Monday, July 30

I skipped a follow-up post of my appointment a few weeks ago, but there wasn't much new to report and I figure since I had an appointment on Monday, I would just post updates from that one.
I went in on Monday for my first of my 2 times a week appointments.  It was at 8:30 in the morning and we were finished by about 10:40.

First we went to the ultrasound where they took growth measurements and did the biophysical profile.  (From WebMD, a biophysical profile is: Special ultrasound methods are used to keep track of movement, increases in heart rate with movement (nonstress test), muscle tone, breathing rate, and the amount of amniotic fluid surrounding your baby.)  They estimated the baby's weight at 4 pounds, 15 ounces which is pretty good for just a few days over 32 weeks.  After the ultrasound was finished, we headed back to the waiting room for a few minutes until we could be taken back for the non-stress test.  We went in and I got hooked up for that test- two monitors on my belly- one to measure the baby's heart rate and another to measure contractions and then I had a hand-held button to push when I felt movement.  The baby was doing lots of moving and it probably took 15 minutes and me lying down on my side until the nurse was finally able to get a consistent heart rate.  Then we sat for 20 minutes while that all finished.  Finally we were taken to a regular room for my prenatal appointment.  She said everything looked good with the baby, the heart rate was 143 I believe.  The baby scored a perfect 10/10 on the biophysical profile (BPP).  They had measured the size of the omphalocele and it was 2.71 cm x 2.3 cm and is still only containing bowel.  The baby was also measuring a little ahead by size measurements- 33 weeks, 4 days (I was 32 weeks, 2 days this day).

I asked about scheduling the C-section because I am anxious to know dates and get some planning done.  She responded with "So you are delivering in Peoria right?"  To which I was a little bummed, but basically said I didn't really know and had been told both and wasn't sure what I was actually doing.  She called a NP for the pediatric surgeons (they are only in Urbana for office hours on Wednesdays) to ask if they had anymore details.  So as of right now, we have no idea which one I will deliver at (Peoria- 1.5 hours from our house or Carle-1.5 blocks from our house).  We should know after August 15th- that day we will meet with the pediatric surgeon and the Nurse Practitioner.  They will lay out all of our options and the pros and cons of delivering at both Carle and Peoria.  Then (unless something changes between now and then) we will get to decide which hospital we prefer to deliver at.  It is overwhelming to think about making that choice (both have Level 3 NICUs, but Peoria is the Children's Hospital and where the surgeons are actually coming from).  We are trying not to worry about it too much and hope that the decision will be clear to us when we find out the information at our appointment on the 15th.

Things are continuing on pretty normally here- I feel rather large and the heat could drop a little bit.  We had thunder and then it started to rain here- for about 30 seconds and then the sun came back out in full force.  We started telling Oliver a little bit about the baby and that he won't be able to see it right away because it has an owie- he talks about when he saw Parker and is pretty exciting about this baby too.  When we told him that, he right away said "but I won't touch the baby, I'll just look."  We told him that we would bring back pictures and take videos so he would be able to see those and he seemed all right with that.  Parker is pretty unaware of it all, he "knows" I have a baby in my belly, but so does he, Oliver, Eric, and pretty much every other person we see.  Eric has work stuff going on for the next 3 appointments so I think I will be charging up the iPod so I can keep myself entertained at the appointments.  Luckily, we have friends in town who have been so helpful in watching the boys so we can both go to appointments.  I'll try to report back shortly after Thursday's appointment.  Have a great night.

