Saturday, January 4, 2014

Risky Business

We're down to the home stretch at just over 3 weeks before Claire's scheduled arrival. And yet, I'm terrified. Not in the normal babyloss mom kind of way, but something additional.

All was going pretty smug and well (honestly) until the end of my 32nd week.

The amazing husband gave me a hand and foot rub and all I had to complain about was a demanding toddler, lower back and hip pain. Typical pregnant girl problems. The day after that hand/foot rub, I complained they both itched a lot. Chalked it up to cheap lotion or whatever.

Fast forward a few days at my 33w appointment. I mentioned the extreme palm and foot itching to my OB. She also said itching was normal in pregnancy. Listen, I know. It's not my first rodeo. My belly itched like crazy with Andrew and now it doesn't because it's been down that road a few times. But this hand and foot itching? It seemed... abnormal. My urine was also getting progressively darker, despite the insane amounts of water I have been drinking to hopefully cleanse this away. It wasn't dehydration. I can't possibly be drinking more water. And I was spending 3-4 hours up in the middle of the night itching my skin to scabs. The only temporary relief was showering and I have been taking about 3-4 each day... mostly in the middle of the night when the itching was at its worst.

Two days later, I called back to ask if I could be tested for Cholestasis. It's a condition in which your liver does not process bile acids properly and could possibly leach these acids into your bloodstream which are toxic at high levels for the baby. It's a simple blood test that takes forever to get back. Seven days. That's a full-on eternity when you're in late pregnancy. It's also rare. When I went in for the blood test, neither of the ladies administering had ever done one or seen that test. Oh, to be in the 1% again. It's getting old.

At my non-stress test yesterday (going 2x/weekly), Claire was sleeping and performed crappy (to my standards since I've been through plenty of these) but the OB wasn't worried because there were a few good accels. Then she measured my belly and told me I was measuring 2.5 weeks behind. What? I just saw my regular OB on Tuesday and she mentioned no such thing with the same measuring device. I suppose I can chalk that up to being subjective, but it wasn't the best news to hear after the NST was just marginal. Add a growth ultrasound to my fluid check ultrasound on Tuesday.

Then she told me my levels were in. My bile acids as of 12/27 were 132. That was eight days ago and since I suspected the itching was not just a no big deal sort of thing, I took matters into my own hands and changed my diet. I'm eating very low fat and just started a hot water and lemon juice cleanse each morning. I've upped my vegetable and Vitamin K intake and I'm living on hope. When I tested, I had just eaten pizza the night before and was not on any sort of diet before then. Perhaps, perhaps, that could have contributed to such high numbers. The idea is that if I lower my fat, there will be fewer bile acids my liver has to process and fewer to enter the bloodstream. We'll see if my logic is helpful.

If you do any kind of research (in medical journals or even Google...), you'll note that bile acid levels of 132 are high. Anything above 40 is high and risky. As in, risk of meconium in fluid, stained placenta and stillbirth. Yep, stillbirth. Lucky ol' me gets to deal with that fear again in another form. Yet, my OB, another practice OB and the coordinating MFM I saw all through Benjamin's pregnancy don't seem to be worried. In fact, they've told me that they've seen elevated levels many times before and none of those cases have ever lead to a demise. Ah, see that's where I lose my mind. Because you've never seen one, it doesn't mean I can't be your first case. And to have already lost a baby and have everyone scratching their heads after as to why? Not exactly the game I want to play.

The one silver lining is that I was prescribed Ursodiol, which is meant to help break up those bile acids and hopefully lower that number to a more manageable and less risky territory. But there are no guarantees. I took my first dose about an hour ago and will take them 3x/daily until I deliver. Of course the risk of stillbirth increases exponentially after 37 weeks. And those bile acids can spike at any time with no way of knowing because the blood test takes a week to come back!

In the meantime, I will be hopefully going in for another blood test to see if the diet (and few doses of Ursodiol) are working. It will take another week for those results and put me just under 36 weeks. I just might lose my mind in that week. If you call, I probably won't answer (like I haven't been anyway).

