In the mind of a 2 1/2 year old

My 2 1/2 year old is crazy.  And not always in a good way.  We've been having an extremely difficult time lately with boundaries, discipline, expectations, communication, etc.  And I've heard that a lot of this is normal 2-3 year old behavior.  But woah.  There are days when I just feel like I can't take another moment of his screaming or defiance.  Just earlier this week he had his first incident at school where his defiance landed him in the director's office because his teacher couldn't get through to him.  Oh yes.  It's a fun time.  :)

But he's 2 1/2.  He's VERY particular about how he wants things done.  He's smarter than I ever imagined a child his age could be.  And he's testing what he can get away with.  I remind myself 5,000 times a day - this is normal, this is normal, this is normal.  He will not act this way forever, he will not act this way forever, he will not act this way forever.

And then for every insane, crazy, difficult moment we have, we have moments of sheer joy - when I see what a kind and gentle little boy he really can be, and I wonder how a child could be so wonderful.

(Yes, it's a great big roller coaster.)

We haven't told him much about the baby at all.  We certainly told him nothing during the first trimester.  Explaining a baby to a child is hard enough without then worrying about un-explaining it.  And then we've brought it up here and there a couple of times since our 12 week ultrasound.  He has an 8 month old cousin "A" who he has been around several times since she was born and he ADORES her.  You have never seen anything sweeter.  He is SO gentle an SO compassionate with her.  He wants to share toys with her and hug her, and he tells us that he loves her.  So every now and then we will say, "Would you mommy and daddy to get you a friend like "A"?"  And he always says, "YES!" with so much enthusiasm.  

But last night we went further with this story than we've gone before.  We told him he has to be careful with my belly (good grief he loves to jump into my lap) because there is a baby brother inside my belly.  And one day baby brother will come out and our son will have a little friend just like "A."   

And the whole time I'm explaining this I'm feeling like I'm talking to myself and he is not going to comprehend a single solitary word.  Let me tell you something . . . don't ever underestimate the mind of an almost 3 year old.

First reaction.  "Can I touch baby brother?"  Yes.  Of course touching through my shirt did not suffice, he wanted to touch my belly.  I explained when he was touching that baby brother is safe inside right now.

Second reaction.  Runs to grab a matchbox car and jams it in my belly button and says, "It's for baby brother."  Cue pregnancy hormones and the tears started coming.  Aside from being ridiculously funny that he thought he could share one of his cars with baby brother through my belly button, how much sweeter of a reaction could you ask for from a little boy???

Third reaction.  "I want baby brother to come out now."  Hahahaha.  Oh dear.  My son barely understands the concept of tomorrow.  We tried to explain that he won't come out for a while longer - and it's going to seem like a long time.  How much he understood of that explanation, I have no idea.

And that was pretty much it for the conversation last night.  And you never know how much they might remember or forget either.  But I will say again, never underestimate the mind of an almost 3 year old.

We were getting ready for school this morning, and as I was getting dressed he came running up to my belly and yelled, "Hi baby brother!"  And then proceeded to ask me if I could take baby brother out.  LOL.  

It's going to be an interesting several months watching him work through what little understanding we could possibly expect him to have of what's really about to happen to his only-child life.  And an even more interesting transition once baby brother arrives.  (I told my husband last night that I predict baby brother will be here for about 45 minutes before our son asks if we can put him back!)

But one thing I know for sure, our son is going to make one amazingly awesome big brother!  :)

Our BOY looks great!

Where do I even begin?

I would try to explain my anxiety leading up to today's appointment, but I think I'd rather show you my anxiety. Azumio is a company that has several cool iPhone apps. One that can read your heart rate, one that assesses the quality of your sleep, and one that claims to measure stress. The heart rate and sleep apps are very cool and for the most part I've found them surprisingly accurate. The stress app is fun, but I don't know how scientific it is . . . My stress level seems to always fall in the medium range (30ish to 50ish percent). What are the odds my stress level is always in the same range? Well as my appointment was running a few minutes late and I felt more and more sick, I thought I'd check my stress level for a way to pass a few minutes:



My highest reading ever prior to this was 48%!!!

Luckily my appointment started shortly thereafter.

I learned that my second AFP level was 2.8 MoM - worse than the first reading.  We had a very long ultrasound (it lasted almost an hour) and the technician was very thorough.  We had to stop a couple of times, take a break, have me roll over, move around, etc because baby boy was not exactly wanting to cooperate with all the spine shots that the technician needed.  But he finally obliged and she got all the measurements for both the standard anatomy scan and the scan for the elevated AFP.

And yes, it's a he.  Obviously and clearly, a he.

To get right to the point, his brain and spine look PERFECT.  As does everything else for that matter, with the exception of his left kidney, which has a little bit of extra fluid on it.  Not only did they tell us that it's nothing to worry about, but we went through this EXACT same thing with our son (even the same kidney), and know first hand that it's really not a problem.

