Hello everyone!
I can’t believe that we’re down to single-digit weeks until I’m full-term, and while we still don’t have an exact date for delivery, every day is one day closer to us meeting our Littlest! I started writing this e-mail late last week but was in such a discouraged mindset, I knew it wouldn’t be worth reading so I put it off. I’m still not feeling up to my usually-at-peace self, but I figured procrastination just makes things fuzzier for my brain to remember. 😉
We had two really interesting Dr. appointments this last Wednesday, and are feeling really confident in the care and direction we’re being given.
Our first appointment was with Dr. Thomas, my high-risk OB. When I got there and got into the exam room, I could tell my heart was going pretty fast, but I had been experiencing quite a bit of the racing heart for a week or so previous, and got lots of “experience confirmation” from friends/family that they too experienced episodes of that while pregnant, so I wasn’t really worried, more in “FYI” mode. However, my heart was going 133 bpm and my blood pressure was 88/56, that caused some concern for the Dr.
He basically said he’s concerned that while I am getting almost normal levels of fluid and food by mouth, my body isn’t able to handle the stress the third-trimester growth Littlest is putting on it, and he is concerned I’m suffering from low blood volume. I’m still losing weight, though not as drastically as I was before. My glucose tolerance test came back normal, my iron levels are slightly low but nothing really bad (not anemic, just enough that if I can keep down the supplements, they’ll hopefully help), so he wanted to put me back on a liter of IV fluids a day, along with vitamin/mineral infusions every Monday, Wednesday and Friday. I am currently on my second bag of vitamins today, we’ll see if I start to see a difference once the third bag goes in on Wednesday.
He still doesn’t feel like I’ll make it to 37 weeks, he says most of his babies with congenital birth defects come early, and he is waiting on the Perinatologist (Dr. Woods) who is checking Littlest’s growth etc. to give him the “go” for scheduling my delivery. If I go into labor, I’m not sure what would happen, but I’m guessing they’d either try to stop it until a certain point in the pregnancy, but after that point (whenever it is), they’d just go ahead and deliver by Cesarean. I’m very much a no-go for “natural” delivery.
After Dr. Thomas, we had our 30.5 week ultrasound at Dr. Woods’ office, and got some really good news as well as some really GREAT pictures!
Littlest is measuring slightly small for his gestational age, which is normal and not at all a concern. He’s about 3 lbs. right now, and everything is looking good. The best news was that there is now NO fluid on his brain, he has a large head but nothing that would cause them to deliver any earlier than 10 days before his due-date at this point.
We had such a fun time seeing his face, hair, eyelashes, eyelids opening and shutting, his yawning and what our tech called “his biceps.” He is like his brother, and has quite developed upper arms already. (That was something our u/s techs saw with Oldest, very pronounced arms!) We did also see a little bit of a “pillow” of spinal fluid at the spine malformation site, this was interesting because we have NEVER seen anything behind his spinal malformation.
I don’t know if I had explained what Dr. Woods thought his back was like, but they normally see a sac of fluid behind the spinal malformation. Mac’s spine has had NO sac or bulge of spinal fluid until last week. The sac they normally see is called a cyst, and is full of spinal fluid and the spinal cord/nerves that result from the spine not forming correctly.
There is a myelomeningocele, which has the nerve roots/spinal cord in it, and the more rare meningocele, which just has the fluid and no spinal cord etc. The ultrasound would look something like the following image links, and the cerebellum malformation would NOT be present in a meningocele (where there is no cord/nerve pulled into the cyst).
Here is what an ultrasound of a myelomeningocele usually looks like:
http://download.imaging.consult.com/ic/images/S1933033208705019/mmc8-midi.jpg
Here is an illustration of a myelomeningocele: http://www.sths.com/adm/graphics/images/en/13984.jpg
If baby’s brain can’t cycle all the fluid back down into the back/abdomen for reabsorption into the body, you get more fluid on the brain. If there is a leak in the cyst, or there is no covering, the fluid on the brain is much, much less in-utero but is harder for the body to manage after the closure surgery, since it hasn’t had to cycle the fluid back down at all. Littlest’s case is unique (and rare, I can’t find much mention of it at all, and although I’ve seen one image, I can’t find it now and it was very disturbing), in and that he has no membrane covering his opening, and so has not had a “closed cycle” and therefore, the upper parts of his brain have been able to develop normally without the build up of fluid associated with a malformed cerebellum (lower part of the brain). However, this is also bad because it is much more at-risk for infection or at least introduction of foreign substances at birth/delivery/before surgery.
So, back to the Dr. appointment.
The pillow we saw could be a membrane forming to cover his back, which would be good because it would protect his brain and spinal cord from infection. It could also start a closed cycle which could possibly introduce fluid onto his brain now, we just have to keep an eye on it via the serial ultrasounds I’m having. The best, most sterile place for him to be is inside me right now, and since his head looks SO great, Dr. W told us on Wednesday that she wouldn’t schedule his delivery any sooner than 10 days before his due date. This would make the earliest scheduled date May 13, barring any complications that arose between now and then, whether with his development or me going into labor early.
Prayer for us would be appreciated on the following things:

• That Littlest’s head would continue to do well, that there would be no development of hydrocephalus.
• That my body would rise to the challenge of the third trimester, and that Littlest’s growth would continue as it has, without my body throwing any curveballs.
• Pray that I would stop having so many contractions, because of how my previous labors have gone, I know that if these were to switch from false labor into the real thing, there is a very short window of time for my body to let people know that it’s going to deliver.
• Praise that I’m able to eat and drink more like a normal person, and pray that I would start to be able to digest foods that will help my body build good quality blood.
• Pray that Littlest’s back would be protected, both during the last few weeks of pregnancy, and especially during delivery/surgery.
• Pray that we would have wisdom in dealing with the questions that are looming over us once he is born. Due to the uniqueness of his malformation(s), we may have to decide to place a shunt at the initial closing site, or we may decide to wait, and we don’t want to put a superfluous shunt in, nor do we want him to develop brain damage if he gets too much fluid on his brain.
• Pray that as I look at the last few weeks of pregnancy and am struggling with discouragement that my body isn’t doing what I want it to do, I would have peace knowing that God is in control and HE has a plan for how I’m supposed to spend the last few weeks of pregnancy, and to give my own ideals over to Him.

I hope this isn’t too confusing. If you have any questions, please feel free to ask them, I’m very happy to discuss our Littlest!