Baby's newest profile shot

28 weeks- July 2nd

Profile view of our baby at today's ultrasound

Eric and I went in for my 28 week appointment today.  We started off with an ultrasound where we saw the baby moving around a lot.  It is a pretty active little baby typically and has consistently been that way for ultrasounds.  The appointment was actually more relaxing and less new information than we have had in awhile so that was nice.
We met with one of the nurse practitioners after our ultrasound.  She said things are looking good.  We asked if she would call it an omphalocele and she said yes.  She also said that if they have any concerns as to which it could be, they error on the side of caution and go with omphalocele so that they all keep looking for other things instead of getting more comfortable with the gastroschisis.  She said the baby was in the 64th percentile for weight and over 3 pounds already.  That was exciting to hear!  Another thing that was exciting during the ultrasound is that the abdominal cavity was measuring at 30 weeks, 6 days and I am inferring for myself and hoping that means the surgery to put the bowel back in will be super successful because there will be plenty of room.  They said my amniotic fluid is increasing, which is to be expected, but that it is still in the normal range.
I scheduled my next appointment for Wednesday, July 11th prior to leaving on vacation.  We were also able to schedule the rest of our appointments for the rest of my pregnancy.  Starting at 32 weeks (July 30th), I get to go two times a week for appointments.  Each appointment will consist of a biophysical and non-stress test for the baby and then a prenatal appointment for myself.  While I am not necessarily excited to spend 4+ hours a week at the hospital, we knew this was coming eventually and are glad they are taking good care of myself and the baby.  Before my next appointment, I get to go and get more blood drawn.  I went in this past Saturday for my glucose test and it came back normal!  If I have counted right in the first 28 weeks of this pregnancy, I have had 9 appointments and assuming no more get scheduled, in the last 9 weeks (bringing me to 37 weeks), I will have 12 more.
Here's hoping for another positive and uneventful appointment next week!

June 19th

June 19th- I had my typical appointment of getting an ultrasound, although this took quite awhile today.  Eric went along for today's appointment.  After the tech did the typical ultrasound, she came back in and said the doctor wanted her to get some additional shots of the heart and get a few recordings of different heart sounds.  So she came in and did that.  Then the doctor came in and wanted to do another ultrasound to look at a few things himself.  So I had ultrasound number 3 for the day.

He told us that he is pretty confident from today's ultrasound and looking back at previous ones that the baby actually has an omphalocele instead of gastroschisis.  He said it has held more of a consistent shape and that usually the gastroschisis looks more like spaghetti floating around versus the rounded shape.  He did say it is off to the right of the umbilical cord which is typical for gastroschisis, but is still thinking it is an omphalocele.  He confirmed that the only thing in the omphalocele is bowel and no organs appear to be in the omphalocele.  He said that the size of the omphalocele is not likely to change other than size relative to the baby.  In a nutshell, this means that the bowel that is in a protective membrane so it is not subject to the amniotic fluid the way that the intestines are with gastroschisis.  This is a positive, however, omphaloceles are very often connected with other genetic issues, specifically heart or spinal issues, whereas gastroschisis is a chance thing that is not genetically related.  We are hopeful that we aren't looking into any major genetic issues.  Nothing in the ultrasounds we have had show any real need for concern.  They have done lots of looking at the heart and haven't seen anything that concerns them. 

The doctor made it sound like the plan for the birth and after would be similar- C-section followed by surgery.  He gave a little more detail into the actual C-section in terms of how long it will take and when we will schedule.  He said roughly start to finish will be about 1 hour and that we will schedule it for between weeks 37 and 38.  We are still going every two weeks for appointments and ultrasounds at this point.  This doctor did make us feel a little more nervous about pre-term labor and said we have a higher probability than a typical pregnancy and stated multiple times that I should not do too much, but at the same time, I asked if there was anything I shouldn't be doing and he told me to just keep doing what I'm doing. 

It sounds like 32 weeks will be a big week for us, we will meet with neonatalogy again that week, we will meet the pediatric surgeon or surgeons that will be working on our baby, and we will schedule the date for the C-section.  We will also be able to set up a tour of the NICU so we have an idea of what to expect when we get there.  Our next appointment is Monday, July 2nd and I will be 28 weeks. 

Our First 'Regular' Appointment

On June 4th, I went in for my first regular appointment with maternal fetal medicine (MFM) after finding out about the baby's gastroschisis.  The ultrasound was pretty short, but they were able to get the images they wanted.  After the ultrasound, I met shortly with one of the nurse practitioners in MFM.  She didn't really have much to say, but told me that I was going to be meeting with the head of neonatalogy from Carle (our local hospital) that day.  I was somewhat confused because at this point, we were planning on delivering and doing everything in Peoria.