A couple of other important notes.  My cervix - which I had been worried about because of the extremely low pain I've been having . . . 4cm and closed - EXCELLENT.  My placenta - so ridiculously anterior that it's hard to believe a random biological event would be that perfect centered in the front . . . but it's already moved up from my 12 week appointment and is not anywhere remotely near my cervix at this point.  Fluid levels are normal.

Size.  Hahahahahaha.  Hahahahahaha.  Oh lucky me.  Everything, and I mean everything is measuring ahead by almost a week.  From the skull to the femur.  And a 19 week fetus should weigh ~8.5 ounces and our boy is already estimated to be 10 ounces.  He seems to be following in his big brother's footsteps already!

After the ultrasound we got to meet with our MFM doctor (he didn't actually perform the ultrasound).  When we were referred to this practice, I of course did my research and found that overall it was a well liked and well trusted practice in our area.  They have two locations and doctors bounce back and forth between both locations depending on the day.  While all the doctors are well liked, Dr. K. is who you want to see.  He's the most senior, and general considered *the* MFM guy.  I was freakin ecstatic when I heard he was the doctor there today.  I was THRILLED.  He reviewed my chart - both the test results sent over by my midwives and the ultrasound images and said he absolutely rules out any neural tube defects with the baby.  The absolute only problem he sees is the kidney issue that the tech had already told us about.  He made us swear that we understood it was really a non-issue (he was relieved we've been through it before, so he didn't have to sell that point).  BUT . . . big BUT . . .

My MoM levels did rise fairly significantly considering there was only 1 week between blood draws.  And remember, those aren't absolute levels - those are levels relative to the median adjusted for gestational age.  So at 16w6d my levels were 2.56x higher than you would expect them to be and at 17w6d my levels were 2.8x higher than you would expect them to be.  So we can not rule out the possibility of placenta problems.  Dr. K. highlighted everything I really already knew . . . The possibility of pre-term labor.  The possibility of IUGR.  The possibility of placental abruption.  But he was also very pointed with his words.  He said, "You are parents.  You are hearing 'pre-term labor' and 'IUGR' and 'placental abruption.'  The word I want you to focus on is 'possibility.'  You may very likely experience none of these things."  But they will be monitored starting in the third trimester with detailed ultrasounds by his staff.  So we scheduled our first one in October when I will be 26 weeks.

Needless to say, the appointment was a HUGE PHENOMENAL success.  Better than we could have ever hoped.  And for whatever brief moments of "oh, we won't get to parent a little girl" we may have had, we are both super excited and actually downright thrilled to fill out our family with another little boy.

And if you made it this far, here are some pictures of our little healthy man.

People always commented on how perfectly symmetrical my son's "softball" head was when he was a bald baby.  Looks like little brother will be no different:



And I'm not actually a fan of 3D ultrasounds, but with the elevated risk concerns, they did do several 3D images and measurements.  (And yes, I did block out his boy parts out of this picture.  Even fetuses deserve a little privacy.)



And one final note.  We finally told big brother about all of this tonight.  I'll share that story tomorrow.  But I teared up on more than one occasion.  For as difficult as our 2 1/2 year old can be sometimes, he has moments when I truly can't imagine a more perfect child on the planet.  :)

Thank you so much for all your thoughts and prayers over the last week.  I can not begin to tell you what it means to me, and I can happily sign off tonight saying I actually feel like we might get to bring this little guy home in January.

There will be an update tomorrow

Just an FYI. I know some people got worried when I didn't get an update up from our last ultrasound quickly. This will probably go down a lot like that one did. Afternoon appointment. Pick the toddler up from school. Dinner. Family time. Toddler bedtime. Call family to relay news. Blog. But I promise I won't leave people hanging until Friday.

Also, if I took a picture of my belly right now after a big dinner and 3 (yes 3) cupcakes, you'd think I was 30 weeks pregnant. I saw myself in the mirror and did a double-take. LOL. Don't judge on the cupcakes please, what I really want is wine.

19 Weeks (a day early)

I'm not 19 weeks until tomorrow, but tomorrow is a big day and I want to make a fairly "normal" 19 week update.  We'll know a lot more tomorrow than we know today, and that could be either good or bad - and I'd like to at least do one more weekly update in a way that won't be impacted by whatever we learn tomorrow.

So 19 weeks.  Really darn close to half way done.  Our fruit this week is mango.  LOL.  Whatever.  When we were talking about blueberries and limes I sort of had an idea.  Now we go from onion to sweet potato to mango and in my mind, those aren't really a logical growth progression.  Anyway.  Baby should be about 6 inches long.  I'm definitely feeling him/her move a lot more now.  Still not big obvious movements, but if I'm quiet and I pay attention, it's happening a lot more frequently.  Fetal movement is a wonderful WONDERFUL thing.

I've gained 4 pounds since my last freak out about weight, so in total I'm up 7.  Not bad at all.  (But don't expect these weight updates to continue when I inevitably blow up and gain 20 pounds in a week.)  And my stomach, while still not protruding too much, is starting to fill out and get a bit rounder.  When I'm lazy and slouching, I actually think I look almost pregnant and not just fat.  When I stand up straight (like I do for my pictures), there still isn't much there, but at least I can see some growth since 17 weeks.

