Perinatologist

Trenton and I got a call last week that every expectant parent fears the most.  It was my OB calling to let us know that some red flags were raised based on my most recent ultrasound that I had over 3 weeks ago, and that I was being referred to a Perinatologist.  I didn't even know what that was.  Google defines this doctor as "an obstetrical specialist concerned with the care of the mother and fetus at higher-than-normal risk for complications."  My general OB had me come in that day to explain that there was a concern for intrauterine growth restriction (IUGR).  Apparently her head was measuring a month behind, which was especially a concern because, up until now, it had been measuring as it should...Meaning, this wasn't simply a case of having an otherwise healthy, but small baby. Her growth had suddenly lagged behind.  I felt like I had been punched in the gut, and nobody could give me any information until I saw the specialist.  I tried to stay away from any kind of forum on the internet that wasn't legitimate as I researched what little information I did have.  But even the "official" websites did little to reassure me.  No matter how many books I flipped through, or websites I visited, the fact remained that my highly trained and experienced doctor was worried enough to send me to a specialist.  I felt like I couldn't breathe.

Thankfully I didn't have to wait long to see the new doctor.  Despite the ultrasound tech's attempts at distracting me by asking me which foods I've been craving and what names we were considering, I watched carefully as she measured the baby's abdomen, her femur, and finally the width and diameter of her noticeably oblong shaped head. I also noticed as the words "Still Breech" burned across the top of the screen.  What's that supposed to mean?  Still Breech? I thought doctors didn't start sharpening their knives until the baby is confirmed breech at 37 weeks, but I digress.  The "Level II" ultrasound didn't seem any different than all the others until I was taken into the perinatologist's office and noticed several different screens that revealed very detailed images of my baby's brain and other body parts.  My meeting with him was both reassuring and terrifying.  He said that there is a crescent shaped fold that should be present at 31 weeks in a normally developing fetal brain, and my baby had this fold, meaning that her brain is developing as it should.  But the baby's head was taking on an abnormal shape where it was longer from front to back and smaller from side to side.  The reassuring news is that her head circumference was measuring within the normal range.  It was the measurement from side to side that lagged so far behind that it threw off the ultrasound's measurements and revealed a head size that was 4 weeks behind.  This means her brain is still growing- the shape of her head is just a little wonky.  So that's the good news.  The bad news is that we won't know why for another couple weeks (or maybe until the baby is born).  Unfortunately in a situation like this, the comparison between ultrasounds is more telling than a single diagnostic ultrasound.  And you can't have comparison without being forced to endure a passage of time.  He did put my mind at ease (a little) by saying that a lot of 3rd trimester breech babies have this issue because their heads get lodged under the mom's rib cage (ouch) and their head is literally being squeezed as it grows.  He also said that, based on the baby's other appropriately measuring body parts, he didn't suspect IUGR.  Still there are many causes for this problem that could have very serious implications.  Some that my delicate, hormonal heart just can't explore right now.  He did say that if the next ultrasound reveals a head size that has not improved, he will take the baby (at 35 weeks), as she'd have a better chance on the outside than continuing in my, apparently hostile uterine environment.  (I wish I had a happy uterus like those women who get pregnant easily, carry to term with a few braxton hicks contractions, and barely bleed after childbirth.  But before I go down that road, I need to remember that I hardly have the energy to get dressed in the morning, let alone carry around hateful feelings toward my irritable uterus.) As if this all weren't enough to swallow, he also raised a concern with the baby's heart.  He was extremely vague about this, and dodged all my questions by simply saying, "We'll have to perform a fetal echo-cardiogram in a week."  Again, I felt a wave of guilt.  I knew that maternal heart issues do raise the fetal risk, but it's so frustrating not knowing exactly what we're dealing with.  Up until this appointment I hadn't let the thought intrude my mind, but suddenly I came to the realization, and a sort of acceptance, that there is a very real possibility something could go wrong.  When I was explaining to my dad that I have no other choice but to relinquish control of this (not that I ever really had control) and put myself and my unborn baby's life in the hands of the Lord, he said, "You'll feel so much better when you do."  I wish I were better at it.

I have a picture frame sitting next to my desk that says, "Family- forever, for always, and not matter what."  I bought the frame at a 90% off sale Hobby Lobby was having last year for $2 and always thought the saying was sweet.  It never had any deeper meaning until recently- when I realized just how important forever is and how- no matter what- Trenton and these 3 children will always be my family.  With that knowledge and foundation- what couldn't I handle?

I was going through some pictures that were loose in Emma's baby book tonight and realized there were so many of my pregnant belly.  I also noticed that I had significantly less taken during my pregnancy with Ben, and only 1 from this pregnancy so far.  That made me very sad, especially when considering that this is the last time a baby will take up residence in my stomach.   So- here I am at 32 weeks.  I'm going to try and take a picture of the bun each week until she's done baking.

I realize this picture is tricky to figure out.  I always feel silly sharing my ultrasound pictures because I know how it feels to be on the receiving end of an excited mom-to-be showing her ultrasound picture...  "And here's her little nose...doesn't it look like she has my nose?"  Um...no- it looks like a mushroom floating in cream sauce.  But for my record I wanted to post this, my very first 4d ultrasound picture.  What you're looking at is her face with a hand covering her mouth and nose and one of her eyes.  The glob of white up on her forehead is her foot.  During this ultrasound, which was done at 28 weeks, her head was sitting under my ribcage with her legs up over her head and her bottom sitting on my pelvic bone.  She was in this same position at the 18 week ultrasound as well, so it must be comfy for her.  I wish it were comfy for me.

Can you believe that is in my stomach?  Even though I've given birth twice- it still completely blows my mind that I am growing a human being!  My body has somehow figured out how to take cells from its self and create a brain, a heart, fingers... toenails!  As she rolls around in my stomach right now, she already possesses the gear necessary to be a mommy herself someday.  Even more amazing is the fact that each baby leaves behind a part of its self when born, which then becomes a part of me.  This would mean that Ben has little fragments of Emma coursing through his veins, and little bun is made up of tiny bits of both her brother and sister!

I think that's pretty special. 


Until next time,
Janet, Trenton, Emma, Ben, and Baby