautiful thing.

one week ago my beta-hcg was 2257. that number is supposed to double every 48-72 hours in a “healthy” pregnancy. the higher the number, the longer it takes to double. so, to know that things have been progressing well between my test one week ago and my test yesterday, we hoped to see a number anywhere between 13,542 and 27,084. and the magic number is…

…

…

17,969.

there is a lovely site that tracks women’s self-reported beta results; according to them, the median beta for women who are on the same day of their pregnancy as i was yeterday is 5509. the low is 290, the high is 36924.  i can handle being ever-so-slightly above average.

the site also calculates beta doubling-time for those of us who are math impaired. my doubling time is 55.8 hours, which fits right into this table:

1st column: beta range; 2nd, median doubling time; 3rd, slowest doubling time; 4th, # of women reporting

2048 – 4096	45.32	12.46	230.55	1422
4096 – 8192	49.80	15.64	266.06	1013
8192 – 16384	61.20	20.02	19557.84	649
16384 – 32768	72.04	21.92	4695.28	386

so again, i’m totally, perfectly, squarely average.

on another interesting note (remember, you signed on to all this tmi crap), betabase tells us that:

you won’t expect to see a gestational sac or the fetus until the HCG level reaches at least 1,200 mIU/ml.   And you probably won’t see a heartbeat until that level reaches at least 6,000 mIU/ml.

this puts the new kid, right now, in heartbeat range. which seems appropriate, because just today a suspiciously-looking-like-a-heart type of thingy has appeared, in shadowy form, pulsing in the new kid’s widget. freaky. but since i’m not allowed to go for a transvaginal ultrasound for two more weeks, we’ll just keep waiting….