I think that's it for today.  I'm just trying to find a way to pass the time until 1:30pm tomorrow.  It's going to be a long and difficult couple of days.

Let's change the subject. Boy or Girl?

Okay, I need to lighten the mood for the next 48 hours.  I'm stressed and worried, but this pregnancy is not doomed and I need to try to stay as focused on the non-scary things as possible.

Since our focused ultrasound will now be combined with our anatomy scan, that means we should find out the sex of the baby in about 48 hours.  Based on everything we saw (er, didn't see) and the ultrasound tech's strong opinion from our 12 week ultrasound, we have thought for a while now that we may likely be having a girl.  But I'm having some mommy intuition that it's a boy.  What do old wive's tales say?

Baby's heart rate?  Girl
Maternal food cravings?  Boy
Chinese birth chart? Girl
Mayan conception calculator? Boy
First trimester sickness?  Girl
Maternal complexion? Boy

Surprise - they seem to split about 50/50?!?!?!  (Which is no surprise at all, if you are like me and don't believe in any of these things at all.)

Do I have a preference?  I won't lie.  I would love to have a little girl.  This will be our last child and I always imagined having a family with at least one boy and one girl (there was a time in my life when pregnancy wasn't such a horrifying event and I wanted more than 2 children).  I want to experience the joys of parenting both a little boy and a little girl.  And honestly, with my husband, my son, and our dog - the testosterone in this house is a little overwhelming at times . . . I need to buy a pink dress - and I don't even like pink.

Then I think about my son, and how much he is "all boy" and how much he would LOVE to have a brother to romp with, get dirty with, wrestle with, etc.  And it makes my heart want to explode with joy.

Does it really matter either way?  Heck no.  If we find out we are having a healthy girl on Thursday, tears of joy will stream down my face.  If we find out we are having a healthy boy on Thursday, tears of joy will stream down my face.

Almost everyone I know who has a feeling about this (husband, mom, sister in law, etc) all think it's a girl.  I'm going against everyone else and the 12 week ultrasound and saying boy.  I suppose we will see how good maternal instinct really is . . .

2 Days

I can wait 2 more days, right?

I have a Level 2 ultrasound scheduled with a specialist on Thursday at 1:30pm.  Because my overall anatomy scan was scheduled for next week, they are going to try to combine the 2 and get all the measurements they need, so this should be the most detailed ultrasound I've ever had.

Unfortunately, the ultrasound will likely be as stressful as the wait between now and then, because the results won't be interpreted fully until after the ultrasound is complete.

Who wants to drink some alcohol for me between now and Thursday afternoon?????????

First AFP result confirmed

Not much else to say right now. Part of me feels sick. Part of me feels numb. But at least there is no question that I need to be seen by MFM. My office faxed the referral this evening and I will call in the morning to try to get an appointment ASAP.

At some point, I just laugh . . .

Because there is nothing else to do. In the latest news, I have been bitten by another deer tick. It was successfully removed at home, and it was small enough that I'm fairly certain it had not been attached long enough to transmit Lyme Disease.

Seriously? I've been in the yard twice in the last week. My husband takes our dog out at least 4 times a day, mows the grass, does all the yard work and has never been bitten by a tick in the 10 years he has lived here. I've lived here for 4 years, been bitten 3 times, all 3 times when pregnant.

You can't make shit like this up.

The science behind maternal AFP

I am a nerd. An over-researching knowledge-seeking math and science minded nerd.

Knowing that my AFP is elevated and that elevates my risk for birth defects or placenta problems is scary. But what is AFP? What is a normal level? What exactly does all of this mean? How are neural tube defects or placenta problems indicated by this one measurement? (They don't exactly seem like related complications.)

Yes, sometimes google is a scary place to look for answers. But if you know to stick to the science and avoid the more informal sources - you can really get great information.

AFP (alpha-fetoprotein) is produced by the liver of a fetus. Its not something produced by a healthy adult liver so in non-pregnant adults, AFP should be found in trace amounts. AFP produced by the fetus is excreted into the amniotic fluid and then some of this protein crosses the placenta and is then found in the mother's blood. All pregnant women should have AFP in their blood - in fact too little AFP in maternal serum can be an indicator of Down Syndrome. The question is - why are my levels elevated? And exactly how elevated are my levels?

Let's start with that second question first. AFP levels are reported as "multiples of the median" or MoM. As gestational age and maternal weight change throughout pregnancy, AFP levels vary widely. So they are not reported as absolute values tested from maternal serum. Rather they are reported as how much they deviate from what is considered normal for a particular gestational age and maternal weight (and a few other factors including race and diabetic status). So an AFP level of 1.0 is considered "perfect" - exactly the median. An AFP of 0.5 means the mother has half as much AFP as you would expect. And an AFP of 2.0 means the mother has 2 times more AFP than you would expect. On the low end, anything below 0.5 is considered too low. On the high end, there is some controversy. Some labs use 2.0 as their cutoff. While other labs use 2.5 - stating that 2.0 increases false positives significantly without a marked increase in effectively detecting more birth defects. My lab uses 2.5. What was my level? 2.56. Severe defects are usually seen when MoM values are above 7.0 and my lab recommends a repeat draw for anyone between 2.5 and 3.5. So, in some ways, that's comforting. My level is not grossly abnormal. That being said, I'd obviously feel much MUCH better if that number was a helluva lot closer to 1.0.

