Category: IUGR

  • An IUGR Delivery

    An IUGR Delivery

    “Well if the baby’s as small as they say, labour will be a breeze.”

    File that under more comments not to say to someone navigating their way through an IUGR diagnosis. 

    15 months before I went into labour with N, I had delivered Y.

    That was a twenty-six hour production. And I didn’t even know I was in labour! I got to the hospital for a regular OB appointment and the receptionist kindly pointed out that the sharp stabbing pains I kept having at regular intervals, were actually contractions. Who knew?

    Not the case this time around.

    I ended the last post, 3 hours away from the end of Shavuos and on my way to the hospital.

    I have at times been called stubborn, I’ll admit it. And most of those times, maybe I was being stubborn… But I was so determined to make it to the end of Chag that no one was going to tell me I was in labour. I had seen the OB and had a full scan Friday afternoon, hours before lighting and all was well – or as “well” as it could have been, given the diagnosis of IUGR. Baby was still deemed better in than out. I don’t know what it was about Shavuos. I was well aware that I was allowed to make my way to the hospital, regardless of the fact that it was a holiday. I just felt like we had run there so many times, that so much had been thrown into chaos since our diagnosis, that all I wanted was a quiet, drama free yuntif.

    Alas, baby did not agree.

    We arrived at the hospital and M and I were totally ready for another 26 hour drawn out experience. Honestly, the contractions weren’t bad at all, and I was fully capable of walking around and talking, but I just knew something was going on and I knew I had to go in. 

    We were admitted pretty quickly, and apart from declining filling out the questionnaire on our triage experience, it wasn’t as complicated as I thought it would be, given that it was Shavuos. 

    We got into the delivery room and got comfortable. I walked around and we laughed and wondered if we’d actually be having the baby today. After having to prepare so many times, and having one false go, we just weren’t sure. 

    But I had made it. And not just to 37 weeks, but to 37 weeks ONE day! If labour stopped again, I knew that the OB was planning the induction for that week anyway, so I was as calm as I could have been. I had read about so many women making it to 25 weeks, or 30 or 32. I knew it was a big deal that we had made it to over 37 although I was still terrified that we may have pushed the baby too far.

    And then the nurse walked in. She explained, that if the baby was under 2000g it would be taken to the NICU immediately. I asked what the last estimate was from our most recent ultrasound, but the information was unavailable. I did the math. 2000g… That’s over 4 pounds. Obviously, now at “full-term,” my baby was going to be at least 4lbs… Right?

    The next hour or so was pretty peaceful. The contractions were completely manageable. I was informed that the anesthesiologist would be heading into a complicated c-section shortly and if I wanted an epidural my window was closing. I wasn’t in pain but figured better safe than sorry. I was at about 6cm with regular contractions. The anesthesiologist came in and asked if I was in to be induced today. She was shocked when she found out how far I was, given how little discomfort I was in.

    Ha.

    So I got the “walking epidural” and got into bed to rest for a bit.

    Ha.

    My total active labour was 22 minutes. The epidural never had a chance. Truthfully I never clicked the button because I thought I had all the time in the world, because…

    Y = 26 HOURS

    N = 22 MINUTES

    Out of nowhere I had a contraction that seriously had me convinced I was dying. Within seconds I was screaming that I was about to deliver. Everyone assumed it was just hitting me that I was in labour. My OB was actually on-call and he had just checked on me and let me know it would be a couple of hours still. When the nurse called him asking him to come back in, he was reluctant.

    He barely made it. 

    In 22 minutes and with four pushes, and the most vividly excruciating pain I’ve ever experienced, I went from laughing and walking around to silence in the room.

    The cord was wrapped around our baby’s neck twice. And they were all staring at him.

    M told me that it was a boy, but I wanted to know what else was going on. 

    And then they passed him to me and I knew.

    IUGR was in my arms.

    Growth restriction, my restricted baby, was in my arms.

    I held him as tightly as I could because I did not want him to be weighed. I didn’t want that number to enter the room and ruin the moment. 

    My beautiful baby. I could see the strength in his eyes, but there was no mistaking the struggle in his size.

    He fit in my hands. Not my arms, but my hands.

    And the nurse, with the most understanding and compassionate eyes, held out her hands and I passed him over to her. 

    And a minute later the number entered the room.

    1774g.

    I had given birth to a full-term, 3lb 14oz baby. 

    You just don’t know what a 3lb baby will look like until you’ve held one. I’ve had people say, that so and so was so tiny, when now I was realizing, they were basically double my baby.