This baby would live if delivered today. It terrifies me to play Russian Roulette again, despite knowing she needs more time for maturity, growth, and lung development. This is the last time I can do this. It's simply too hard.

Feel free to comment with success stories. You know, if you know someone as unlucky as me who has had just about all the issues under the sun in pregnancy.


Amy L. said... [Reply to comment]

Ugh, Brandy, how terrifying, and even more so (in my mind) with a medical team that doesn't seem to be taking you seriously enough. Thinking of you and keeping you and Claire in my prayers, Mama...

Sarah said... [Reply to comment]

I haven't dealt with this issue, but I am also a one-percenter. I have a bicornuate uterus (only 1% do!), and I had excess amniotic fluid during my pregnancy with Genevieve (the 1% again!). My MFM told me that the amniotic fluid problem almost never repeats unless you have gestational diabetes, which I didn't. Next pregnancy, the excess fluid was back, of course. The baby always did fine on tests, just as Genevieve had. After weeks and weeks of fretting and questions from me, my doctors opted to deliver Henry at 36 weeks. He was healthy and is now a beautiful, chubby 7-week-old. Tests run after his birth show that something was going wrong with the placenta, though the doctors still can't explain why.

I am so sorry you are going through this. Just keep pushing for the best care for Claire, and be sure to voice all of your concerns to all of your doctors.

Jen said... [Reply to comment]

Hi Brandy, I just gave birth to a daughter this past October. I was diagnosed with placenta previa at my 19 week appointment and the placenta never moved. Between weeks 27 and 33 of my pregnancy I had 3 bleeds, and when I had the third I was hospitalized until I gave birth (via c-section) at 35 weeks, 3 days to a healthy, 6 pound 12 ounce baby girl. She spent no time in the NICU. After having a textbook "perfect" pregnancy with our first daughter (who is now 3), this pregnancy was quite scary for my husband and myself. Oh, and I was also diagnosed with mild pre-e while hospitalized and that led to the nurses padding my bed rails. Needless to say we are done having kids. Good luck with everything and I am sure that things will go well for you. I will be thinking of you!

Laura Jane said... [Reply to comment]

This carrying a baby business is no friggin' joke. It's so scary to carry the weight of wanting a living baby on your shoulders.

Hoping the medications work and your drs take you seriously.

My New Normal said... [Reply to comment]

How incredibly scary. I swear, we BLM's really do deserve a free pass with future pregnancies. I'm so sorry you're having to deal with this, it's just not right.

Have you considered asking the doctors to induce you early? That's what we did with Frostina due to my "history." 37 weeks is considered full term and Frostina was completely healthy and didn't need any additional support when she was born.

As it turns out, we made the right decision because she had barely any amniotic fluid left and the cord was wrapped around her neck. So I have no regrets about making the choice to deliver at 37 weeks.

I am pretty sure I will push for the same thing this pregnancy if I'm blessed enough to make it that far.

My thoughts and prayers are with you. I'll have my angel talk to your angel and I'm sure they can take good care of Claire until she arrives safely.

Mihaela said... [Reply to comment]

Hi! I'm sorry you have to add this to the stress of the pregnancy. Ryan from jubilant images just went through this wih her second baby. She got diagnosed because of the itch around 33 weeks. She has ib weekly NSTs and was scheduled for and had a C section at exactly 37 weeks on Dec 28. Her son and her are both fine. Can you request a c section no later than 37 weeks? That's what her doctors told her she needed. And her son was fine, no Nicu or any other issues.will be thinking of you through these last few weeks.

Melissa said... [Reply to comment]

UGH! I just hate this. This is miserable. Come'on sweet baby Claire hang on. I have no experience with this myself but I am right here beside you hating every single moment of this with you.

I get profoundly frustrated when Dr's do not listen. Is it possible to have someone advocate for you, even E to just step up and say enough is enough, induce at 37. Does the hospital have a patient advocate or a patient advisor? They have them here and I used mine to get some things DRILLED through a particular stubborn doctors head.