So what causes elevated levels in mothers? There are 2 known causes and then there is the "it's not necessarily a problem" explanation so I'll start with that first.

This is the most common outcome. I have to keep telling myself this. Some babies make more AFP than others. Some completely healthy placentas let more of the protein cross into the mother's blood. It is not necessarily an abnormality (particularly at my level) and does not necessarily indicate a problem. These are the "false positives" with this test and 90% (YES NINETY PERCENT) of mothers with elevated AFP fall into this category.

Now let's go into the concerns with elevated AFP that apply to the remaining 10%.

1). Neural tube defects. These are defects where the baby's brain and/or spine do not close properly and part of this system remains literally open. These disorders range from things as serious as anencephaly (if you google it, don't look at pictures) to more minor cases of spina bifida and everything in between.

The opening in this system allows much higher amount of AFP to be leaked into the amniotic fluid than would normally be excreted by a baby with a closed system. More AFP in the amniotic fluid means more passes the placenta and more gets into mom's blood.

While NTDs are the most common defects associated with elevated AFP, it can be caused by any abnormal opening in the baby. So it's important to rule out other problems like an open abdominal wall.

The second concern?

2). Abnormal placenta. It is possible for the baby to be fine, for the AFP levels in the amniotic fluid to be normal, and for the levels in my blood to be elevated due to problems with the flow back and forth between the placenta. (It seems that "leaky placenta" is the jargon for this.) A placenta that is not allowing proper flow back and forth has been linked to many complicated and very serious third trimester problems. These include: intra-uterine growth restriction (IUGR), preterm labor, premature placental deterioration, placental abruption, and still birth. All of those things life threatening for the baby.

So what can be done about any of this?

1). Ultrasounds to rule out birth defects. Technology has come a LONG way. With specialized equipment, extremely trained specialist, and most recently the addition of 3D and 4D ultrasounds, I've read that ultrasounds are now almost 99% effective at identifying birth defects when using a specialist trained to look for specific problems.

2). Amniocentesis. This is a little more controversial and not used as much as it used to be for this problem. Many things can be determined from sampling the amniotic fluid. A full chromosomal analysis of the fetus can be done, but an open abdominal wall is not necessarily a chromosomal problem. So while amniocentesis can be used to definitively (100%) diagnose something like Down's Syndrome, it is not 100% in identifying all birth defects - specifically the ones we are concerned about here. The other thing amnio could tell us here is how much AFP is in the amniotic fluid. If the AFP in the fluid is elevated, that points more towards problems with the baby. If the AFP in the amniotic fluid is normal, that points towards problems with my placenta.

So what's the controversy with amnio? It requires sampling the amniotic fluid. That is insertion of an insanely long needle through my abdominal wall and uterus, and into the baby's sac to withdraw the fluid (while watching via ultrasound so as to not go too far and stick the baby). Invasive is an understatement. And it does come with an small elevated risk of miscarriage after the procedure.

Given that amnio isn't a definite answer for this problem, it carries some risks, and ultrasounds have become so amazingly advanced, amnio isn't likely something we would consider.

3). Ultrasounds and non-stress tests to monitor possible placenta problems. Let's say we are fortunate enough that ultrasounds rule out birth defects with the baby. How on Earth do you rule out problems with the placenta? Unfortunately, you don't. You just monitor them very very closely. This is done with ultrasounds and non-stress tests done frequently (every 2-3 weeks) to try to stay ahead of possible problems like growth restriction, preterm labor, etc . . . BEFORE you ever get to the concerns of placental abruption or still birth.

So that is where we are. As much as I know that my levels aren't *that* high and as much as I know that 90% of people flagged by these tests have no problems, I really don't care how this re-test comes out. I NEED the high risk consult. I need someone who knows what they are looking for to tell me that my baby and my placenta are okay and monitor them with a trained eye. I KNOW my previous losses are completely unrelated to this. But in 2 weeks we cross over from being in the miscarriage category to the stillbirth category, should something go wrong. And I can not take any chances, no matter how slim, that we could possibly be adding a late second trimester or third trimester still birth to my fucked up obstetric history.

18 weeks

No pictures this week.  Too busy and no change from last week.  Baby should be about the size of a sweet potato.  That's getting quite big when I think about it.  Not nearly the size of the watermelon I delivered in December 2009, but it's still a substantial size.

I don't really know what to say this week.  Let me give some updates on things I haven't talked about in a while.

Sickness.  95% GONE!  Yay.  If I weren't so worried about other things I'd be doing a somersault about this.  I still have moments either right after I eat or when I've gone too long without eating when I feel pretty gross, but it's been several weeks since I've wanted to hang my head in the toilet, and I am thrilled to have some relief.