    1774g. A number I will never forget. 

    And with that number, my beautiful baby boy, who I had held for far too shortly, was on his way to the NICU.

    I begged M to go with him and insisted I would be fine. The second he was rushed out and the door closed I cried.

    And cried. And cried.

    The nurse, our incredible, incredible nurse held me. 

    I asked if my baby was going to be okay and she told me that I had to make sure I was so that I could be there for him.

    She stayed with me until I was transferred to a room. She brought me to my room and settled me in. She was there during one of my most difficult hours. 

    And then she left.

    I had to stay in recovery for at least an hour. The second the hour mark hit, I pushed that nurse button repeatedly. Finally someone came and within two hours of giving birth, I was up and on my way to the NICU.

    And then the epidural finally kicked in. Because, obviously right?

    So into the wheel chair I went. NOTHING was keeping me away from my baby for another second.

    And with that, physically numb but emotionally raw, I received my welcome to the NICU.

    IUG…What?
    Part 2: An IUGR Pregnancy
    Part 3: An IUGR Delivery
    Part 4: IUGR and the NICU
    Part 5: IUGR 9 Months Later

    Originally posted on http://www.itsybitsybalebusta.com
    03/2016



  • An IUGR Pregnancy

    An IUGR Pregnancy

    There are a lot of fancy and scary definitions out there, but let me just lay it out for you:

    The baby isn’t growing at a healthy pace. It’s small, too small. It’s not getting the nutrients it needs, it often isn’t getting the oxygen or blood flow that it needs. It’s restricted in all sense of the word.

    I personally feel, “uncertainty,” best defines an IUGR pregnancy. No one was ever sure about anything. From why growth had stalled to what to do about it.

    After the diagnosis, I was very closely monitored. Twice-a-week I was sent for a biophysical profile ultrasounds and dopplers and every second week they’d add on an anatomical one. You know the long ultrasound you get at 20 weeks? Yeah, every two weeks. After each ultrasound I’d walk down the hallway to my OB’s office and wait for his decision. 

    Let me explain. Every time we went to the hospital for these ultrasounds, we went with the knowledge that our baby could be born that day. That means twice-a-week I grabbed my hospital bag and baby’s, made sure my parents were aware so they could come and pick up our toddler, M had to let work know that the baby may be coming today so he may not be in tomorrow and I had to mentally prepare myself that today could be the day this baby came into the world. Over a month early.

    Twice a week.

    So, I’d go through the ultrasound, beg the technician to tell me if there was any growth, anything promising whatsoever and then walk down that hallway to await the decision.

    So many times I saw the struggle painted on my OB’s face. The flow is looking okay, not great but okay. There’s no significant growth from 72 hours ago. MCA, dopplers, cord flow – all of these were terms I had learned and terms, whose numbers that day, were determining factors in our story.

    And it always ended the same way.

    “Let’s wait.”

    So we’d get back in the car, call everyone and let them know that baby was staying in a little longer (at least another 72 hours) and we’d try to calm down from the adrenaline and go home.

    After taking off so many days, M couldn’t make it to one appointment so my Mom came with me. I remember her asking why all this talk of induction and why they couldn’t just wait and let the baby come naturally.

    In all the chaos I had never thought to ask.

    And that’s when the OB we saw that day explained why. Because IUGR babies have a difficult time handling labour. That the rate of still birth was higher (for many reasons, from the condition not being detected, from the baby not being delivered soon enough or from stress during delivery, which is why they had decided on a c-section etc).

    This new knowledge plagued me. Now I didn’t know if I wanted to insist on them delivering our baby immediately or if every day we waited, maybe the baby would grow. If we could just make it to 37 weeks, outside of the “premature” time frame it could mean one less fight for our baby. But could the baby make it in there, not growing? Not thriving?

    Susanne Remic said it best. “From the moment you’re told your baby is not growing well, you feel a little like a ticking time bomb.” 

    I’d stare at the OB’s face every appointment as he contemplated the facts before him. The confusion and struggle was clear as day. It wasn’t until that appointment that I understood this was essentially a life or death decision. What was better, an IUGR 32-weeker or an IUGR baby left in-utero until 37 weeks, potentially not getting what it needed? 

    I’d ask what I could do. “Take it easy and keep eating and come in the second you feel something isn’t right.”

    I never wanted to leave. What if I missed something that wasn’t right. The kicks were never strong to begin with, I rarely felt movement. I had enough guilt that my body wasn’t helping my baby to grow sufficiently that the added responsibility of being sent home for 72 hours at a time was overwhelming. 

