Wednesday, April 29, 2009

The other shoe

While neglecting this blog the last couple weeks, what we haven't been writing about is how this pregnancy has now shifted from extremely healthy and extremely low-risk (although not necessarily easy, see the nose incident and that persistent morning sickness) to a moderately risky one necessitating pretty vigorous medical management. Great. We all know how much I love doctors.

The short story is that over about the last two weeks we've determined that I have developed a not-so-common (but not necessarily so uncommon) liver problem specific to pregnancy, with relatively conclusive labs coming back yesterday morning. I'm not going to name it, because expectant parents read here and you have enough to worry about; you don't a new tempting scary link. I promise, if you really need it, you can find out more than you ever wanted to know starting with the info here, but really, don't look it up unless you have good cause.

In addition to the most insane skin itching I've ever felt in my entire life, which was our tipoff that something was really wrong, this condition comes with substantial increases in scary stuff like pre-term labor, stillbirth, fetal distress and some other stuff. As near as we can tell, the real risk is to the baby, while the risk on my end is primarily completely losing my mind due to being up all night itching and itching and itching. The risks to the baby are minimized (to the point of being nearly eliminated) with medication, sufficient monitoring to make sure things are OK in there, and most effectively, early delivery at about 37 weeks.

Especially given that we've been earnestly planning our home birth, encouraged in our plans by that super-healthy pregnancy I was having, this is extremely unwelcome news. I'm at 34 weeks now. We will most likely have a baby in 3 weeks if not sooner. We had thought we were on more like the 6 to 8 weeks schedule, especially since for first pregnancies, the babies like to come a little late.

Obviously there are plenty of worse late-term complications out there. Even though moderately risky and unpleasant, this one doesn't seem to represent a huge hazard to the baby as long as we do what we need to do. I get that. I really do. But I'm still not happy about it.

We do at least now get some payoff for my putting up with those pesky back-up OB appointments. I was able to get labs through quickly without having to futz around to find a doctor willing to take me this late in the game, and even though I have a general distrust of doctors (oh, except my father, sorry Dad), for a host of reasons, some good and some not, I do at least like this OB, and count her among the "good ones." She was willing to be unofficial back-up for my midwife at a time when that is really not at all politically expedient in this area. She also seems to have a good grasp of what actually is and isn't evidence based in obstetrics. At my appointment this morning, she was extremely reassuring and is handling the transfer of care appropriately and respectfully. I feel like we're in good hands, even if it's not where we want to be.

We had been considering switching from this local back-up hospital to one a long drive south with a better c-section rate, but with our midwife's encouragement, we'll be staying with the local hospital, not only for continuity of care and to avoid the stress of traveling so far for monitoring, but also for the safety of having the hospital close in case of pre-term labor. Our midwife will also be continuing to work with us, but now in a labor support role. We trust her. She's been smart about all of this, encouraging testing at the right time and supporting appropriate transfer of care to a more medical approach. We'll be glad to have her there.

I suppose now we have to figure out what to do with those nice boxes of birth supplies out on our porch. Does anyone need a lot of chux, vinyl table cloths or drinking straws?


giggleblue said...

i'm so very sorry to hear about your condition and any anger or disappointment you feel in association with it is completely okay! it sucks to have a plan of labor and delivery and to find that it doesn't exactly turn out that way. mourning the loss of that is acceptable.

it seems like you have a firm understanding that medical intervention is needed in situations like these, however that fact alone still doesn't make things "better". i'm wishing you the best birthing experience possible although i know it is not what you had intended it to be.

please do keep us posted on how you are doing! sending warm wishes and thoughts to you, yours and the new baby. *hugs*

JenLF said...

Hugs to you. I'll be sending good health vibes to you from across the river, and keeping you in my thoughts and prayers.

Anonymous said...

Oh Lyn, I'm sorry. I know how important your birth plan was to you, and I'm sorry that it's changing. I'm glad that you have lots of time to prepare and vision a healthy (if entirely different) delivery.

Wishing you lots of health, not so much itching, and a good three weeks for prep. As to the Chux, make sure to keep plenty for after delivery. M swore by them, especially for nighttime milk leaks.

Anonymous said...

I'm so sorry to hear that you all are dealing with this! We will keep you in our thoughts and prayers - prayers for much less itching, an easy delivery, and most importantly, a healthy baby and Mama.
- Carla, Josh, and Frieda

Anonymous said...

I'm sorry that you're going to have such a different birth than you imagined, but I'm so relieved that the potential dangers are mitigated by medication and monitoring. Good luck navigating the new doctors and plan. I hope that everything stays as uneventful as possible and you and the baby stay in good health.

Heather T said...

What a bummer to get this news so late in the game and then have to adjust to a new plan!

I'm at 22 weeks now and have known long before even trying to get pregnant that I would need to deliver at 37 weeks by c-section. We've accepted it and we have wonderful OBs to work with (I'm somewhat allergic to doctors too), but it still seems like we keep entertaining every thought of how we could change the situation. Maybe we can wait until 38 or 39 weeks, or maybe everything will suddenly look different in the last few weeks, or...and on and on it goes.

Stay healthy and upbeat and it will all add up to something wonderful very soon!

Unknown said...

i'm sorry about the complications and the big change in birthing plans.

chux are fantastic for diaper changes on the go.

Lyn said...

Thanks for the kind words. Do keep us in your prayers (Jen, Josh, Carla -- Misheberach mentions appreciated if you make it to services). Mostly we're adjusting and shifting into our patented team approach to taking on the world when faced with a problem. But we're also both extremely distracted and kind of stupid. Work? Yeah...not so much.

Anonymous said...

i'm sorry you're dealing with all this! as you said, of course the most important thing is that you and the baby are healthy and you minimize the risks. but it's a real loss, making major changes to your birth plan.

so glad this got diagnosed and you can deal with it proactively!

Anonymous said...

I am sorry the other shoe dropped and that you are having to make such different decisions then you orginally planned. I have been reading you guys for a while (although I think this is my first comment) and although I don't know you I do feel you guys must be dealing with this really really well. I am hoping you have a really safe delivery and a healthy baby. - L

Unknown said...

I saw the link from FB -- haven't been to your blog before although I know you both. I do have a friend who had the liver-itching-needing to induce early pregnancy (which ended maybe at 32 weeks when she couldn't take the itching anymore -- she'd been in the hospital for 2 weeks then, and on medical marijuana beforehand. . .) Her daughter is 14 or 15 months old now and she is in Boston (and she and her husband are both doctors), and I am happy to hook you up with her if that would be helpful.

Lyn said...

Welcome Talya! Your friend's situation sounds horrible. Fortunately my itching waited until well into third trimester to start, and has been somewhat eased with medication (though sleep is still hard to come by).

Anonymous said...

I heven't been following along as closely as usual and so I am late to the game here. I just want to say I am sorry you have to deal with this scare and ubrupt change of plans but I am glad to hear that with the exception of the pre term birth, all should be well for both you and baby. Best wishes for your new and exciting plans. I am sure all will go well.