Exhaustion / fatigue / insomnia.  Still really tired most of the time, but so much better.  And for the most part my insomnia seems to have gotten better too.  No complaints about this improvement either.  Although, I do at some point expect I *might* be lucky enough to have some of the more traditional 2nd trimester energy before the insomnia comes back in the 3rd trimester.  I won't push my luck though, I'm just happy to not be taking 2-3 hours to fall asleep at night and sleeping through until morning again.

Movement.  I mentioned a couple weeks ago that I thought I might have been feeling the baby move.  I'm almost certain that I am now feeling small movements sporadically throughout the day.  None are up front, which would make sense with the anterior placenta.  Most are well over to the left side and definitely remind me of my first sensations with my son.  They are still too subtle and sporadic to provide any sort of comfort about the baby's well being, but every now and then a small sensation here or there is a nice addition to my day.

Unfortunately with the developments of the last 48 hours, this week feels like a bittersweet update to me.  I'm feeling better and I'm feeling movement.  Awesome.  I also have this fear of a defect with the baby or my placenta lingering over my head, and I'm scared shitless.  As scared as I was waiting to see the heartbeat the first time.  As scared as I was going into the NT scan.  The unknowns are really overwhelming.  At a time when we really should be at one of the most exciting and stress free parts of pregnancy (if there is such a thing).  At a time when I really was getting ready to make our official pregnancy announcement to the world.  (I had just emailed the place I ordered our picture frames from on Monday to say, "Where are they?  I ordered them 5 weeks ago and I need them soon.")  At a time when I was hoping our only unknown would be whether or not my son was going to have a baby brother or a baby sister.  Instead I sit here, wanting to crawl back under my rock.  Wishing we hadn't told so many people already.  Trying to in some way mentally prepare myself for what could be devastating news.  And at the same time, trying to put one foot in front of the other and convince myself it will all be okay - because I can't even begin to process the alternative.  And all the while, trying to be a loving and patient mommy to a very "spirited" 2 1/2 year old who is testing limits constantly.

For now, I'm juggling.  I'm not good at it, but I'm managing.  What other choice do I have?

It may not be the best career move I've ever made . . .

. . . but I'm taking an hour out of one of the busiest days I've had since I can remember to go get my blood work done today.  The wait until tomorrow was at my request, because work is so busy.  My office said I could come in as soon as I have time.

So 10:45am today it is.  It still may be early next week before we get any results, but a full day delay on my part that's not necessary makes no sense.

It's never good when the doctor calls . . .

NOTE:  I considered not blogging this, because so many of you know me in real life away from the anonymous internet world.  And I don't want to talk about it outside the anonymous internet world right now.  But this is my outlet, my safe place, and I trust the people I've shared this forum with to keep things this way.  If you know me personally, let me restate - unless I bring it up with you directly, I do not want to talk about this.  I am very emotional about it right now, and I need the people I interact with every day to help me keep my sanity by acting normal.

So my midwives' office has a policy.  Abnormal test results are ALWAYS reported by phone as soon as they are available.  And normal test results are ALWAYS reported at the next standard appointment. This means 2 things.  1) Don't bother the poor nurses by calling to ask about your test results - either they are normal, or they aren't back yet.  2) If you see their number pop up on your caller ID out of the blue - freak the fuck out.

I didn't even freak out when I saw the number pop up today.  I knew exactly what they were calling for - I was 100% positive I had failed my glucose test and this was going to be a phone call to tell me I had gestational diabetes.  My heart wasn't even pounding when I answered the phone.

Yeah.  Fuck me.  Gestational diabetes is the least of my worries right now.

At my appointment last week I had the 3rd and final part of what is considered comprehensive early screening.  Blood work and an ultrasound at 12 weeks combined with additional blood work done between 16 and 18 weeks not only give you the results of your risk for trisomy disorders (that comes from the 12 week blood work), but also give you the results of your risk for neural tube defects (that comes from the 16-18 week blood work).

Turns out my alpha-fetoprotein (AFP) is elevated to a level that puts this baby at a high risk for having a neural tube defect.  I wasn't even sure I was hearing my midwife correctly.  What the fuck?  We saw the baby at 12 weeks and everything looked good.  Now you are telling me that I'm at high risk for brain and/or spinal cord defects.  I started taking notes, because my brain just wasn't processing.

Things we know right now:

1) Most importantly (and what I try to keep reminding myself):  These tests are designed to catch as many cases of problems as possible.  As a result they cast a wide net, and are known for flagging normal pregnancies as high risks.  We knew this when we opted for these tests.  (It's the difference in screening tests vs. diagnostic tests.)  It was a risk we were willing to take and now we are living with the results.  There is a very high chance of everything being okay with this baby and the elevated AFP not being a sign of anything at all.  Unfortunately, we need more testing to know for sure.