The neonatalogist was very nice.  I tried to remember all of our questions (I didn't realize I was meeting with him and so I didn't bring my questions for him or have Eric along).  He brought some relief to us.  The pediatric surgeons from the children's hospital in Peoria are working with Carle Hospital (where both Oliver & Parker were born) and so the baby will be able to have the surgery done at Carle and then stay in the NICU here (it is a level III NICU).  He went through some of the logistics of what will happen.  He said I will have a C-Section sometime after 37 weeks and that the baby would go immediately to surgery.  Basically, they will get the baby out, then show us the baby, take the baby to NICU if any stabilization if needed, and then on to surgery.  He said the baby will be intubated and will likely be for a few days after surgery while the lungs get used to a smaller amount of space in the abdomen.

He confirmed that the typical NICU stay is 1 month to 1 1/2 months.  He also said that I should eventually be able to breastfeed the baby, but obviously not right away so they will provide me with a pump while I'm in the hospital and will store milk in the NICU for when the baby is able to eat.  He said that the typical reason babies have to stay longer is that their intestines are not able to handle eating formula or breastmilk and they have to be able to eat on their own before going home. 

I think I hit all the key points from this appointment.  I am working on getting this caught up before my next appointment on July 2nd so that I can just do a quick update after each appointment and stay on top of things :)

Finding out

On February 3rd we had a positive pregnancy test followed by our first prenatal consult on March 7th and prenatal appointment on March 8th.  Everything moved along normally, Sara saw the midwives and she was able to skip the gestational diabetes test (yay!), because of morning sickness (not yay).  We had a dating ultrasound on March 29th and we were told our due date was September 22nd.  After another appointment, morning sickness began to subside and we went to the typical 20-week sonogram. After the sonogram one of the midwives came in, after a longer than typical wait, and said that the sonogram technician believed they saw an omphalocele. She gave us some information about omphaleceles and we were told that maternal-fetal medicine would call us the next week with an appointment for a follow up Level-2 sonogram.  Essentially, this is a head-to-toe sonogram that is much more detailed and comprehensive than the typical 20-week sonogram where they would look at the (possible) omphalocele and look at everything else more closely.

After the appointment we went home and talked about what we heard at the appointment and went to our computers to look up information on omphalocele. During our reading we also read about a related condition called gastroschisis, but largely ignored this condition.

After internal-fedal medicine called we had an appointment date: May 21. At the appointment the doctor changed the diagnosis from omphalocele to gastroschisis. She said that this was a good change, which we somewhat disagreed with.  Essentially, in the case of an omphalocele the organs are outside the abdomen, but still protected by a membrane; where as gastroschisis the organs float freely in the amniotic fluid.  However, omphaloceles can also be associated with other genetic abnormalities such as heart defects, which is not the case for gastroschisis.  The doctor looked at the heart closely and found no issues, which was great news.

After the confirmation of a gastroschisis we were told that we would need to switch from the midwives to maternal-fetal medicine as they handle these cases better compared to the midwives. We would also have bi-weekly sonograms to check the status of the baby. Furthermore, we learned that our hospital could not effectively handle delivering babies with a gastroschisis and that we would need to deliver in Peoria (a town 1.5 hours away) in their children's hospital.  Basically, a baby with a gastroschisis requires a pediatric surgeon to reinsert the organs into the abdomen.  After that, the baby will need to stay in the NICU for recovery from a few weeks to a few months.

From the beginning

This blog will discuss the progress of us, our kids, and our third baby as we maneuver doctor appointments, sonograms, the NICU, and then home. Our baby has a small omphalocele or gastroschisis (click on the words for more detailed descriptions), the doctors have not determined the exact diagnosis yet, which is a small hole in the baby's abdominal wall that allows the bowel and other organs to grow outside of the baby's abdomen. 

The first few posts will primarily catch the blog up to the present.