LookItsJessica said... [Reply to comment]

Hmm-- I've never heard of your pregnancy complication and I'm so sorry you're having it! I always hated when doctors didn't take my concerns seriously. I know they deal with preggos everyday, but us moms are only pregnant a few times and small things can cause worry. I really hope your medication helps and you have some itching relief.

I had a multitude of weird pregnancy problems as well. As soon as one would resolve, another would crop up. Towards the end, I was told I had a calcified placenta. I did what you did-- goggled, researched, changed my diet, drank an antioxidant smoothie each day. My doctors were mildly concerned but I was convinced the worst would happen. It's so difficult to just wait it out knowing that if your baby was born today, they would live and do fine. I would hope and pray for my water to break late pre-term because it was better than a tragic outcome. Avery was obvi just fine and even though the last few weeks were scary, we made it. Not the same type of problems you are having but still a success story. Are you right around 34 weeks now? Will they let you go to 40 weeks or induce sooner? I hope it goes by quick quick quick!

Jessica said... [Reply to comment]

Why do doctors not trust our instincts? So glad you pushed back when you knew something was off...hopefully (please, oh please!) will turn out to be nothing. So close, yet so far! I can't wish enough that your sweet girl arrives safe and sound. And if she needs to arrive a wee bit early, my vote is for the 17th. I would love to share my birthday with Claire!

Caroline said... [Reply to comment]

No advice or words of wisdom. Just sending you and Claire all the love and hope I possibly can. Wish it wasn't so hard. xo

Molly said... [Reply to comment]

Ugh I'm sorry for more worries and complications. Hoping for the best--swift delivery and healthy baby and mom!

Renel said... [Reply to comment]

Fucking hell. You knew. Get her the fuck out and be done with this pregnancy. I was induced at 36 weeks and 6 days. I hope your dietary changes gelp. I bet you'll know if it's helping by the itch factor before the numbers actually come back. I'm glad you got meds. Sending a hug.

Mama Bear said... [Reply to comment]

I'm sorry this is so hard and scary. You are doing a great job! Each day Claire grows on the inside right now helps so try to just make it through each day and night one at a time. Lots of Benjamin snuggles, creative healthy food concoctions, breathe hope and love down into your belly (I know that sounds so lame but I really do think it helps and our babies can feel our love in utero).
Whenever you and your medical team decides Claire is better off in your arms, you will get her out safely and she will continue to grow and develop on the outside.
Sending love from Antarctica xoxo

Brie said... [Reply to comment]

I'm so sorry you're having to go through this. One of my friends had severe itching (not sure what it was diagnosed as) but she too had blood tests done, and was delivering her daughter by c section the same day her results came back. I can contact her and ask her what it was if you'd like to know.

Are you seeing the same OB that you did with the boys? Any compassion there?

I understand your fears and wish I could take them all away or at least be able to guarantee Claire's birth will be a happy day. Fingers crossed for these last few weeks.

Maggie's Mom said... [Reply to comment]

I'm so sorry that you're having this additional stress - it really seems so unfair. Will be praying for you and Claire.

Unexpected Delays said... [Reply to comment]

Oh Brandy... I cannot even imagine. My thoughts are with you and baby Claire every day. How early will they allow her to come?

RyAnne Carr said... [Reply to comment]

How scary. I would keep pushing the doctors. Abigail was induced at 36 weeks 5 days and came out fine. Im a fan of getting them out instead of leaving them in considering our losses. Just hang on a few more weeks. It makes me so mad that you have to "fight" to have your mom intuition heard, especially considering everything you have been through. Praying for you and Claire.

Darcey said... [Reply to comment]

Oh Claire...just a little bit longer. Now I get the IG post from earlier.

It just can't be easy can it?? So glad you are pushing tests to make sure everything is being done close momma and I know that is what makes it that much harder...gah!!

ekiwi said... [Reply to comment]

My brother in law's, best friend's, wife had this. She went in for a check at 37 weeks and mentioned the itching palms and feet and was induced that same day. Their son was a healthy 7 pounder. Sending up many prayers and positive thoughts for you and wee Claire.