2) The most common course of action for a test result like this is to repeat the test.  FUCK me.  Another blood test and another week of waiting for results.  Results that will either say that I'm not at high risk for an NTD (and conflict with the current test) or will confirm that I am high risk (but not with any more or less certainty than what we already know).  So I go Thursday morning for this test.  It feels like an exercise in futility to me, but what do I know?

3) The results of the next blood test determine the course of action.  Which could be nothing.  Or could be a consult with a high risk specialist and a comprehensive Level 2 ultrasound.  The anatomy scan we already have scheduled for 9/6 is also a comprehensive Level 2 ultrasound, but if we are referred to a specialist for possible NTD concerns, the ultrasound would be performed and reviewed by people even more trained at how to detect these specific problems than a standard ultrasound tech.  (Although glaring severe deformities should not only be detected by ANY ultrasound technician, but would have likely also been seen at our 12 week ultrasound.)

My midwife was very reassuring.  She told me at least 5 times that these results do not mean that my baby has these problems.  Just that we need to do some more digging.  She also mentioned possible problems with the placenta causing elevated AFP - and Dr. Google confirms that while elevated AFP doesn't always indicate a NTD, it can be a predictor of placenta and growth problems that will occur later in pregnancy.  (So if it's not an NTD, I'll still have plenty to worry about . . . )

So I think no matter how my second blood test comes out, I'm going to ask for the high risk consult.  Best case scenario, this next test comes back normal and I have conflicting results to worry about.  I'm just the type of person who wants all the information when it comes to stuff like this.  And I don't think I'll find conflicting blood tests very comforting to sit on for the next 22 weeks.  Given that we don't know for sure what causes elevated AFP, I would rather err on the side of caution.  I've made it this far, and this is our last pregnancy.  I'm not leaving anything up to chance.  There are already enough things in pregnancy out of my control.

As I said to the few friends I shared this personally with tonight . . . After I passed my loss milestones and had a perfectly wonderful NT scan, my midwives referred to my pregnancy as any other low risk second trimester pregnancy.  Intense cervical pain and pressure, anterior placenta, a heart beat that couldn't be found at 17 weeks, and now increased AFP.  This is my low risk second trimester.  After my luck of having 4 consecutive 1st trimester losses.  I'm trying really hard not to play the "why me" game.  I'm trying really hard not to feel sorry for myself right now.  But this just fucking sucks.  I'm tired.  And I feel really close to emotionally breaking.  And I just get to sit and wait some more . . .

The insanity continues

I follow the blog of a fellow RPL survivor very closely.  She's been through 6 miscarriages - all either chemical pregnancies or first trimester losses.  She is currently over 30 weeks pregnant and I remember watching her blog progress through first trimester, then second trimester, and while I was breathing a sigh of relief for her, she just seemed to get more and more freaked out by various things that could go wrong.  I didn't understand . . . she had no reason to believe she would have a late(r) term loss . . . she had gotten past the most risky part in her history.  Why wasn't she enjoying that part of pregnancy?

Now, I understand.

Aside from constantly worrying if baby is growing appropriately, I have had very low intense pain and pressure for several weeks now.  I called my doctor about it once around 13 weeks and was told it was fine.  And I brought it up at my appointment again last week.  And again, with no contractions and no bleeding, I'm told it's fine.  But here's the thing - it doesn't feel fine.  At all.  I'm not even 18 weeks pregnant and I feel as much pressure on my cervix as I felt during early labor with my son.  It is painful to walk.  It should not be painful to walk when I'm not even half way through pregnancy, should it?  It doesn't feel right.  And I know the logical explanations . . . it's the ligaments stretching, I'm carrying this one lower than my son (who admittedly was VERY high), it's normal to feel more pressure earlier in second pregnancies because the muscles aren't as helpful as they used to be, it could be because my placenta is a bit low.  I know.  I know.  I know.

But I also know that this doesn't feel right.  And I just feel fucking crazy.  I don't trust my body and I don't trust my own intuition (because it's impossible to distinguish what's rational to worry about and what's irrational).

I have no history of pre-term labor or PPROM.  My cervix was barely progressing at my 38 week appointment with my son.  So why is this pressure and pain so terrifying to me?  And how do I let it go?  Or when do I say, enough is enough and I want to be seen and have my cervix checked?

I'm so tired of worrying.  And I can't stop.  And I just want to stay in bed and cry.  And this is just from the mental insanity.  The constant pain from being up and walking around isn't dong me any favors either.

:(

17 weeks

Sticking with this silly "fruit" theme, baby should be the size of an onion right now.  Maybe onions are bigger in other places in the country, but technically baby is supposed to be between 5 and 5 1/2 inches long . . . Do you have onions that big where you live?  We certainly don't!

So if you read yesterday's update, it was a stressful appointment.  Only made more stressful by a baby in such an odd position that it was almost impossible to see anything at the ultrasound.  Picture someone sitting up straight with their legs crossed on the floor, and then picture only being able to look at them straight down from the ceiling.  Literally, that's what we saw.  It took some poking and jabbing just to get an angle where we could see the heart flicker.  And that was that.