    The goal was 37 weeks. If we could just get to 37 weeks we’d be out of the premature time frame. At 36 weeks I went into labour. It was like my body just wouldn’t get on the same page. Induction had been pushed off to 37 weeks but baby was having none of that, apparently.

    We headed to the hospital where a nurse, unfamiliar with the situation, excitedly informed us, “you’ll be having a baby tonight!” M and I tried to make the most of our first outing since the birth of Y, 15 months earlier, and tried to laugh through the craziness. 13 hours later contractions significantly slowed down and after even more ultrasounds, I was sent home and told not to go too far since delivery was imminent. 

    I spent that week like the ones before. Two doctor’s appointments, more BPPs and dopplers. More waiting. More worrying. 

    I made Shavuos, (which happened to be a 3-day-Chag) and headed into the holiday hoping for rest, quiet and minimal drama. 

    At 37 weeks 1 day, 3 hours before Shavous was over, I was on my way to the hospital.

    IUG…What?
    Part 2: An IUGR Pregnancy
    Part 3: An IUGR Delivery
    Part 4: IUGR and the NICU
    Part 5: IUGR 9 Months Later


    Originally posted on http://www.itsybitsybalebusta.com
    03/2016



  • IUG… what?

    IUG… what?

    A year ago, I had no idea that IUGR Awareness Day coming up, on March 13th, was a thing.

    A year ago, I had no idea IUGR was a thing.

    Intrauterine Growth Restriction.

    Three words that changed my pregnancy, my delivery and my life. 

    Forgive me if that sounds dramatic, but it’s the truth.

    I don’t know how to share what IUGR has meant to our family. I don’t know how to put into words the fear, uncertainty, chaos and isolation that comes along with it. But I do know that if there was someone out there that could have reached out and understood that my baby wasn’t going to be little just because I am, then I wouldn’t have felt so alone. That just because I’m all of 4′ 11″ a 3lb baby wasn’t something I should have just expected. I actually had an ultrasound technician tell me, “In my country we say big dog, big puppy; little dog, little puppy.” 

    Yeah.

    So here it is. Here’s the series I would have wanted to read. And if someone out there, going through this diagnosis, this uncertainty, right now could, at the very least, not feel alone and at best, feel comforted, then it’s worth putting it all out there…

    At 30 weeks pregnant with my second baby, I went for a routine ultrasound. Our hospital policy includes a late pregnancy ultrasound, and thank Gd it did. I knew right away that something wasn’t right. I saw the look of confusion on the technician’s face. Four times I answered what my due date and LMP was but she just didn’t seem satisfied with it. I smiled at our little moving bundle on the screen, wiped up the gel and walked over to my OB down the hall for my appointment.

    That’s where he told me that our baby was measuring small. And not just small but “too small”. For 26 years I had dealt with being called small, short etc. But this time no one was laughing it off. This time words like “induction,” “at high risk,” “closely monitor,” “low birth weight,” were being thrown around. Something was wrong and it wasn’t even something that people could understand. 

    I would say, “They’re concerned, the baby is measuring too small.” 

    Everyone else would say, “Well look at you!” or “Ultrasounds aren’t accurate!” or “I bet it’s going to be 8lbs!”

    People would ask how far along I was, and when I’d respond they’d look shocked and tell me how lucky I was to be so small.

    Never in my life, have I hated being told that more. 

    All I wanted was to be big. I wanted that jump, that huge weight gain which would mean my baby was growing, was thriving and was getting bigger. 

    Instead I stayed small. 

    I left that appointment feeling a horrible combination of confusion and guilt. I had already been doing everything I possibly could to have a healthy pregnancy. I had cut out fried eggs, deli, caffeine, anything even semi-questionable. I was eating as healthy as possible. I was chasing a 14-month-old and going for walks and keeping active. I never missed a doctor’s appointment, and I rested as much as I was able to.

    So why had my body stopped helping the baby? Why wasn’t it growing?

    You get pregnant, you get bigger, the baby grows, you deliver.

    Why was my story stalling on the second part?

    After being “small,” for 26 years, why couldn’t just this once, I move passed that? 

    I went home, cried and waited for our next doctor’s appointment the following week.

    Next, I’ll share what an IUGR pregnancy looks like. 

    IUG…What?
    Part 2: An IUGR Pregnancy
    Part 3: An IUGR Delivery
    Part 4: IUGR and the NICU
    Part 5: IUGR 9 Months Later


    Originally posted on http://www.itsybitsybalebusta.com
    03. 08. 2016