I am super anxious about our 20 week ultrasound.  And I know ALL pregnancies are different.  But seriously, I do not understand how a 5 inch baby can hide inside like this.

Here is a picture from exactly 16 weeks when I was pregnant with my son:

Here is my 17 week picture from today:

Seriously, I'm worried.  Overall, I'm a little thicker now than I was with my first pregnancy, but not by a lot.  The baby could be hiding in some of my newer "padding" - but I was never short on padding to begin with.  I know there is nothing I can do but wait.  But I really feel so incredibly stressed about something possibly being wrong in there.

And to emphasize my point.  Here is my "progression" (yeah right) so far this pregnancy . . .

I wish I could just stop worrying.  :(

A quick appointment update

What a day.

It started with the gag-inducing drink (aka glucose test). Within 15 minutes I had a headache.

Followed by my midwife not being able to find the baby's heartbeat. Yeah. You read that right. Thankfully I "only" had to wait through 5 minutes of her trying and 5 minutes getting into the ultrasound room to reveal baby is still well - and cozily tucked behind what is an extremely anterior (as centered as it gets) placenta. The placenta is also a bit low right now - so we'll be keeping a close eye on where it moves.

That was then followed by blood work with a new lab tech who was more interested in talking to me about her daycare issues than she was with trying not to gouge my vein out of my arm. (And I'm no rookie when it comes to blood work!)

And I've had a headache with somewhat distorted/blurry vision throughout the day. I definitely have sugar issues.

So despite the stress, all is still well in baby land. Anatomy scan is scheduled for 9/6.

Time for Tylenol and bed.

Weight Gain, Gestational Diabetes, Fear, & 16 Weeks (Sort Of)

There are a few thing on my mind today, and the thoughts may not flow smoothly.  So this may not be the most cohesive post I've ever pulled together.

I'll address the 16 week part first.  I missed my 16 week update last week.  Baby should be close to 5 inches long now and is supposed to hit a growth spurt in the next few weeks where he/she will double in length.  I wanted to take a "bump" picture, but with no air conditioning and a challenging week in other regards, it just didn't happen.  So that's on the agenda for 17 weeks instead.

I have an appointment Wednesday morning.  I've sort of managed to keep the anxiety away since the NT scan, but it's definitely coming back.

For starters, there is my bump - or lack thereof.  It's non-existant.  Some days I feel like I'm showing some.  But then the next day it's gone completely.  I swear that my stomach looks flatter today than it did 8 weeks ago.  And I'm still very very comfortably wearing pre-pregnancy pants.  My uterus should be about half way between my pubic bone and my belly button AND my muscles are supposed to be much more relaxed this time around since I've done this before.  Yet, my stomach is not growing.  At all.  With my son I didn't really show until well past 20 weeks, but that's common for first pregnancies.  I feel like for the size that my uterus should be and the size that this baby should be, that my pants should at least be tight.  I know that everything could be fine . . . but it makes me worry.

Then there is weigh gain.  I ended first trimester up about 3 pounds.  And now, over 4 weeks later, here I am . . . still only up by about 3 pounds.  I won't lie - I gained way too much weight with my son.  AND I'm starting this pregnancy overweight.  So a very slow and overall low weight gain for this pregnancy is healthy.  But no weight gain at all between 12 and 16 weeks also makes me nervous.

And THEN there is waiting another 4 weeks for an ultrasound.  Sigh.  On Wednesday they will check for a heartbeat, but that will only comfort me mildly.  What if the baby isn't growing appropriately?  We have no way of knowing that until our 20 week ultrasound.  (And then, after that NO more ultrasounds for the entire pregnancy?!?!?!?!?!?!)

Or God forbid . . . what if there is no heartbeat on Wednesday?  I am not prepared for that.  I just ordered some things for this baby last week.  I am ready to start buying things for a nursery.  I am not at all mentally prepared for this being over.  And I'm sort of upset that I feel like I've let my guard down.  :(

So what's this talk about gestational diabetes?  Sigh.  Well I'm being tested for that on Wednesday morning as well.  (And will be tested at least once again later.)  Normally, women are only tested once - sometime between 24 and 28 weeks.  Earlier testing is only recommended in cases with increased risk.  I did not have GD with my son.  I do not have a family history of either diabetes or GD.  And while I am overweight, my BMI is not at the level where my risk for GD would be increased.  So why the early testing?  Because my son was  a few ounces shy of 10 pounds at birth, and I had severe blood sugar issues in my pregnancy with him.  Don't quote me on these exact numbers (it's been a while), but when you take the glucose tolerance test - you drink a super sugary drink, wait 1 hour, then they test your blood sugar.  Anything between 90ish - 130ish is considered normal.  Anything over 130 could indicate diabetes (at which point they do a longer and more intense test involving fasting and blood checks over the course of 3 hours).  Anything under 70ish is considered hypoglycemia and many people start feeling a bit sick (light headed, dizzy, etc) at this point.  At levels below 50, blood sugar is dangerously low and people lose consciousness shortly after dropping below 50.

My OB who I used for my pregnancy with my son had delivered over 5,000 babies in the course of 20 years of practice.  When she gave me the results of my glucose tolerance test with my son she told me I was the lowest result she had EVER seen.  54.  Yep.  One hour after drinking sugar water, I had so little sugar in my body that I was close to losing consciousness.  In some ways this was relieving news - because no one knew why I had been having episodes of coming very close to passing out (they had tested me for anemia and found nothing, and were chalking it up to overall low blood pressure).  So at least we had some answers.  But on the other had, this was pretty scary.  My pancreas, instead of not producing enough insulin like it would in the case of diabetes, was producing enough insulin to eradicate all the sugar in my body.  And while GD is much more dangerous for mom and baby, extreme hypoglycemia has it's own risks and indicated a severe problem with how my pancreas was tolerating pregnancy.

After consulting with an endocrinologist and a nutritionist, the treatment for my problem ended up being a diet identical to a diabetic diet.  If my body was over-reacting to sugar, I needed to not eat it.  So for the last 12 weeks of pregnancy, I managed my hypoglycemia this way.  Some days were better than others.  I always felt terrible right after eating, and many times had to sit down and put my head between my legs, but never passed out.  And as soon as pregnancy was over, it went away.

So now, here we are, and because my son was so large (a side effect of GD) and because we know my pancreas was crazy last time, I'll be tested for GD this week.  I'm also already starting to notice that I feel like complete crap shortly after I eat.  So I'm thinking about getting a home glucose meter regardless of the outcome of Wednesday's test.  They aren't that expensive, and if I'm going to have sugar issues (one way or the other), I'd like to know when it's happening and try to make correlations for myself to which foods make it worse.  I'm already realizing that sugar is making things worse, so it wouldn't surprise me in the slightest to find out that I either have GD or hypoglycemia again.  FUN TIMES!

I think that's all of my rambling for now.  I need to try to stay calm between now and Wednesday.  I'll have a lot more information then . . .

Major Milestone

Aside from the fact that I *think* I may have felt the baby once or twice in the last 24 hours - I passed a HUGE milestone today.  HUGE.

I bought some things for this baby.  I still can't believe I did it.  And I'm kinda having a panic attack about it now.  I'm afraid of getting to far ahead of myself.  I'm afraid of assuming everything is going to go well for the next 5 months.  But here I am, buying stuff for a baby.  Damn internet sales.

(As for the possible movements, I'm still not sure about that yet.  I'll definitely celebrate that when I'm more certain!)

I am SO hungry.

Ugh.  It's been a week.  We had a long weekend vacation which was wonderful, but things have not gone so smoothly since getting back.  I won't whine about everything that has sucked since Monday.  I will say that the straw that broke the camel's back was our air conditioner going out yesterday morning. Two technicians have now confirmed that the compressor completely blew and we need a new unit.  Which will take several business days.  Which means we are out of A/C through the weekend.  It's 85 degrees in our house at 10:30am.  Our poor 110 pound long haired black dog looks like he is going to have a heat stroke at any minute.  If there were any hotels in a 20 mile radius of home that accepted dogs his size, I'd get a hotel just for his sake.  But there are not, so we are working with fans, open windows, and lots of cold water.

So why is this post about my hunger?

Because on top of the sweltering heat, and my crazy pregnancy hormones, I am having the most bizarre food aversions ever.  I am starving hungry.  I keep opening the pantry door, refrigerator door, freezer door and am almost in tears from the hunger pain - yet everything we have turns my stomach.

So what do I want?  OMG, if I only knew.  I want something cold.  But NOT sweet.  The thought of ice cream makes me sick.  Even fruit sounds gross to me.  Dairy is out - the thought of cheese or yogurt is also grossing me out.  Salty?  Maybe.  I think I could eat a pickle if I had one, but it doesn't sound that good and wouldn't fill me up anyway.  Sour sounds good too.  Seriously, I could consider sucking on a lemon at this point.  But what can I eat that's cold and salty or sour and filling?

Maybe Chipotle for lunch?  It's not exactly cold, but the sour cream, salsa, and lime rice might do the trick.  If I don't pass out before lunch.  I have a work meeting at 11am.  Hopefully it will end in time for me to run out, because I have an A/C sales person coming at 1pm.

But seriously.  WTF is up with this insanity at 16 weeks?  A hungry miserable pregnant woman in a blazing hot house is just a recipe for an emotional meltdown.  And/or passing out.

I have to force myself to eat something . . . even if I am not going to hold it down.  I can't take the hunger pain much longer.

Speaking of 16 weeks - that post may or may not come today.  We'll see if I find food and feel up for it later . . .

15 weeks (a couple days late)

Nothing at all to report this week. Baby should be about the size of an orange or approximately 4 inches long.

I might be starting to feel better (excluding some motion sickness a couple days ago, it's been 3 or 4 days since I've been sick). And I feel like I might be starting to "show" more. (Still all fat being displaced at this point.)

But I've jinxed myself about the sickness before and it's possible I've just been eating too much lately.

So for now, that's all I have to report. Boring week.